126 results on '"Rajasekaran, S."'
Search Results
2. Identification of extracellular matrix proteins in plasma as a potential biomarker for intervertebral disc degeneration
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Nayagam, Sharon Miracle, Ramachandran, Karthik, Selvaraj, Ganesh, Sunmathi, R., Easwaran, Murugesh, Palraj, Narmatha Devi, Anand K. S., Sri Vijay, Muthurajan, Raveendran, Tangavel, Chitraa, and Rajasekaran, S.
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- 2024
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3. Teacher’s Competence in First-Aid Management of Epistaxis in Schools
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Prabakaran, S., Gowthame, K., Balaji, D., Navin, R. B. Namasivaya, Rajasekaran, S., Balan, B. Sarath, Adithya, V., Shanmugh, J., and Vijayalakshmi, S.
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- 2024
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4. Comparing the Efficacy of Acetic Acid vs Gentian Violet in Chronic Discharging Ears
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Gowthame, K., Prabakaran, S., Navin, R. B. Namasivaya, Rajasekaran, S., Muthukumar, R., Balaji, D., Kumar, B. Sarath, and Adithya, V.
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- 2024
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5. A Rare Case Report of Nasal Schwannoma
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Muthukumar, R., Gowthame, K., Rajasekaran, S., Prabakaran, S., Navin, R.B. Namasivaya, Balaji, D., Kumar, B. Sarath, Preethi, T., George, Rani, and Adithya, V.
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- 2024
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6. Dual Drug Therapy Versus Single Drug Therapy in Prevention of Pinna Keloid Recurrence
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Namasivaya Navin, R B, Gowthame, K, Balaji, D, Prabakaran, S, Rajasekaran, S, Vijayalakshmi, S, U Gopan, Greeshma, and Adithya, V
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- 2024
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7. The incidence and risk factors for unplanned readmission within 90 days after surgical treatment of spinal fractures
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Kanna, Rishi M., Shafeeq, Gulam Muhammed, Shetty, Ajoy P., and Rajasekaran, S.
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- 2024
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8. Integrated renewable electrification system modeling and tri-objective optimization analysis for net zero energy institutional building: a simulated case study of green hydrogen production
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Rajasekaran, S., Krishnamoorthy, Murugaperumal, Srinivasan, Suresh, and Gouda, Pramod Kumar
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- 2024
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9. Canalicular Adenoma of Parotid- A Rare Case Report
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Muthukumar, R., Rajasekaran, S., Prabakaran, S., Namasivaya Navin , R. B., Balaji, D., Gowthame, K., Sarath Kumar, B., and Adithya , V.
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- 2024
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10. The Variants of Frontal Recess and Its Effect in the Development and Prevalence of Frontal Sinusitis in Patients in a Tertiary Care Hospital: A Retrospective Observational Study
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Dhanasekaran, Balaji, Prabakaran, S., Namasivaya Navin, R. B., Karthika, S. R., Rajasekaran, S., and Adithya, V.
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- 2024
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11. Does Prophylactic Pinning Affect the Proximal Femur Morphology in Slipped Capital Femoral Epiphysis?
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Venkatadass, K., Jain, Deepak, and Rajasekaran, S.
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- 2024
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12. Ent Manifestations in Sculptors of South Chennai, India: A Cross Sectional Observational Study
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Namasivaya Navin, R. B., Balaji, D., Gowthame, K., Prabakaran, S., Rajasekaran, S., and Karthika, S. R.
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- 2024
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13. Audiological Profile in Allergic Rhinitis, a Hospital Based Study
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Prabakaran, S., Navin R. B., Namasivaya, Dhanasekaran, Balaji, Rajasekaran, S., and Karthika, S. R.
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- 2024
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14. An Observational Study of Hearing Loss Among Menopausal Women
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Namasivaya Navin, R. B., Prabakaran, S., Balaji, D., Gowthame, K., Rajasekaran, S., Sarath Kumar, B., Shree, Ramya, and Lakshana, R.
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- 2024
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15. Cervical Spondylotic Myelopathy
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Murugan, Chandhan, Shetty, Ajoy Prasad, Rajasekaran, S., Slullitel, Pablo, editor, Rossi, Luciano, editor, and Camino-Willhuber, Gastón, editor
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- 2024
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16. Carbon Monoxide Poisoning in a Child: A Case Report.
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Asani MO, Belonwu R, Rajasekaran S, and Ibrahim M
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Medicine - Abstract
Summary: The exact incidence of carbon monoxide (CO) poisoning in Nigeria is unknown. Globally, CO poisoning is frequently unrecognized and under-reported since the clinical presentation is relatively non-specific. The circumstances usually involve an unsuspected increase of CO in an enclosed environment. We .. present the case of a five-year old girl who was brought to the Emergency Paediatics Unit with altered consciousness and profound muscle weakness following exposure to exhaust fumes from a petrol powered electric generator. The generating set was usually operated within the kitchen during the preceding year, but on that particular day, a large refrigerator was placed beside the kitchen door thereby preventing its complete closure. She made an uneventful recovery following treatment with 100 percent oxygen. The case highlights the susceptibility of children to CO poisoning caused by operating petrol powered electric generators within the house. Health education of the community is necessary to avert such hazards.
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- 2024
17. Foot pressure transfers are altered in lumbar radiculopathy but reversible after surgery: a prospective, pedobarography study
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Kanna, Rishi M., Prashasth, B.S., Shetty, Ajoy Prasad, and Rajasekaran, S.
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- 2024
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18. Congenital Stenosis of the Spine—A Cross-Sectional Study of 1019 Whole-Spine Computed Tomography Scans to Determine Prevalence and Association Among Multilevel, Tandem, and Triple Region Stenosis
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Mubarak, Mohammed, Murugan, Chandhan, Iyer, R. Dinesh, BT, Pushpa, Shetty, Ajoy Prasad, Kanna, Rishi Mugesh, and Rajasekaran, S.
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- 2024
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19. Correction: An Observational Study of Hearing Loss Among Menopausal Women
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Navin, R. B. Namasivaya, Prabakaran, S., Balaji, D., Gowthame, K., Rajasekaran, S., Kumar, B. Sarath, Shree, Ramya, and Lakshana, R.
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- 2024
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20. Cloud intrusion detection system using deep learning (artificial intelligence).
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Mukil, A., Rajasekaran, S., Abdulla, R., and Lukose, J.
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MACHINE learning , *ARTIFICIAL intelligence , *SYSTEM administrators , *TELECOMMUNICATION systems , *HAZARDS , *DEEP learning , *INTRUSION detection systems (Computer security) - Abstract
When it comes to the procedure of assessing the nature of hazards as well as keeping on top of destructive behaviour in communication networks, the intrusion prevention system, more often referred to as IDS, is an element that is of the utmost importance. IDS enables the system administrators of various companies and organisations to identify illegal access attempts made by intruders. In order to construct behavior-based intrusion detection systems (IDSs), a broad variety of machine learning algorithms have been deployed, and the outcomes of these applications are promising in terms of identifying new types of intrusions and assaults. The goal of this research is to investigate the KDD dataset and evaluate a number of different deep learning-based approaches, namely normal length memory (LSTM). The suggested DNN model has reached the highest feasible level of accuracy for the second incident, weighing in at 97.13%. [ABSTRACT FROM AUTHOR]
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- 2024
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21. Congenital stenosis of the spine- A cross-sectional study of 1019 whole-spine CT scans to determine the prevalence and association between multi-level, tandem, and triple region stenosis.
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Mubarak, Mohammed, primary, Murugan, Chandhan, additional, Iyer, R Dinesh, additional, BT, Pushpa, additional, Shetty, Ajoy Prasad, additional, Kanna, Rishi Mugesh, additional, and Rajasekaran, S., additional
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- 2024
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22. Does preventive care bundle have an impact on surgical site infections following spine surgery? An analysis of 9607 patients
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Bagga, Rajdeep S., Shetty, Ajoy P., Sharma, Vyom, Vijayanand, K. S. Sri, Kanna, Rishi M., and Rajasekaran, S.
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Study design: Retrospective cohort study. Objectives: The purpose was to analyze the effect of care bundle protocol on SSI in our institution. Summary of background data: Postoperative surgical site infections (SSI) pose significant health burden. In spite of the use of prophylactic antibiotics, surgical advances and postoperative care, wound infection continues to affect patient outcomes after spine surgery. Methods: Retrospective analysis of 9607 consecutive patients who underwent spine procedures from 2014 to 2018 was performed. Preventive care bundle was implemented from January 2017 consisting of (a) preoperative bundle-glycemic control, chlorhexidine gluconate (CHG) bath, (b) intra-operative bundle-time specified antibiotic prophylaxis, CHG+ alcohol-based skin preparation (c) postoperative bundle-five moments of hand hygiene, early mobilization and bundle auditing. Patients operated from January 2017 were included in the post-implementation cohort and prior to that the pre-implementation cohort was formed. Data were drawn from weekly and yearly spine audits from the hospital infection committee software. Infection data were collected based on CDC criteria, further sub classification was done based on procedure, spinal disorders and spine level. Variables were analyzed and level of significance was set as < 0.05. Results: A total of 7333 patients met the criteria. The overall SSI rate decreased from 3.42% (131/3829) in pre-implementation cohort to 1.22% (43/3504, p= 0.0001) in post-implementation cohort (RR = 2.73, OR = 2.79). Statistically significant reduction was seen in all the groups (a) superficial and deep, (b) early and late and (c) instrumented and uninstrumented groups but was more pronounced in early (p= 0.0001), superficial (p= 0.0001) and instrumented groups (p= 0.0001). On subgroup analysis based on spine level and spinal disorders, significant reduction was seen in lumbar (p= 0.0001) and degenerative group (p= 0.0001). Conclusions: Our study revealed significant reduction of SSI secondary to strict bundle adherence and monitored compliance compared to patients who did not receive these interventions. Level of evidence: III.
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- 2024
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23. Evaluation of occurrence number and communication based on FMEA operations in product development.
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Rajasekaran, S. and L., Natrayan
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- 2024
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24. Estimation of corrective and preventive action on trend end plug-based machining activities using manual and failure mode with effects analysis.
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Rajasekaran, S. and L., Natrayan
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- 2024
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25. Osteofibrous Dysplasia of Humerus: An Unusual Presentation of a Rare Lesion
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Venkatadass, K., Jain, Deepak, Ahmed, Owais, and Rajasekaran, S.
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- 2024
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26. A 2-Year Outcomes and Complications of Various Techniques of Lumbar Discectomy: A Multicentric Prospective Study
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Goparaju, Praveen, Rajamani, Pritem A., Kulkarni, Arvind G., Kumar, Priyambada, Adbalwad, Yogesh M., Bhojraj, Shekhar, Nene, Abhay, Rajasekaran, S., Acharya, Shankar, Bhanot, Arun, Lokhande, Pramod, Patel, Priyank, Chandra Dey, Paresh, Chhabra, Harvinder Singh, Rajamani, Achimuthu, Rajendraprasad Dave, Bharat, and Krishnan, Ajay
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Study Design Prospective Study.Objectives There are numerous techniques for performing lumbar discectomy, each with its own rationale and stated benefits. The authors set out to evaluate and compare the perioperative variables, results, and complications of each treatment in a group of patients provided by ten hospitals and operated on by experienced surgeons.Methods This prospective study comprised of 591 patients operated between February-2017 to February-2019. The procedures included open discectomy, microdiscectomy, tubular microdiscectomy, interlaminar endoscopic lumbar discectomy, transforaminal endoscopic lumbar discectomy and Destandau techniques with a follow-up of minimum 2 years. VAS (Visual Analogue Score) for back and leg pain, ODI (Oswestry Disability Index), duration of surgery, hospital stay, length of scar, operative blood loss and peri-operative complications were recorded in each group.Results Post-operatively, there was a significant improvement in the VAS score for back pain as well as leg pain, and ODI scores spanning all groups, with no significant distinction amongst them. When compared to open procedures (open discectomy and microdiscectomy), minimally invasive surgeries (tubular discectomy, interlaminar endoscopic lumbar discectomy, transforaminal endoscopic lumbar discectomy, and Destandau techniques) reported shorter operative time, duration of hospital stays, better cosmesis, and lower blood loss. Overall, the complication rate was reported to be 8.62%. Complication rates differed slightly across approaches.Conclusion Minimally invasive surgeries have citable advantages over open approaches in terms of perioperative variables. However, all approaches are successful and provide comparable pain relief with similar functional outcomes at long term follow up.
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- 2024
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27. Clinical outcomes of primary total knee arthroplasty in non-syphilitic neuroarthropathy of the knee.
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Soundarrajan D, Singh R, Rajkumar N, Dhanasekararaja P, and Rajasekaran S
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- Humans, Male, Middle Aged, Female, Aged, Treatment Outcome, Retrospective Studies, Knee Prosthesis, Adult, Arthroplasty, Replacement, Knee methods, Arthroplasty, Replacement, Knee adverse effects, Range of Motion, Articular, Arthropathy, Neurogenic surgery, Arthropathy, Neurogenic diagnosis, Knee Joint surgery, Knee Joint physiopathology
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Purpose: Total knee arthroplasty (TKA) in syphilitic neuroarthropathy using earlier implant designs was associated with poorer outcomes. Literature on TKA for non-syphilitic neuroarthropathy using modern contemporary prosthesis is scarce. We aim to analyse the clinical and radiological outcomes of TKA in neuropathic joints., Methods: A final cohort of 17 patients (21 knees) with the diagnosis of neuropathic joint undergoing primary TKA between January 2013 to January 2019 were included in the study. The preoperative ambulatory status, range of motion, type of prosthesis, level of constraint and any augmentation used were retrieved from medical records. Radiological evaluation includes Koshino's staging, the magnitude of deformity defined by the Hip-Knee-Ankle (HKA) angle, and any progressive loosening. Pre and postoperative functional scores were obtained by the Knee Society (KSS) and Knee Society Functional Score (KSS-F). Any complications or reoperation were noted till the final follow-up. Preoperative and follow-up functional scores, HKA and range of motion were compared using the paired Samples test., Results: The mean follow-up was 40.2 months (range, 15 to 75 months). Preoperatively, according to the Koshino staging, five knees were in stage 3 (23.8%). The mean HKA angle in valgus knees was 23.6
0 (range, 11.10 to 42.50 ) and for the varus knees was 19.30 (range, 4.90 to 39.60 ). The prosthesis used were posterior stabilized in 7 knees (33.3%), varus-valgus constrained in five knees (23.8%) and a rotating hinge was required in nine knees (42.8%). Metaphyseal sleeves were used along with hinge prosthesis in six knees (28.6%). The mean arc of motion improved from 102.4 ± 22.7 degrees to 105.7 ± 15.5 degrees postoperatively (p = 0.27). The knee society and knee society functional scores improved from 23.3 ± 9.3 and 28.3 ± 12.2 preoperatively to 81.1 ± 5.4 and 80.4 ± 8.5 during the follow up respectively (p < 0.001). There were no progressive radiolucent lines in any knees at the final follow-up. One patient had intraoperative bony medial collateral ligament injury, one patient had deep vein thrombosis after five days from the index surgery and another had postoperative periprosthetic tibial shaft fracture., Conclusion: According to our study, the clinical outcomes of TKA for neuroarthropathy show significant improvement with the diagnosis of non-syphilitic neuroarthropathy, utilization of modern constrained prostheses, and early rehabilitation, at medium-term follow-up. Tibial and femoral stems are preferred for equal stress distribution and to prevent early loosening., (© 2024. The Author(s) under exclusive licence to SICOT aisbl.)- Published
- 2024
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28. Early major fracture care in polytrauma-priorities in the context of concomitant injuries: A Delphi consensus process and systematic review.
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Pfeifer R, Klingebiel FK, Balogh ZJ, Beeres FJP, Coimbra R, Fang C, Giannoudis PV, Hietbrink F, Hildebrand F, Kurihara H, Lustenberger T, Marzi I, Oertel MF, Peralta R, Rajasekaran S, Schemitsch EH, Vallier HA, Zelle BA, Kalbas Y, and Pape HC
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- Humans, Time-to-Treatment statistics & numerical data, Time-to-Treatment standards, Fractures, Bone therapy, Fractures, Bone surgery, Fractures, Bone complications, Fractures, Multiple, Multiple Trauma therapy, Multiple Trauma complications, Delphi Technique, Consensus
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Background: The timing of major fracture care in polytrauma patients has a relevant impact on outcomes. Yet, standardized treatment strategies with respect to concomitant injuries are rare. This study aims to provide expert recommendations regarding the timing of major fracture care in the presence of concomitant injuries to the brain, thorax, abdomen, spine/spinal cord, and vasculature, as well as multiple fractures., Methods: This study used the Delphi method supported by a systematic review. The review was conducted in the Medline and EMBASE databases to identify relevant literature on the timing of fracture care for patients with the aforementioned injury patterns. Then, consensus statements were developed by 17 international multidisciplinary experts based on the available evidence. The statements underwent repeated adjustments in online- and in-person meetings and were finally voted on. An agreement of ≥75% was set as the threshold for consensus. The level of evidence of the identified publications was rated using the GRADE approach., Results: A total of 12,476 publications were identified, and 73 were included. The majority of publications recommended early surgery (47/73). The threshold for early surgery was set within 24 hours in 45 publications. The expert panel developed 20 consensus statements and consensus >90% was achieved for all, with 15 reaching 100%. These statements define conditions and exceptions for early definitive fracture care in the presence of traumatic brain injury (n = 5), abdominal trauma (n = 4), thoracic trauma (n = 3), multiple extremity fractures (n = 3), spinal (cord) injuries (n = 3), and vascular injuries (n = 2)., Conclusion: A total of 20 statements were developed on the timing of fracture fixation in patients with associated injuries. All statements agree that major fracture care should be initiated within 24 hours of admission and completed within that timeframe unless the clinical status or severe associated issues prevent the patient from going to the operating room., Level of Evidence: Systematic Review/Meta-Analysis; Level IV., (Copyright © 2024 American Association for the Surgery of Trauma.)
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- 2024
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29. Response to the Letter to the Editor by Cioccari et al.
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Konwinski LM, Steenland C, Miller K, Boville B, Fitzgerald R, Connors R, Sterling EK, Stowe A, and Rajasekaran S
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- Humans, Patient Safety
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Competing Interests: The authors disclose no conflict of interest.
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- 2024
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30. Does the gut microbiome influence disc health and disease? The interplay between dysbiosis, pathobionts, and disc inflammation: a pilot study.
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Rajasekaran S, Vasudevan G, Tangavel C, Ramachandran K, Nayagam SM, Muthurajan R, Gopalakrishnan C, Anand SV, Shetty AP, and Kanna RM
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- Humans, Adult, Middle Aged, Pilot Projects, Male, Female, Case-Control Studies, Intervertebral Disc Displacement microbiology, Intervertebral Disc Displacement surgery, Discitis microbiology, Gastrointestinal Microbiome physiology, Dysbiosis microbiology, Dysbiosis immunology, Intervertebral Disc Degeneration microbiology
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Background Context: Gut microbiome alterations resulting in inflammatory responses have been implicated in many distant effects on different organs. However, its influence on disc health is still not fully investigated., Purpose: Our objective was to document the gut biome in healthy volunteers and patients with disc degeneration and to understand the role of gut dysbiosis on human disc health., Study Design: Experimental case-control study., Patient Sample: We included 40 patients with disc degeneration (DG) and 20 healthy volunteers (HV). HV comprised of age groups 30 to 60 years with no known record of back pain and no clinical comorbidities, with normal MRI. Diseased group (DG) were patients in the same age group undergoing surgery for disc disease (disc herniation-25; discogenic stenosis-15) and without instability (with Modic-20; and non-Modic-20)., Outcome Measures: N/A., Methods: We analyzed 16S V3-V4 rDNA gut metagenome from 20 healthy volunteers (HV) and compared the top signature genera from 40 patients with disc degeneration (DG) across Modic and non-Modic groups. Norgen Stool DNA Kit was used for DNA extraction from ∼200 mg of each faecal sample collected using the Norgen Stool Collection Kit.16S V3-V4 rDNA amplicons were generated with universal bacterial primers 341F and 806R and amplified with Q5 High-Fidelity DNA Polymerase. Libraries were sequenced with 250×2 PE to an average of 0.1 million raw reads per sample (Illumina Novaseq 6000). Demultiplexed raw data was assessed with FastQC, and adapter trimmed reads >Q30 reads were processed in the QIME2 pipeline. Serum C-reactive protein (CRP) was measured by the immunoturbimetry method and Fatty acid-binding protein 5 (FABP5) was measured in albumin-globulin-depleted plasma through global proteome analysis., Results: We observed significant gut dysbiosis between HV and DG and also between the Modic and non-Modic groups. In the Modic group, commensals Bifidobacterium and Ruminococcus were significantly depleted, while pathobionts Streptococcus, Prevotella, and Butryvibrio were enriched. Firmicutes/Bacteroidetes ratio was decreased in DG (Modic-0.62, non-Modic-0.43) compared to HV (0.70). Bacteria-producing beneficial short-chain fatty acids were also depleted in DG. Elevated serum CRP and increased FABP5 were observed in DG., Conclusion: The study revealed gut dysbiosis, an altered Firmicutes/Bacteroidetes ratio, reduced SCFA-producing bacteria, and increased systemic and local inflammation in association with disc disease, especially in Modic changes. The findings have considerable importance for our understanding and prevention of disc degeneration., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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31. Odontoid Fracture with Locked Posterolateral Atlantoaxial Dislocation: A Case Report and Review of Literature.
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Iyer RD, Mengesha MG, Shetty AP, and Rajasekaran S
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- Humans, Male, Adult, Spinal Fusion methods, Tomography, X-Ray Computed, Fracture Fixation, Internal methods, Odontoid Process injuries, Odontoid Process surgery, Odontoid Process diagnostic imaging, Atlanto-Axial Joint injuries, Atlanto-Axial Joint surgery, Atlanto-Axial Joint diagnostic imaging, Joint Dislocations surgery, Joint Dislocations diagnostic imaging, Spinal Fractures surgery, Spinal Fractures diagnostic imaging, Spinal Fractures complications
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Case: Odontoid fractures with atlantoaxial dislocations are rare injuries. We report a case of a 41-year-old man with a Type 2 odontoid fracture with locket facet and posterolateral dislocation. He underwent single-stage C1-C4 posterior fixation and fusion, and at 2-year follow-up, he is symptom-free without any residual pain. Follow-up radiograph and CT scan show healed odontoid fracture with posterior fusion., Conclusion: This case highlights successful management of a complex odontoid fracture by a single-stage posterior surgery. Closed reduction is usually unsuccessful, and open reduction using posterior approach is preferable., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C422)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)
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- 2024
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32. Historical Perspectives on the Evolution of Spino-Pelvic Fixation and its Implications on Clinical Care A Narrative Review.
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von Glinski A, Yilmaz E, Godolias P, Benneker L, Oner FC, Kandziora F, Schroeder G, Schnake K, Dvorak M, Rajasekaran S, El-Sharkawi M, Vaccaro A, Bransford R, Schildhauer TA, and Chapman JR
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Study Design: Broad narrative review., Objectives: To review and summarize the evolution of spinopelvic fixation (SPF) and its implications on clinical care., Methods: A thorough review of peer-reviewed literature was performed on the historical evolution of sacropelvic fixation techniques and their respective advantages and disadvantages., Results: The sacropelvic junction has been a long-standing challenge due to a combination of anatomic idiosyncrasies and very high biomechanical forces. While first approaches of fusion were determinated by many material and surgical technique-related limitations, the modern idea of stabilization of the lumbosacral junction was largely initiated by the inclusion of the ilium into lumbosacral fusion. While there is a wide spectrum of indications for SPF the chosen technique remains is defined by the individual pathology and surgeons' preference., Conclusion: By a constant evolution of both instrumentation hardware and surgical technique better fusion rates paired with improved clinical results could be achieved., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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33. SARS-CoV-2 Genotyping Highlights the Challenges in Spike Protein Drift Independent of Other Essential Proteins.
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Prokop JW, Alberta S, Witteveen-Lane M, Pell S, Farag HA, Bhargava D, Vaughan RM, Frisch A, Bauss J, Bhatti H, Arora S, Subrahmanya C, Pearson D, Goodyke A, Westgate M, Cook TW, Mitchell JT, Zieba J, Sims MD, Underwood A, Hassouna H, Rajasekaran S, Tamae Kakazu MA, Chesla D, Olivero R, and Caulfield AJ
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As of 2024, SARS-CoV-2 continues to propagate and drift as an endemic virus, impacting healthcare for years. The largest sequencing initiative for any species was initiated to combat the virus, tracking changes over time at a full virus base-pair resolution. The SARS-CoV-2 sequencing represents a unique opportunity to understand selective pressures and viral evolution but requires cross-disciplinary approaches from epidemiology to functional protein biology. Within this work, we integrate a two-year genotyping window with structural biology to explore the selective pressures of SARS-CoV-2 on protein insights. Although genotype and the Spike (Surface Glycoprotein) protein continue to drift, most SARS-CoV-2 proteins have had few amino acid alterations. Within Spike, the high drift rate of amino acids involved in antibody evasion also corresponds to changes within the ACE2 binding pocket that have undergone multiple changes that maintain functional binding. The genotyping suggests selective pressure for receptor specificity that could also confer changes in viral risk. Mapping of amino acid changes to the structures of the SARS-CoV-2 co-transcriptional complex (nsp7-nsp14), nsp3 (papain-like protease), and nsp5 (cysteine protease) proteins suggest they remain critical factors for drug development that will be sustainable, unlike those strategies targeting Spike.
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- 2024
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34. An interplay between orthopaedic trauma and pregnancy-A case series of 42 patients.
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Raj P, Ahmed O, Roy Wilson Armstrong B, Perumal R, Jayaramaraju D, and Rajasekaran S
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Background: Pregnancy and trauma are complex situations with significant implications for maternal and fetal health. Physical and psychological trauma during pregnancy can lead to pre-term labor, abruptio-placenta, and fetal injury or death. Management of trauma is challenging due to physiological and anatomical changes, which can affect fracture management and the risk of radiation exposure. A multidisciplinary approach is beneficial for patient care. This study aimed to determine the impact of orthopaedic trauma on pregnancy and its outcome, and influence of pregnancy on fracture management., Methods and Material: A retrospective-study was conducted at a Level-1 trauma-care-center, focusing on 54 pregnant women who sustained trauma between January 2015 and December 2022. The study included patients with closed or open fractures, but excluded those without fractures. Forty-two patients were available with minimum 1 year follow-up. Data was collected from hospital records and PACS, including demographic details, emergency care, and laboratory parameters. Changes made in protocol in fracture management due to pregnancy (primary definitive fixation vs staged management), and impact of trauma on pregnancy outcome; mode-of-delivery, maternal and fetal loss were evaluated., Results: The mean age was 30-years (range: 21-43years). Road-traffic-collision was most-common mode-of-injury (66.7 %). 38.1 % were in the first-trimester, 35.7 % in second, and 26.2 % in third-trimester. Eight patients had polytrauma, seven had multiple-injuries, and 27 had isolated-injuries. The maternal-mortality-rate was 0.45 %. Three polytraumatized patients ended up with intrauterine death, two polytrauma patients underwent elective abortion, one patient presented with spontaneous-abortion, and fetal loss was 14.3 % (6-of-42). Out of 42 patients, 10 had open-injuries and 32 had closed-injuries. Nine patients underwent LSCS(lower-segment-caesarean-section), six of them were planned for elective-LSCS due to injury and associated fractures (two patients with pelvic injuries, two neck femur fracture patients, one open distal femur fracture, and one ankle fracture dislocation)., Conclusion: Orthopaedic trauma during pregnancy can significantly affect pregnancy outcomes and is associated with a notably higher risk of fetal loss. An elective-caesarean-section is recommended for patients with polytrauma, pelvic-injuries, and those who are immobilized for longer-duration. During the third-trimester and in polytraumatized patients, external-fixator-application for lower-limb-injuries is a safe strategy, and definitive fixation could be performed post-delivery., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier Ltd.)
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- 2024
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35. Comparative analysis of 'functional excision' of heterotopic ossification around the hip - computed tomography (CT) navigation guided versus conventional excision.
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Soundarrajan D, Fanta HT, Singh R, Dhanasekararaja P, Rajkumar N, and Rajasekaran S
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- Humans, Male, Female, Retrospective Studies, Middle Aged, Adult, Hip Joint surgery, Hip Joint diagnostic imaging, Treatment Outcome, Aged, Tomography, X-Ray Computed methods, Surgery, Computer-Assisted methods, Ossification, Heterotopic diagnostic imaging, Ossification, Heterotopic surgery
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Purpose: We aim to analyse and compare the efficacy of the excision of HO around the hip with and without CT-guided navigation. We also aim to compare the functional outcome between CT navigation guided versus conventional excision of HO., Patients and Methods: This study is a retrospective analysis of prospectively collected data from 2015 to 2022. There were 23 patients (24 hips) in the final cohort. Intraoperative CT navigation guided excision was performed in 7 hips and conventional excision of HO was done in 17 hips. The HO was classified by Brooker's grading in radiographs. CT scan was taken preoperatively in all patients to exactly identify the volume, location and preoperative planning. The functional outcome was analysed according to Harris Hip Score (HHS) and International Hip Outcome Tool (iHOT) for self-ambulatory patients and improvement in the sitting or nursing care was assessed in patients mobilising with wheelchair or walker support. Any complications or recurrence noted postoperatively and in follow-up were recorded., Results: The mean follow-up was 41.2 months in the CT navigation-guided excision group and 55 months in the conventional excision group. According to Brooker's grading, grade IV was present in 20 hips and grade III in four hips. Twelve patients were self-ambulatory and the other 12 patients were requiring support for mobilisation. There was a significant improvement in the HHS from 21.3 ± 3.7, 18.3 ± 2.5 preoperatively to 75.2 ± 8.3, 72.2 ± 4.3 postoperatively in the CT navigation guided and conventional group respectively (p < 0.001) in the self-ambulatory group. There was one anterior wall and one partial posterior wall fracture in the conventional group. One patient in the conventional group had a deep infection and recurrence. One patient had a superficial infection and another had superficial vein thrombosis in the CT guided excision group., Conclusion: Intraoperative CT navigation helps to exactly localize the HO and facilitates safe excision. Functional excision of the HO leads to better nursing care and functional outcomes between both groups., (© 2024. The Author(s) under exclusive licence to SICOT aisbl.)
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- 2024
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36. A Whole Spine MRI Based Study of the Prevalence, Associated Disc Degeneration and Anatomical Correlations of Lumbosacral Transitional Vertebra.
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Bhagchandani C, Murugan C, Jakkepally S, Shetty AP, Kanna RM, and Rajasekaran S
- Abstract
Study Design: Retrospective cohort study., Objective: Lumbosacral transitional vertebra (LSTV) results in numerical alterations of the lumbar and sacral segments. Literature concerning true prevalence, associated disc degeneration, and variation in numerous anatomical landmarks concerning LSTV is lacking., Methods: This is a retrospective cohort study. The prevalence of LSTV was determined in whole spine MRIs of 2011 poly-trauma patients. LSTV was identified as sacralization (LSTV-S) or lumbarization (LSTV-L) and further sub-classified into Castellvi's and O'Driscoll's type respectively. Disc degeneration was evaluated using Pfirmann grading. Variation in important anatomical landmarks was also analysed., Results: Prevalence of LSTV was 11.6% with 82% having LSTV-S . Castellvi's type 2A and O'Driscoll type 4 were the commonest sub-types. LSTV patients demonstrated considerably advanced disc degeneration. The median termination level of conus medullaris (TLCM) in non- LSTV and LSTV-L groups was at middle L1 (48.1% and 40.2%) while in the LSTV-S group, it was at upper L1 (47.2%). The median level of right renal artery (RRA) in non- LSTV patients was at middle L1 in 40.0% of individuals while in the LSTV-L and LSTV-S groups, it was at upper L1 level in 35.2% and 56.2% respectively. The median level of abdominal aortic bifurcation (AA) in non-LSTV and LSTV-S patients was at middle L4 in 83.3% and 52.04% respectively. However, in the LSTV-L group, the most common level was middle L5 (53.6%)., Conclusion: The overall prevalence of LSTV was 11.6%, with sacralization accounting for more than 80%. LSTV is associated with disc degeneration and a variation in the levels of important anatomical landmarks., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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37. Improving Self-Healing Dental-Restorative Materials with Functionalized and Reinforced Microcapsules.
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Huynh BQ, Rajasekaran S, Batista J, Lewis S, Sinhoreti MAC, Pfeifer CS, and Fugolin AP
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Dental resin composites are widely used in clinical settings but often face longevity issues due to the development and accumulation of microcracks, which eventually lead to larger cracks and restoration failure. The incorporation of microcapsules into these resins has been explored to introduce self-healing capability, potentially extending the lifespan of the restorations. This study aims to enhance the performance of self-healing dental resins by optimizing the microcapsules-resin matrix physicochemical interactions. Poly(urea-formaldehyde) (PUF) microcapsules were reinforced with melamine and subsequently subjected to surface functionalization with 3-aminopropyltriethoxysilane (APTES) and (3-mercaptopropyl)trimethoxysilane (MPTMS). Additionally, microcapsules were functionalized with a bilayer approach, incorporating tetraethyl orthosilicate (TEOS) with either APTES or MPTMS. X-ray photoelectron spectroscopy (XPS) and thermogravimetric analysis (TGA) confirmed an increased Si:C ratio from 0.006 to 0.165. The functionalization process did not adversely affect the structure of the microcapsules or their healing agent volume. Compared to PUF controls, the functionalized microcapsules demonstrated enhanced healing efficiency, with TEOS/MPTMS-functionalized microcapsules showing the highest performance, showing a toughness recovery of up to 35%. This work introduces a novel approach to functionalization of microcapsules by employing advanced silanizing agents such as APTES and MPTMS, and pioneering bilayer functionalization protocols through their combination with TEOS.
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- 2024
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38. Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish Optimizing Management and Minimizing Risk of Osteoporotic Vertebral Fractures - Perspectives of the AO Spine KF Trauma and Infection Group Key Opinion Leaders.
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Joaquim AF, Bigdon SF, Bransford R, Chhabra HS, Yurac R, Kumar V, El-Sharkawi M, Benneker LM, Karamian BA, Canseco JA, Scherer J, Hassan AA, Schroeder GD, Öner CF, Rajasekaran S, Vialle E, Kanna RM, Vaccaro AR, Tee J, Camino-Willhuber G, Fisher CG, Dvorak MF, and Schnake KJ
- Abstract
Study Design: Literature review with clinical recommendations., Objective: To highlight important studies about osteoporotic spinal fractures (OF) that may be integrated into clinical practice based on the assessment of the AO Spine KF Trauma and Infection group key opinion leaders., Methods: 4 important studies about OF that may affect current clinical practice of spinal surgeons were selected and reviewed with the aim of providing clinical recommendations to streamline the journey of research into clinical practice. Recommendations were graded as strong or conditional following the GRADE methodology., Results: 4 studies were selected. Article 1: a validation of the Osteoporotic Fracture (OF)-score to treat OF fractures. Conditional recommendation to incorporate the OF score in the management of fractures to improve clinical results. Article 2: a randomized multicenter study comparing romosozumab/alendronate vs alendronate to decrease the incidence of new vertebral fractures. Strong recommendation that the group receiving romosozumab/alendronate had a decreased risk of new OF when compared with the alendronate only group only. Article 3: a systematic literature review of spinal orthoses in the management of. Conditional recommendation to prescribe a spinal orthosis to decrease pain and improve quality of life. Article 4: post-traumatic deformity after OF. A conditional recommendation that middle column injury and pre-injury use of steroids may lead to high risk of post-traumatic deformity after OF., Conclusions: Management of patients with OF is still complex and challenging. This review provides some recommendations that may help surgeons to better manage these patients and improve their clinical practice., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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39. A woman with leonine facies and monoclonal gammopathy.
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Mehta H, Bishnoi A, Singh C, Rajasekaran S, Chatterjee D, Kumaran MS, and Handa S
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- Humans, Female, Facies, Middle Aged, Aged, Paraproteinemias complications, Paraproteinemias diagnosis, Paraproteinemias pathology
- Abstract
Competing Interests: Conflicts of interest The authors declare no conflicts of interest.
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- 2024
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40. From Modic to Disc Endplate Bone Marrow Complex - The Natural Course and Clinical Implication of Vertebral Endplate Changes.
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Rajasekaran S, Ramachandran K, K S SVA, Kanna RM, and Shetty AP
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Study Design: Review article., Objectives: A review of literature on the epidemiology, natural course, pathobiology and clinical implications of vertebral endplate changes., Methods: A literature search was performed using the Cochrane Database of Systematic Reviews, EMBASE, and PubMed. Studies published over the last 10 years were analysed. The searches were performed using Medical Subject Headings terms, and the subheadings used were "Vertebral endplate changes", "Modic changes", "Disc Endplate Bone Marrow complex"., Results: The disc, endplate (EP), and bone marrow region of the spine constitute a unified morphological and functional unit, with isolated degeneration of any one structure being uncommon. Disc degeneration causes endplate defects, which result in direct communication and a constant cross-talk between the disc and the vertebral body. This may result in a persistent inflammatory state of the vertebral bone marrow, serving as a major pain generator. This review article focuses on vertebral endplate changes and how the current understanding has progressed from the Modic classification to the Disc Endplate Bone Marrow complex classification. It provides a clear portrayal of the natural course of these alterations and their clinical implications in low back pain., Conclusions: In light of the heightened interest and current prominence of vertebral endplate changes within the spine community, we must progress beyond the Modic changes to achieve a comprehensive understanding. The DEBM complex classification will play a major part in disc degeneration research and clinical care, representing a considerable advancement in our understanding of the vertebral endplate changes over the classical Modic changes., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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41. Risk predictive score and cord morphology classification for intraoperative neuromonitoring alerts in kyphosis surgery.
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Rajasekaran S, Ramachandran K, Thippeswamy PB, G S B, Anand K S SV, Shetty AP, and Kanna RM
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Background: Intraoperative neuromonitoring (IONM) alert is one of the worrying events of kyphosis corrective surgery, which can result in a postoperative neurological deficit. To our knowledge, there is no risk prediction score to predict such events in patients undergoing kyphosis surgery., Purpose: To develop a new preoperative MRI-based cord morphology classification (CMC) and risk prediction score for predicting IONM alerts in patients with kyphotic deformity., Study Design: Retrospective analysis of prospectively collected data., Patient Sample: About 114 patients undergoing surgical correction for kyphotic deformity., Outcome Measures: Intraoperative neuromonitoring alerts and postoperative neurological status using AIS grading., Methods: Kyphotic deformity patients undergoing posterior spinal fusion were retrospectively reviewed. Based on the morphology of the spinal cord and surrounding CSF in MRI, there are 5 types of cord. Type 1 (normal cord): circular cord with surrounding visible CSF between the cord and the apex, Type 2 (flattened cord): cord with <50% distortion at the apex with obliteration of the anterior CSF; Type 3 (deformed cord): cord with >50% distortion at the apex with complete obliteration of the surrounding CSF; Type 4 (stretched cord): the cord is stretched and atrophied over the apex of the curve. Type 5 (translated cord): horizontal translation of the cord at the apex with buckling collapse of the vertebral column. Preoperative radiographs were used to measure the preoperative sagittal cobbs angle, sagittal deformity angular ratio (S-DAR), sagittal vertical axis (SVA), apex of the curve, and type of kyphosis. Clinical data like the duration of symptoms, clinical signs of myelopathy, neurological status (AIS grade), grade of myelopathy using the mJOA score, and type of osteotomy were documented. Multivariate logistic regression was used to determine the risk factors for IONM alerts and the risk prediction score was developed which was validated with new cohort of 30 patients., Results: A total of 114 patients met the inclusion criteria. IONM alerts were documented in 33 patients (28.9%), with full recovery of the signal in 25 patients and a postoperative deficit in 8 patients. Rate of IONM alerts was significantly higher in Type 5 (66%), followed by Type 4 (50%), Type 3 (21.1%), Type 2 (11.1%), and Type 1 (11.1%) (p-value<.001). Based on multiple logistic regression, 7 factors, namely preoperative neurological status, mJOA score≤6, presence of signs of myelopathy, apex of the curve above T5, preoperative sagittal cobbs, S-DAR, and MRI-based CMC, were identified as risk predictors. The value for the risk factors varies from 0 to 4, and the maximum total risk score was 13. The cut-off value of 6 had good sensitivity (84.9%) and specificity (77.8%) indicating a high risk for IONM alerts. The AUC of the predictive model was 0.92, indicating excellent discriminative ability., Conclusion: We developed and validated a risk predictive score that identifies patients at risk of IONM alerts during kyphosis surgery. Identification of such high-risk patients (risk score≥6) helps in proper evaluation and preoperative counselling and helps in providing a proper evidence-based reference for treatment strategies., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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42. Non-functioning parathyroid cyst presenting as a neck mass.
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Rajasekaran S, Barwad A, and Mitra S
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Competing Interests: Conflict of interest: None.
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- 2024
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43. A prospective randomized control trial comparing outcomes of casting, pinning, and plating for distal end of radius fractures (AO type A2, A3, C1, or C2) in the elderly population.
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Ahmed O, Balakrishnan P, Perumal R, Agraharam D, Velmurugesan PS, Jayaramaraju D, and Rajasekaran S
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- Humans, Female, Aged, Male, Prospective Studies, Treatment Outcome, Aged, 80 and over, Radiography, Radius Fractures surgery, Radius Fractures diagnostic imaging, Casts, Surgical, Bone Plates, Hand Strength, Fracture Fixation, Internal methods, Fracture Fixation, Internal instrumentation, Fracture Fixation, Internal adverse effects, Range of Motion, Articular, Bone Nails
- Abstract
Purpose: With this prospective randomized control trial (RCT), we aim to provide the outcome analyses of the three most used treatment modalities for distal end of radius (DER) fracture management in the elderly., Methods: A prospective randomized control trial was performed. Fifty-two patients with DER fractures (AO A2, A3, C1, or C2) were randomized to the casting (n = 17), percutaneous pinning (n = 18), and the volar plating group (n = 17). Radiological measurements measured were radial inclination (RI), radial height (RH), volar tilt (VT), and ulnar variance (UV). The outcome was measured based on range-of-motion, grip strength, Patient-Related-Wrist-Evaluation (PRWE) score, and the Quick-Disabilities-of-the-Arm-Shoulder-Hand (QDASH) score., Results: Immediate post-operative and 1-year-follow-up X-rays showed a significant difference measurement between the groups (p < 0.05). Pairwise comparisons of the casting and pinning groups (p < 0.05) and the casting and plating groups (p < 0.05) revealed significant differences at the 1-year follow-up, but not the pinning and plating groups (p > 0.05). The analysis found significant differences in clinical outcomes after 1 month of follow-up, with the plating group outperforming the other two (p > 0.05). However, after a year of follow-up, all groups had comparable outcomes; however, the plating group showed improved palmar flexion (p < 0.001), radial deviation (p < 0.001), and a lower PRWE score (p < 0.05), indicating better wrist function. Complications were more in casting group., Conclusion: The study found a radiologically significant difference between groups throughout the follow-up, but it did not affect functional results. Clinical outcomes were similar across the groups, with plating showing better palmar flexion and radial deviation. Grip strength was also better in the plating group, but statistically insignificant. The study suggests plating should be chosen over other treatments for high-demand patients., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)
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- 2024
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44. Linguistic isolation correlates with length of stay and mortality for pediatric oncology patients in California.
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Ennett S, Das A, Burcham M, Fitzgerald R, Boville B, Rajasekaran S, Kortz T, and Leimanis-Laurens ML
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- Humans, California epidemiology, Child, Female, Male, Child, Preschool, Adolescent, Infant, Hospital Mortality, Length of Stay statistics & numerical data, Neoplasms mortality, Intensive Care Units, Pediatric statistics & numerical data
- Abstract
Objective: To evaluate social drivers of health and how they impact pediatric oncology patients' clinical outcomes during pediatric intensive care unit (PICU) admission via correlation with patient ZIP codes., Methods: Demographic, clinical, and outcome variables from Virtual Pediatric Systems®, LLC for oncology patients (2009-2021) in California PICUs (excluding postoperative) using 3-digit ZIP Codes with social drivers of health variables linguistic isolation, poverty, race/ethnicity, and education abstracted from American Community Survey data for 3-digit ZIP Codes using the Environmental Protection Agency's EJScreen tool. Outcomes of length of stay (LOS), mortality, acuity scores, were compared with social variables., Results: Positive correlation between mortality and minority racial groups (Hispanic/Latino) across ZIP Codes (correlation coefficients of 0.45 (95% CI: 0.22-0.64, p < 0.001) in 2017, 0.50 (95% CI: 0.27-0.68, p < 0.001) in 2018, 0.33 (95% CI: 0.07-0.54, p = 0.013) in 2020, and 0.32 (95% CI: 0.06-0.53, p = 0.018) in 2021). Median PICU length of stay significantly correlated with linguistic isolation (coefficient of 0.42 (95% CI: 0.18-0.61, p = 0.001) in 2021 versus -0.41 (95% CI: -0.61 to -0.16, p = 0.002) in 2019), which included PRISMIII (n = 7417). Mixed effects logistic regression model for other constant variables (PRISMIII, cancer type, race/ethnicity, year), random effect of patient, linguistic isolation (percentage as a continuous value) was significantly associated (95% CI: 1.01-1.06; p = 0.02) with mortality; (OR = 1.03)., Conclusions: Linguistic isolation was correlated with LOS and mortality, however variable year to year., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)
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- 2024
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45. Synthesis and Evaluation of Gelatin-Chitosan Biofilms Incorporating Zinc Oxide Nanoparticles and 5-Fluorouracil for Cancer Treatment.
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Kaliyaperumal V, Rajasekaran S, Kanniah R, Gopal D, Ayyakannu Sundaram G, and Kumar ASK
- Abstract
In this study, a novel multifunctional biofilm was fabricated using a straightforward casting process. The biofilm comprised gelatin, chitosan, 5-fluorouracil (5-FU)-conjugated zinc oxide nanoparticles, and polyvinyl alcohol plasticized with glycerol. The 5-FU-conjugated nanoparticles were synthesized via a single-step co-precipitation process, offering a unique approach. Characterization confirmed successful drug conjugation, revealing bar-shaped nanoparticles with sizes ranging from 90 to 100 nm. Drug release kinetics followed the Korsmeyer-Peppas model, indicating controlled release behavior. Maximum swelling ratio studies of the gelatin-chitosan film showed pH-dependent characteristics, highlighting its versatility. Comprehensive analysis using SEM, FT-IR, Raman, and EDX spectra confirmed the presence of gelatin, chitosan, and 5-FU/ZnO nanoparticles within the biofilms. These biofilms exhibited non-cytotoxicity to human fibroblasts and significant anticancer activity against skin cancer cells, demonstrating their potential for biomedical applications. This versatility positions the 5-FU/ZnO-loaded sheets as promising candidates for localized topical patches in skin and oral cancer treatment, underscoring their practicality and adaptability for therapeutic applications.
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- 2024
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46. A tale of recurrent secretory carcinoma of submandibular gland in an adolescent male: A rare presentation of a rare tumor.
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Kapatia G, Kaur M, Jain D, Rajasekaran S, Rajan N, Soni A, and Sekar A
- Abstract
Mammary analogue secretory carcinoma (MASC) is a rare salivary gland tumor which shares its histologic, immunohistochemical, and genetic features with the secretory carcinoma (SC) of breast. In this case report, we describe a case of MASC in a young adolescent male with swelling in the right angle of mandible which is a relatively rare site to present along with its correlation of cytological, histological, and immunohistochemical features. A 16-year-old male came with the complaint of swelling in the right angle of mandible since 2 years. Contrast-enhanced computed tomography (CECT) neck revealed differential diagnosis of nerve sheath tumor, pleomorphic adenoma, and adenoid cystic neoplasm was kept, and subsequently fine-needle aspiration cytology (FNAC) was done. FNAC was done in which differential diagnosis of myoepithelial neoplasm, acinic cell carcinoma, and SC was given. Surgical excision was done followed by histopathological examination. Immunohistochemistry panel was also applied, and final diagnosis of SC was rendered. SC has distinct cytological, histological, and immunohistochemical features which should be recognized by the pathologists for the appropriate management of the patient., (© 2024 Wiley Periodicals LLC.)
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- 2024
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47. Correction to: Comparison of imageless robotic assisted total knee arthroplasty and conventional total knee arthroplasty: early clinical and radiological outcomes of 200 knees.
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Rajasekaran S, Soundarrajan D, Singh R, Shiferaw BA, Rajasekaran RB, Dhanasekararaja P, and Rajkumar N
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- 2024
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48. A novel variant of type-II Monteggia equivalent in an adult: A case report with a 6-year follow-up.
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Mohamed Z, Ahmed O, Agraharam D, Shahidali JS, Soundararajan M, Jayaramaraju D, and Rajasekaran S
- Abstract
Case: An 18-year-old right-handed male student presented after a road-traffic-accident; he had type-II Monteggia fracture dislocation associated with ipsilateral type-I capitellum fracture and comminuted lateral condyle avulsion fracture. He underwent open reduction and fixation of ulna with 3.5 DCP with autologous olecranon bone grafting and fixation of capitellum using Herbert screw along with lateral collateral ligament (LCL) repair using fiber wire. At 6-years follow-up good outcome was seen without functional restrictions despite 15 degrees of restriction in pronation., Conclusion: Monteggia type-II variant with type-I capitellum fracture and LCL avulsion is a unique combination that represents a novel variant of type-II Monteggia equivalent, which adds to the existing classification of Monteggia equivalents., Competing Interests: All authors have no conflicts of interest., (© 2024 The Authors. Published by Elsevier Ltd.)
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- 2024
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49. Subtrochanteric femur nonunion - Chasing the elusive an analysis of two techniques to achieve union: Nail-plate fixation and plate-structural fibula graft fixation.
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Dheenadhayalan J, Sanjana N, Devendra A, Velmurugesan PS, Ramesh P, and Rajasekaran S
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- Humans, Male, Female, Retrospective Studies, Middle Aged, Adult, Fracture Fixation, Internal methods, Fracture Fixation, Internal instrumentation, Bone Transplantation methods, Treatment Outcome, Reoperation, Fracture Fixation, Intramedullary methods, Fracture Fixation, Intramedullary instrumentation, Aged, Bone Plates, Fibula transplantation, Fibula injuries, Fractures, Ununited surgery, Fracture Healing physiology, Hip Fractures surgery, Bone Nails
- Abstract
Introduction: The subtrochanteric region is known for its unique biomechanical properties that contribute to challenges in fracture reduction. To ensure optimal fracture healing, achieving robust mechanical stability is essential. There are very few studies in the literature describing the treatment of subtrochanteric fracture nonunion., Purpose: To analyze the outcomes of two techniques of revision fixation of nonunion in subtrochanteric femur fracture, namely, nail-plate fixation and plate-structural fibula graft fixation., Methods: This was a retrospective analysis of subtrochanteric femur nonunion between January 2011 and December 2019. The demographic details, details of the index surgery, details of the revision surgery and the time to final union were collected. The nonunion was divided based on the level of the fracture into high subtrochanteric and low subtrochanteric. Two revision techniques were used: plate-structural fibula graft for high subtrochanteric and nail-plate construct for low subtrochanteric femur fractures RESULTS: Out of the 54 patients that were included, there was malalignment in 53.70 %, medial comminution in 46.3 %, distraction at the fracture site in 44.4 %, lateral trochanteric wall break in 37.03 % and implant failure in 70.37 % of the patients. There were 20 high subtrochanteric and 34 low subtrochanteric fractures. Union was achieved in 53 patients (98.14 %). The mean LEFS score was 71.4 in the nail-plate group and 66.2 in the plate-structural fibula graft group (p 0.003)., Conclusion: The treatment of subtrochanteric femur fracture nonunion can be a daunting task. The goal is to correct the varus and restore the medial support which will prevent the occurrence of collapse and another failure. We were able to achieve this with both the nail-plate and the plate- structural fibula graft revision methods., Competing Interests: Declaration of competing interest All authors confirm that there is no conflict of interest, (Copyright © 2024 Elsevier Ltd. All rights reserved.)
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- 2024
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50. Can locking plate fixation and free Vascularised fibular transfer with skin island achieve good functional outcome in the treatment of large bone defects of Tibia ? A study of 26 cases.
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Dheenadhayalan J, Imran A, Devendra A, Venkatramani H, Velmurugesan PS, Rajasekaran S, and Sabapathy SR
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- Humans, Male, Female, Adult, Middle Aged, Treatment Outcome, Adolescent, Young Adult, Retrospective Studies, Tibia surgery, Free Tissue Flaps blood supply, Fibula transplantation, Fibula blood supply, Bone Plates, Tibial Fractures surgery, Fracture Fixation, Internal methods, Bone Transplantation methods, Fracture Healing physiology, Quality of Life
- Abstract
Background: Despite the availability of multiple treatment options, management of tibial bone loss continues to be a challenge. Free vascularized fibula graft (FVFG) with a skin paddle offers better advantages over the other methods. We aimed to study the functional outcomes and QALY of patients with large tibial bone defects following FVFG with a locking plate., Materials and Methods: We analyzed 26 consecutive patients with large tibial bone defects treated by free vascularized fibular graft (FVFG) and stabilization using a long locking plate between 2009 and 2018. All were followed up for a mean period of 42 months (24 to 120 months). Bony union, graft hypertrophy, and complications such as stress fracture and infections were assessed. Multivariate regression analysis was performed to identify any association between demographic factors, injury characteristics, treatment-related factors, and fibular hypertrophy. Additionally, The EQ-5D quality-of-life (QOL) indices were obtained using the SF-12 score to evaluate the patients' overall quality of life., Results: The mean age of the patients at the time of presentation was 36.26 yrs (range, 18-60 years). The cause of bone loss was open injury in 16 patients and infected nonunion in 10 patients. Complete union was achieved in 25 patients (96 %) without any requirement of additional surgical procedures. The mean union time of the graft was 4.04 months (range, 3-6 months). The mean fibular hypertrophy calculated by De Boer index was 0.61 %, 11 %, 28.24 % and 52.52 % at 3,6 months and 1 and 2 years respectively. Patients with metaphyseal bone loss have significant fibular hypertrophy. Participants in our study experienced a quality of life equivalent to 0.88 (range 0.79-0.99) of perfect health., Conclusions: FVFG with skin paddle and LCP fixation for massive tibial bone loss achieved satisfactory outcome and QALY even in the challenging healthcare environment of South India, a developing country.It maintains alignment, promotes graft hypertrophy, and prevents stress fractures., Level of Evidence: Level 4 LEVEL OF CLINICAL CARE: Level I Tertiary trauma centre., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)
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- 2024
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