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Lunate dislocation is an uncommon injury occurring in young adults due to high-energy trauma. The volar displacement of the bone may result in compression of the median nerve within the carpal tunnel and is an uncommon cause of entrapment neuropathy. [ABSTRACT FROM AUTHOR]

Abstract: Background: Kleine–Levin syndrome is an uncommon disorder with recurrent episodes of hypersomnia, clearly associated with behavioral abnormalities like binge eating, hypersexuality and abnormal behavior. Many patients may not necessarily fulfill minimum criteria described for diagnosis. We aim to report such patients with atypical presentation resembling the Kleine–Levin syndrome. Method: We evaluated all patients at our clinic who had episodic disturbance in sleep and/or appetite lasting a few days to weeks, not necessarily fulfilling the International Classification of Sleep Disorders (ICSD) criteria for a diagnosis of Kleine–Levin syndrome, over 4 years. All clinical details, especially regarding sleep, appetite and behaviour during episodes, about prior and co-existing illnesses were noted. All patients were investigated with brain magnetic resonance imaging (MRI), electroencephalogram (EEG) and some with polysomnography. Results: Eighteen patients (5 females, 13 males) ranging in age from 12 to 55 years (median 18 years) were included in the study. The median duration of symptoms was 1.5 years, and the median number of episodes in each patient was six. The range of episode length was 18–300h with a mean of 91.2h. Fourteen patients had a history of hypersomnia, 3 had only insomnia and 3 had both during their episodes, while 5 patients reported hyperphagia, 11 reduced appetite and 2 no change in appetite. Ictal EEG revealed evidence of sleep, while polysomnography showed reduced rapid eye movement (REM) latency and normal sleep architecture during the episode. MRI was normal in all patients, except one who showed non-specific abnormalities. All patients showed improvement with carbamazepine. Conclusion: There are many patients with episodic alteration in sleep, appetite and behaviour with a course and treatment response similar to the classical Kleine–Levin syndrome, who otherwise do not fit the classical description for diagnosis of this condition. [Copyright &y& Elsevier]

Septo-optic dysplasia is a rare congenital disorder involving brain and optic pathways. We present typical Magnetic Resonance Imaging (MRI) findings of a case of Septo-optic dysplasia in a 19 year old female patient. [ABSTRACT FROM AUTHOR]

Caesarean section (C-section) rates of over 15% suggest overuse of the surgery which may be difficult to justify on medical grounds. One important contributor to the rise in Csection rates is the rapid expansion of unregulated private-sector providers in number of settings. This study analyses the contribution of private sector in the rapid rise in Csection deliveries in India and the extent to which these can be justified on medical grounds. This is a cross sectional study design using National Family Health Surveys. Logistic regression and propensity score matching (PSM) analyses are performed. The main outcome measured is avoidable C-sections in the private sector. Our findings suggest that the rising trend in C-section rates in the private sector cannot be explained by medical reasons alone. The odds of C-section among women who chose to deliver in private was over 4 times higher than women who chose to delivery in public facilities. Despite, controlling for medical complications, women's characteristics and preferences, our PSM analysis suggest that the public-private gap has doubled over the years and that the difference cannot be explained by known determinants of C-section. Over supply of avoidable C-section to the extent of 21%, as a result of physician induced demand and perverse financial incentives was observed in the private sector. This paper attempts to understand the reason for the high C-section rates in the private sector in India and the extent to which these are avoidable. Our analysis supports the assumption that physician induced demand as a result of perverse financial incentives in the private sector is at play. • Rise in C-section rates is a major public health concern in many countries. • Private sector is the main contributor to a rapid increase in C-sections in India. • Odds of C-section among women who chose to deliver in private was over 4 times higher. • High C-section rates in the private sector cannot be explained by known determinants. • Over supply due to physician induced demand and perverse financial incentives. [ABSTRACT FROM AUTHOR]

Abstract: Background: Metatarsophalangeal joint arthroplasty is an accepted treatment for hallux rigidus. There are few reports of the long-term results of this procedure. Methods: A series of 15 consecutive bio-action first metatarsophalangeal total joint replacements were retrospectively reviewed after a minimum follow-up of 5 years. The patients were assessed using the American Orthopaedic Foot and Ankle Society Score. Patient satisfaction and standard radiographs were also examined. Results: Subjectively, just over half the patients were satisfied with the results of the surgery. Objectively, however mechanical failure of the implant was universal, as determined radiographically. Discussion: Despite some success in relieving symptoms in patients, we have abandoned this procedure because of the high and increasing rate of failure, as demonstrated both clinically and radiologically. [Copyright &y& Elsevier]

To describe the microbiology and antimicrobial resistance patterns of clinical bacterial isolates obtained in patients undergoing left ventricular assist device (LVAD) implantation during their index hospitalization with an attempt to identify areas of improvement to prevent post-LVAD infections. We performed a retrospective chart review of all patients 18 years of age or older who were implanted at our center with a HeartMate 3 LVAD between September 2015 and July 2022. Any microbiologic data (culture type, date of collection, body location, cultured organism) and length of stay of index hospitalization post-LVAD implantation were collected. Results from antimicrobial susceptibility testing were collected if available. 172 patients underwent HM3 insertion during the study period; of note, the institutional surgical prophylactic regimen during this period was vancomycin and cefuroxime started pre-incision and continued until 24 hours after implantation. Positive cultures resulted in 45 patients (26%). A total of 65 different positive cultures were collected. The majority of isolates were gram-negative bacteria (N = 53, 81%). Most of the organisms were isolated from urine (N=33, 51%) followed by respiratory sites (N=15, 23%), and lastly blood (N= 11, 17%). There were no LVAD specific bacterial cultures (driveline or pump pocket) during implant hospitalization. The median time to organism isolation was 14 days (IQR 9-37.5). There was a statistically significant difference in length of stay between patients who developed a positive bacterial culture and those who did not (21 days vs 45 days, p< 0.001). 27% of LVAD patients develop a positive bacterial culture early post-LVAD implantation, with a median time to isolation of 14 days. The majority of cultures grew gram negative organisms in the urine or respiratory tract. Patients with any positive cultures had a significantly longer length of stay. This review identifies areas for quality improvement. [ABSTRACT FROM AUTHOR]

Background The purpose of this study was to investigate the influence of joint configuration and preparation on first metatarsophalangeal (MTPJ) union rates. Methods We performed a retrospective analysis of first MTPJ arthrodeses undertaken in our institution. Clinical notes, radiographs and postal questionnaires were used to determine outcome. Results Two hundred first MTPJ arthrodeses (172 patients) were included in the analysis (34 male: 138 female; mean age 62 yr). The overall union rate was 93.5%. Union was achieved in 109/118 MTPJs (92.4%) prepared in the flat-on-flat configuration and in 78/82 (95%) prepared in the ball-and-socket configuration ( p = 0.438). Higher union rates favoured low-velocity joint preparation [using rongeur only 21/21 (100%), rongeur and burr 26/27 (96.3%) and conical reamer 31/34 (91.2%)] but this did not reach statistical significance ( p = 0.317). There was a 95% satisfaction rate with surgery but male patients were less satisfied ( p = 0.031). Conclusion Union rates were not influenced by joint configuration or preparation techniques. [ABSTRACT FROM AUTHOR]

Abstract: Stonustoxin (SNTX) is a 148 kDa, dimeric, hypotensive and lethal protein factor isolated from the venom of the stonefish Synanceja horrida. SNTX (10–320 ng/ml) progressively causes relaxation of endothelium-intact, phenylephrine (PE)-precontracted rat thoracic aortic rings. The SNTX-induced vasorelaxation was inhibited by l-N G-nitro arginine methyl ester (l-NAME), suggesting that nitric oxide (NO) contributes to the SNTX-induced response. Interestingly, d, l-proparglyglycine (PAG) and β-cyano-l-alanine (BCA), irreversible and competitive inhibitors of cystathionine-γ-lyase (CSE) respectively, also inhibited SNTX-induced vasorelaxation, indicating that H2S may also play a part in the effect of SNTX. The combined use of l-NAME with PAG or BCA showed that H2S and NO act synergistically in effecting SNTX-induced vasorelaxation. [Copyright &y& Elsevier]

Myocarditis constitutes an important component of rheumatic carditis. Antimyosin scintigraphy, which allows noninvasive assessment of myocyte damage, can be used for documentation of cardiac involvement in patients with rheumatic fever where clinical diagnosis is not unequivocal. [ABSTRACT FROM AUTHOR]