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Purpose: Information on carbon dioxide (CO2) emission from different organic sources and their temperature sensitivity to decomposition is scarce in Bangladesh. Therefore, this study quantified the rates of CO2 emission and carbon (C) degradation constants from different organic material mixed soils at variable temperatures in two laboratory experiments. Methods: The first experiment was conducted at room temperature for 26 weeks to study CO2 emission and C mineralization using vermicompost, chicken manure, cow dung, rice straw, and rice husk biochar. Weekly CO2 emission was measured by alkali absorption followed by acid titration. The second experiment comprised two factors, viz. four organic materials (vermicompost, chicken manure, cow dung, and rice straw) and six temperature regimes (25, 30, 35, 40, 45, and 50 °C). Organic materials at 2.5 g C kg−1 soil were mixed in both experiments. Results: CO2 emission reached the peak at 5th weeks of incubation and then decreased with irregular fashion until 21st week. The C emission loss followed in the order of chicken manure > rice straw > vermicompost > cow dung > rice husk biochar, and C degradation constants indicated the slower decomposition of rice husk biochar compared to cow dung, vermicompost, chicken manure, and rice straw. Temperature positively enhanced the mineralization of organic materials in the order of 50 > 45 > 40 > 35 > 30 > 25 °C, which contributed to higher availability of soil phosphorus. Conclusions: High temperature increased mineralization of tested organic materials. Because of slower decomposition rice husk biochar, cow dung and vermicompost application can be considered as climate-smart soil management practices that might help in reducing CO2 emission from soil.

Inter-annual climatic variability in Bangladesh is significant and the probability of occurrence of extreme episodic/ climatic events has increased in the last couple of decades and thus threatening food security. Impact of inter-seasonal climatic va riability on Boro rice (dry season) yield in north-western parts of Bangladesh was analyzed using the historic weather datasets for 1971 to 2010 and MAKESENS model. Boro rice yield increased from 1980 onwards and the growth rate picked up with time. Inter-annual and inter-seasonal climatic variability was noticed through maximum and minimum temperatures, rainfall and sunshine hours. In general, temperatures and rainfall showed increasing trends but sunshine hours were decreasing gradually during the study period. Growth rates in average annual maximum, minimum and mean air temperatures were 0.001, 0.016 and 0.009°C year-1, respectively. On regional scale, Boro-rice seasonal maximum temperature was decreasing by 0.013°C year-1 but minimum and mean temperatures were increasing by 0.024 and 0.006°C year-1, respectively. Annual average sunshine hours in the study location were in decreasing trend by 0.027 hr year-1, but reduction in seasonal sunshine hours was 0.035 hr year-1. Inter-seasonal climatic variability was characterized through the Boro-rice yields in four test regions of north-west region of Bangladesh. Trend line equations were evolved for assessing the impact of climatic variations on Bororice yield. If maximum temperature changes by 1oC, Boro rice yield could be increased by 0.13 t ha-1, but it would reduce by 0.34 t ha-1 with one degree rise in minimum temperature. If sunshine hour decreases by 1 hr, Boro rice yield would decrease by 0.70 t ha-1 in study locations. Combined effects of maximum and minimum temperatures and sunshine hours showed significant influence on grain yields of Boro rice. These imply that temperature tolerant and solar radiation use-efficient rice varieties need to be bred for combating climate change impact in Bangladesh. There is a need to identify optimum sowing/transplanting window for the region, choice of suitable cultivars/ideo-types, and adoption of appropriate water and nutrients management strategies and adoption of appropriate resource conservation technologies for sustainable Boro rice production in Bangladesh.

Objective: The study was designed to describe various clinical features of fibromyalgia syndrome [FMS] in a Bangladeshi population seen at a university rheumatology clinic.Methods: Thirty consecutive patients with FMS were compared with the next patient with rheumatoid arthritis (RA] as well as a healthy painfree normal control INC], of the same sex and similar age. All subjects were evaluated by a physician-administered questionnaire.Results: Virtually all clinical and psychological features were more common in FMS than NCs as well as RA. The frequency of clinical and psychological features of FMS, e.g., fatigue, sleep difficulties, swollen feeling, paresthesia, irritable bowel syndrome, tension-type headaches as well as global anxiety, stress, and depression were similar to those reported in Europe and North America.Conclusion: Characteristics of FMS in a Bangladeshi population are similar to those described in the West. [ABSTRACT FROM AUTHOR]

We report a case of a 63-year-old man who presented to Accident and Emergency department (A&E) with dizzy spells and falls of sudden onset, without any obvious cardiac or vestibular abnormality. He had signifi cant co-morbidity and rupture of the left gastroepiploic artery aneurysm. The atypical presentation and rarity of the case posed a diagnostic dilemma. Once the diagnosis was established by computerised tomography (CT), treatment was uncomplicated with good recovery. [ABSTRACT FROM AUTHOR]

Abstract Background Guidelines recommend inhaled corticosteroids (ICS) for patients with severe chronic obstructive pulmonary disease (COPD). Most COPD patients are managed in primary care and receive ICS long-term and irrespective of severity. The effect of withdrawing ICS from COPD patients in primary care is unknown. Methods In a pragmatic randomised, double-blind, placebo-controlled trial in 31 practices, 260 COPD patients stopped their usual ICS (median duration of use 8 years) and were allocated to 500 mcg fluticasone propionate twice daily (n = 128), or placebo (n = 132). Follow-up assessments took place at three monthly intervals for a year at the patients' practice. Our primary outcome was COPD exacerbation frequency. Secondary outcomes were time to first COPD exacerbation, reported symptoms, peak expiratory flow rate and reliever inhaler use, and lung function and health related quality of life. Results In patients randomised to placebo, COPD exacerbation risk over one year was RR: 1.11 (CI: 0.91–1.36). Patients taking placebo were more likely to return to their usual ICS following exacerbation, placebo: 61/128 (48%); fluticasone: 34/132 (26%), OR: 2.35 (CI: 1.38–4.05). Exacerbation risk whilst taking randomised treatment was significantly raised in the placebo group 1.48 (CI: 1.17–1.86). Patients taking placebo exacerbated earlier (median time to first exacerbation: placebo (days): 44 (CI: 29–59); fluticasone: 63 (CI: 53–74), log rank 3.81, P = 0.05) and reported increased wheeze. In a post-hoc analysis, patients with mild COPD taking placebo had increased exacerbation risk RR: 1.94 (CI: 1.20–3.14). Conclusion Withdrawal of long-term ICS in COPD patients in primary care increases risk of exacerbation shortens time to exacerbation and causes symptom deterioration. Patients with mild COPD may be at increased risk of exacerbation after withdrawal. Trial Registration ClinicalTrials.gov NCT00440687

Maize is a major crop of the Eastern Himalayan Region (EHR) which faces significant environmental challenges including waterlogging (WL) under changing climate. Through microcosm and field experiments, this study aimed to evaluate the phenotypic plasticity and adaptive mechanisms of maize landraces under WL conditions at the seedling and flowering stages. Based on the response coefficient and waterlogging tolerance coefficient 14 landraces at the seedling stage were found to be WL tolerant whereas RCM-12-19, RCM-32-19, and RCM-16-19, emerged as WL tolerant at both stages. At seedling stage, Root Length ratio (RLR) has increased under WL stress to the tune of 98.4 % while Root Mass Ratio (RMR) has ranged from 0.09 to 0.47 for control and from 0.10 to 0.55 under WL. Root:shoot ratio varied from 0.10 to 0.88 and 0.11-1.23 under control and WL, respectively and a total of 19 genotypes reflected tolerance trait under WL. Phenotyping of key root traits (brace root angle (BA1), branching, and crown root number) revealed their substantial contribution to stress resilience, as confirmed by principal component analysis (PCA) and regression models. PCA indicates, for root tissue density (RTD) and root fineness (RF) at seedling stage, genotypes like RCM-34-19, RCM-10-19, RCM-23-19, RCM-42-19, and RCM-31-19 are closely associated with the second principal component (PC2). Whereas, at flowering stage, RCM-39-19, RCM-52-19, RCM-34-19, RCM-32-19, RCM-2-19, RCM-43-19, RCM-5-19, RCM-45-19, RCM-47-19, and RCM-50-19 exhibited strong positive loadings on (PC2) for the trait BA1. The results indicate that brace- and crown roots exhibit genotype-dependent architectural plasticity, which reduces the metabolic cost of soil exploration by increasing BA1, branching of brace roots (BB), and the number of brace roots (BO) while decreasing above-ground whorls (BW); thereby improving nutrient uptake from topsoil under WL stress. RCM-12-19, RCM-32-19, RCM-16-19, and RCM-23-19 demonstrated rapid root growth and branching after WL stress at the flowering stage, supporting their potential for breeding WL-tolerant maize. These findings align with the "steep, cheap, and deep" (SCD) root ideotype, where reduced crown root number and deeper root architecture improve nutrient uptake and yield. Genotype RCM-11-19 apart from scoring high through visual scoring was also found to have the highest dry biomass (76.7 g plant-1) and grain yield (12.2 g plant-1) under WL conditions. This research identifies critical root traits and promising genotypes for developing WL-tolerant maize, contributing to sustainable crop production in rain-fed EHR environments., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Krishnappa Rangappa reports financial support and administrative support were provided by 10.13039/501100013951ICAR Research Complex for North Eastern Hill Region. Krishnappa Rangappa reports a relationship with ICAR Research Complex for North Eastern Hill Region that includes: employment. Krishnappa Rangappa has patent Not Applicable(NA) pending to NA. Authors declare no conflict of Interest If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2025 Published by Elsevier Ltd.)

Low free Tri-iodothyronine (FT₃) levels are generally associated with poor prognosis in patients with various critical illnesses. Acute ST-segment Elevation Myocardial Infarction (STEMI) represents the most lethal form of Acute Coronary Syndrome (ACS) with substantial short- and long-term mortality. This study was done to assess the association between FT₃ levels and in-hospital outcome of the STEMI patients treated with streptokinase therapy. This was an observational study of 140 patients of STEMI treated with streptokinase therapy in the department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from October 2018 to September 2019. The patients were divided into the low FT₃ (FT₃ <3.5 pmol/L; n=70) and the normal FT₃ (FT₃ ≥3.5 pmol/L; n=70) groups according to FT₃ levels measured within 24 hours after admission. During the index hospitalization period, 13 patients died (9.0%) and the overall mortality rates were 18.6% in the low FT₃ group and 5.7% in the normal FT₃ group (p=0.01). The rates of Major cardiac events (MACE) were 45.7% in the low FT₃ group and 18.6% in the normal FT3 group (p=0.001). Multivariate logistic regression analysis showed FT₃ level is an important predictor for in-hospital major cardiac events in patients with ST-elevation Myocardial Infarction (p=0.01). Low FT₃ levels were strongly associated with poor in-hospital outcome in patients with STEMI. The FT₃ level screening may be a simple and valuable way in identifying high-risk STEMI patients.

Purpose: Restricted kinematic alignment (rKA) TKA is relatively newer technique for achieving an overall under-corrected limb alignment. The present study aims to provide an easy and reproducible technique for achieving calipered rKA-TKA (crKA-TKA) using routine instrumentation., Method: A prospective study was conducted including 30 patients (30 knees). All patients underwent crKA-TKA by the same surgeon. Pre-operatively all patients underwent long film standing radiographs, and coronal angles were measured to plan tibial bony cuts and the femoral axis angle (FAA) to restore tibial varus under correction and native distal femoral anatomy, respectively. Intra-operatively while taking tibial cuts, the alignment rod was noted to be always pointing towards the "third metatarsal" of the ipsilateral foot., Results: 30 patients underwent total knee replacement with crKA technique. Angular corrections were satisfactory with all patients reaching the target MPTA of 87.48 ± 0.78 and LDFA of 90.301 ± 2.66 as planned, with an overall under-corrected limb alignment. HKA was achieved within a target of < ± 3 degrees of the native knee (3.56 ± 1.29). Post-operative radiological parameters were checked by two separate observers with excellent intra-class correlation coefficients., Conclusion: The present study validates a novel intra-operative technique of confirming an under-corrected native tibial varus while performing crKA-TKA. The radiological outcomes of the study confirm that with careful pre-operative planning, coronal angular targets were easily achievable with very less outliers. Study further establishes that this method of calipered technique in rKA-TKA using routine digital templating software and standard instrumentations is an alternative method of executing rKA., Level of Evidence: IV, Prospective case series., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2024 Delhi Orthopedic Association. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Background: Infections have a poor prognosis in inpatients with cirrhosis. We aimed to determine regional variations in infections and their association with clinical outcomes in a global cohort of inpatients with cirrhosis., Methods: In this prospective cohort study initiated by the CLEARED Consortium, we enrolled adults (aged >18 years) with cirrhosis who were non-electively admitted to 98 hospitals from 26 countries or regions across six continents between Nov 5, 2021, and Dec 10, 2022. Data at admission, during hospitalisation, and for 30 days after discharge were collected through patient reports and chart reviews. Collected data included demographics; country and country income level per World Bank classifications (high-income countries [HICs], upper-middle-income countries [UMICs], and low-income or lower-middle-income countries [L-LMICs]); comorbidities; characteristics related to cirrhosis and the infections, including types, culture results, and drug resistance profile; antibiotic use; and disease course while hospitalised and for 30 days post-discharge. The primary outcome was in-hospital death or hospice referral in those with versus those without an admission infection (defined by the presence of infection on or within 48 h of admission). Multivariable log-binomial regression for in-hospital death or hospice referral was performed to identify risk factors., Findings: Of 4550 patients screened, 4238 patients (mean age 56·1 years [SD 13·3]; 2711 [64·0%] male and 1527 [36·0%] female) with complete data were enrolled. 1351 (31·9%) had admission infections. A higher proportion of patients in L-LMICs had infections (318 [41·7%] of 762 vs 444 [58·3%] without infection) than in UMICs (588 [30·6%] of 1922 vs 1334 [69·4%]) or HICs (445 [28·6%] of 1554 vs 1109 [71·4%]). Patients with admission infections had worse severity of cirrhosis and were more likely to have had an infection or been hospitalised in the preceding 6 months. The most common specific infection types were spontaneous bacterial peritonitis (391 [28·9%] of 1351), pneumonia (233 [17·2%]), and urinary tract infections (193 [14·3%]). 549 (40·6%) patients were culture-positive for bacterial or fungal infections, with the lowest culture-positive rates in Africa and mainland China. Most of the isolated organisms were Gram-negative (345 [63%] of 549), then Gram-positive (157 [29%]), and then fungi or mixed (47 [9%]), with Escherichia coli, Klebsiella pneumoniae, and Enterococcus spp being the top three isolated pathogens. The overall rate of drug resistance was 40% (220 of 549 with positive cultures), being highest in UMICs. The most used empirical antimicrobials were third-generation cephalosporins (453 [37%] of 1241), followed by the broad-spectrum β-lactams and β-lactamase inhibitors (289 [23%]). De-escalation was observed in 62 (20%) of 304 patients who had their antibiotics changed. Patients with versus without admission infections had a higher rate of in-hospital death or hospice transfer (299 [22·1%] of 1351 vs 232 [8·0%] of 2887; p<0·0001), a result replicated in multivariable analysis (adjusted risk ratio 1·75 [95% CI 1·42-2·06]; p<0·0001). Older age, self-reported female gender, not being in a HIC, lactulose use, and higher MELD-Na score were also associated with in-hospital death or hospice transfer on multivariable analysis., Interpretation: In the CLEARED Consortium cohort of inpatients with cirrhosis, the rates and types of infections, causative organisms, and culture-positivity varied substantially across regions, and infections were associated with a higher mortality risk. Culture positivity, which guides appropriate antibiotic use, was low. Taking a global perspective, considering regional variations in infections, drug resistance, and resources, could help to alleviate disparities in burden and outcomes., Funding: US Department of Veterans Affairs, the Richmond Institute for Veterans Research, the National Natural Science Foundation of China, Shanghai Rising-Star Program, the National Council for Scientific and Technological Development of Brazil, and Shanghai Municipal Key Clinical Specialty., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Total knee arthroplasty is the commonest procedure being done for Osteoarthritis of knee in current practice. In spite of its success many patients suffer from post-operative pain especially in the early post-operative period. The study aimed to evaluate the pain relief and functional benefit of periarticular cocktail infiltration., Methodology: Sixty-four patients undergoing simultaneous bilateral total knee were randomised to receive peri-articular cocktail injection in one knee and a similar amount of normal saline in contralateral knee. Cocktail consisted of ketorolac, ropivacaine and epinephrine. Patients' visual analog pain score (VAS), knee range of motion, quadriceps strength, single step test (SST) were recorded post-operatively., Results: The cocktail infiltrated knee had significantly lesser pain scores during the first 48 h. Intervened knee achieved better knee range of motion at 72 h and 14 days post-surgery. Quadriceps power and SST had better results in cocktail injected knees at 72 h, but no significant difference was detected at 14-day follow-up., Conclusion: Use of peri-articular cocktail injection is an effective modality to achieve better pain relief in early post-operative period. Though the benefits are not long lived, but its superior effects can be utilised for early functional recovery after TKA and improved patient rehabilitation., Level of Evidence: I, Randomized Controlled Trial., (© 2024 Delhi Orthopedic Association. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Background: The preferred procedure for end-stage arthritic knees is Total Knee Arthroplasty (TKA). Hidden blood loss during and after surgery is one of the most frequent side effects of TKA. This study aims to assess the impact of an extra intraoperative dosage of local periarticular tranexamic acid (TXA) on total blood loss and drain output following bilateral TKA in comparison to conventional triple dose IV TXA., Methods: Patients who had bilateral simultaneous TKA between January 2021 and November 2022 were the subjects of a single centre based retrospective observational analysis. In group 1 and group 2, 80 knees (IV TXA with periarticular TXA) were compared to a matched paired control set of 80 knees (3 dose IV TXA)., Results: In all, 80 patients having 160 TKAs performed were included in the study. When the two groups' total and concealed blood losses were compared, they were found to be statistically insignificant; nevertheless, first group's drain output was considerably lower than the second group due to the use of an additional dose of periarticular TXA. Comparable declines in Hb, HCT, and platelet count were observed among the two groups. The secondary goal indicated that although there was no significant difference in range of motion between the groups 72 h after surgery, group 2 had a higher rate of hospital re-admissions within 30 days compared to group 1., Conclusion: The study demonstrated that peri-articular TXA administration during bilateral simultaneous TKA resulted in no additional benefit to the total or hidden blood loss conservation, except reducing the drain amount. However, a unique finding of the current study suggests decreased chances of wound complications and lesser 30-day readmission rate among patients receiving peri-articular TXA. Present study thus advocates the use of TXA as an effective peri-articular adjunct after TKA when a negative suction drain is being used post-operatively., Level of Evidence: Level III, Retrospective comparative study., (© 2024 Delhi Orthopedic Association. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Background and Aim: The aim of this study was to evaluate the role of intrabiliary pressure (IBP) in the pathophysiology of extrahepatic biliary obstruction (EHBO) during percutaneous transhepatic biliary drainage (PTBD)., Materials and Methods: Adult patients with EHBO who underwent PTBD were prospectively enrolled. IBP was recorded during primary PTBD. The parameters of interest were age, gender, etiology of EHBO, baseline and post-PTBD liver function tests, duration for resolution of jaundice (decrease in total serum bilirubin ≥30% of baseline or <2 mg/dL), cholangitis, bile cultures, and serum albumin levels. The level of EHBO was divided into three types: Type 1 - secondary biliary confluence involved; Type 2 - primary biliary confluence involved; Type 3 - mid and distal common bile duct obstruction., Results: IBP was measured in 102 patients, and finally, 87 patients, including 52 (59.77%) females, were analyzed. The mean age of the patients was 56.1±11.6 years. The most common etiology of EHBO was carcinoma of the gallbladder in 44 (50.6%) patients. The mean IBP was 18.41±3.91 mmHg. IBP was significantly higher in Type 3 EHBO compared to Type 1 and 2 (p=0.012). A significant correlation was seen between IBP and baseline total serum bilirubin (p<0.01). There was a negative correlation between IBP and baseline serum albumin (p=0.017). In 56.3% of patients, resolution of jaundice was observed by day 3, but this was not significantly associated with IBP (p=0.19). There was no correlation between IBP and cholangitis (p=0.97) or bacterial cultures (p=0.21)., Conclusion: IBP was significantly associated with the type of EHBO, baseline serum bilirubin, and albumin levels. IBP could not predict cholangitis or the resolution of jaundice after PTBD., Competing Interests: The authors have no conflict of interest to declare.

Background/aims: Quick sequential organ failure assessment (qSOFA) is believed to identify patients at risk of poor outcomes in those with suspected infection. We aimed to evaluate the ability of modified qSOFA (m-qSOFA) to identify high-risk patients among those with acutely deteriorated chronic liver disease (CLD), especially those with acute-onchronic liver failure (ACLF)., Methods: We used data from both the Korean Acute-on-Chronic Liver Failure (KACLiF) and the Asian Pacific Association for the Study of the Liver ACLF Research Consortium (AARC) cohorts. qSOFA was modified by replacing the Glasgow Coma Scale with hepatic encephalopathy, and an m-qSOFA ≥2 was considered high., Results: Patients with high m-qSOFA had a significantly lower 1-month transplant-free survival (TFS) in both cohorts and higher organ failure development in KACLiF than those with low m-qSOFA (Ps<0.05). Subgroup analysis by ACLF showed that patients with high m-qSOFA had lower TFS than those with low m-qSOFA. m-qSOFA was an independent prognostic factor (hazard ratios, HR=2.604, 95% confidence interval, CI 1.353-5.013, P=0.004 in KACLiF and HR=1.904, 95% CI 1.484- 2.442, P<0.001 in AARC). The patients with low m-qSOFA at baseline but high m-qSOFA on day 7 had a significantly lower 1-month TFS than those with high m-qSOFA at baseline but low m-qSOFA on day 7 (52.6% vs. 89.4%, P<0.001 in KACLiF and 26.9% vs. 61.5%, P<0.001 in AARC)., Conclusion: Baseline and dynamic changes in m-qSOFA may identify patients with a high risk of developing organ failure and short-term mortality among CLD patients with acute deterioration.

Background: 20 % of patients remain dissatisfied post-Total Knee Arthroplasty. We intend to find the correlation between sizes of commonly used femoral components and morphometric data of distal femur in Indian population., Materials and Methods: Prospective observational study in 178 knees (178 individuals) was conducted on Magnetic Resonance Imaging scans (Axial section). The anteroposterior dimension at intercondylar notch (AP), anteroposterior dimension on the medial (MAP) and lateral (LAP) femoral condyle, total mediolateral width (ML), width of medial condyle (MLM), lateral condyle (MLL) and intercondylar distance (ICD) and aspect ratio (AR) were measured on males and females separately. These measurements were then analyzed keeping in view the available sizes of three latest knee arthroplasty systems (Attune CR, Next Gen II, Genesis II) to look for correlation and best fitting system., Results: On observation between values of male and female femur, a significant difference was seen in all the parameters (p-value<0.0001) except ICD (p-value 0.6591). On scatter plots, Attune was found to be nearer to the line of best fit compared to other two implant companies in both males and females. Outliers were highest in cases of NextGen II (45 % in males and 46 % in females) whereas it was lowest in the case of Attune (12.5 %in males and 41 % in females)., Conclusion: Attune CR was seen to fit best in the Indian population followed by Genesis II and NextGen II. These femoral implants are designed as per the sizes of the Western population and the Caucasians are oversized for the Indian subcontinent, especially female patients, thus needing improvement in design/sizes., Level of Evidence: III., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2024 Delhi Orthopedic Association. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Purpose: Malnourished adults with knee osteoarthritis (OA) have a lower propensity for physical activities, leading to post-surgical stress and poorer clinic-functional outcomes. The study is aimed to propose an integrative screening procedure for patients and to identify a subset of patients who are undernourished or at risk of undernutrition in the Indian population., Methods: A hospital-based cross-sectional study was conducted at a tertiary care, a university-level teaching hospital for seven months, which included knee OA patients above the age of 45 years, and the following criteria were evaluated anthropometric measurement and blood biochemical parameters and nutritional scoring system., Results: The current study reports a high prevalence of malnutrition (69.5%) in patients with knee OA in the Indian population based on blood biochemical levels, and late presenters are associated with poor nutritional status of an individual. A single gold standard blood biochemical test, serum albumin alone, reports many malnourished individuals in the population, and the remaining blood biochemical parameters may not yield any additional information. Mini nutritional assessment, mid-arm circumference, and mid-calf circumference are poor predictors of malnutrition, and we need a revised cut-off for our group of patients., Conclusion: In the cohort of OA Knee, the prevalence of malnutrition is high (69.5%) in the Indian population. Serum Albumin is the best parameter to detect the presence of malnutrition preoperatively, and MNS is not applicable to detect malnutrition in our subset of patients. The study recommends routinely measuring serum albumin levels in all patients to correct the nutritional abnormality preoperatively, resulting in better surgical outcomes and reduced post-operatively complications., Level of Evidence: IV., Competing Interests: Conflict of InterestsAll authors declare that they do not have any competing interest, concerning this research, authorship, and/or publication of this article., (© Indian Orthopaedics Association 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Purpose: Patients with varus knee osteoarthritis usually compensate at the ankle and typically walk with hindfoot valgus alignment. As the neutral weight-bearing axis of the lower limbs is restored with Total Knee Arthroplasty (TKA), ankle and hindfoot biomechanics also acutely change. This study aims to investigate whether any ankle clinical-radiographical changes occur as a result of bilateral mechanical TKA in patients with bilateral Osteoarthritis knee at a minimum follow-up of 6 months., Methods: The prospective observational study included 61 patients (122 knees) undergoing simultaneous bilateral TKA (mechanical alignment). Tibio-talar angle(TTA), tibial Anterior Surface angle (TAS), lateral distal tibial angle (LDTA), talar-tilt angle (TT), anatomical talocrural angle (aTC), ground surface and distal tibial plafond angle (GP), ground surface and an upper surface of talus angle (GT)and tibial plateau and tibial plafond angle (PP) were measured on long-film radiographs to look for changes in the ankle, whereas functional assessment was done using American Foot and Ankle Society (AOFAS), Foot and Ankle Disability Index (FADI), and Forgotten Joint (FJS-12) scores. Patients were sub-grouped based on the Hip-Knee-Ankle (HKA) axis, and the effect of the severity of knee varus on the ankles after TKA was also analyzed. The minimum follow-up was 6 months., Results: A significant decrease in the tibial plateau-tibial plafond (PP), ground-tibial plafond (GP), and ground-talar dome (GT) angles was noted after TKA (p-value < 0.05). Postoperative functional parameters were comparable to the preoperative status except for FADI, which significantly improved (p-value-0.03). Sub-group analysis based on the severity of knee varus (HKA) revealed GT to be most significantly reduced (p-value-0.036), while the talar tilt (TT) increased (p-value-0.044). Functional outcomes of the ankles clinically improved with the correction of severe knee varus after TKA. At a mean follow-up of 13.2 months post-TKA, 7 out of 61 (11.4%) patients complained of post-TKA ipsilateral ankle pain., Conclusion: Mechanically aligned bilateral TKA in severe varus deformity of the knee significantly decreases the GT angle but increases the varus tilt of the talus with lateral talar incongruency and under-coverage. Although the acute correction of severe knee varus deformity aligns the tibia more neutrally, resulting in an overall clinically evident improvement in ankle functional outcome, the increased varus talar tilt remains a deep concern., Level of Evidence: Prospective, observational, comparative study Level II., (© 2024. The Author(s).)

Background: Anterior Cruciate Ligament (ACL) reconstruction is one of the most common surgeries being currently done. As we usher into the era of Individualized Anatomic Reconstruction, it is very important to understand the native anatomy of ACL. We aimed to assess the ACL footprint dimensions in our patients and correlate it with anthropometric variables, which can help in preoperative decision making., Method: A total of 143 eligible patients with suspected ACL injury presented during the study period. Out of which 92 were included in the study. Data on patient's age, sex, height, weight and body mass index (BMI) was recorded. The length and area of both the tibial and femoral footprints were measured on MRI. The footprint dimensions were correlated with the recorded anthropometric data., Results: The ACL tibial footprint length and area, and femoral footprint length and area were found to be 13.3 ± 2.23 mm, 142.6 ± 26.16 mm 2 , 11.2 ± 1.97 mm, 125.8 ± 28.75 mm 2 respectively. Footprint in males was significantly larger than females. A weak (ρ- 0.21 to 0.4) correlation with weight and moderate (ρ- 0.41 to 0.6) correlation with height was observed. Multivariate linear regression analysis yielded height to be the only significant predictor of footprint dimension from which predictive equations were drawn., Conclusions: Height was found to be the most significant predictor of footprint dimensions in our patients. The predictive equations and graphs can aid in preoperative surgical decision making resulting in a more anatomical ACL reconstruction and improve the post-operative results., Competing Interests: 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.

Aims and Objectives: Over the last decade, YouTube has been extensively used as a learning tool for both physicians and patients, but the reliability of this information remains questionable. The purpose of this study was to look for the reliability and quality of videos on tennis elbow arthroscopy on YouTube., Materials and Methods: We used three search terms on YouTube "tennis elbow arthroscopic surgery," "Arthroscopic ECRB release," and "Arthroscopic debridement for tennis elbow," and screened the first 50 videos according to popularity. The videos were included from 2009 to date. Only videos in the English language were included. Repeated videos and videos without sound were excluded. A total of 74 videos were selected for this study and reliability was checked with DISCERN and journal of the American medical association (JAMA) scores. The quality was assessed with the Global Quality Score Criteria (GQSC) score and TEARS (a novel score). Popularity was tested with the video power index (VPI). A pilot study was conducted using 20 videos to validate the TEARS score., Results: In the pilot study, TEARS showed results in accordance with other scores used. The average number of views was 41,644.97, and the average duration was 5.03 ± 3.39 years. The mean value of DISCERN and JAMA was found to be 21.47 ± 6.28 and 1.05 ± 0.92, respectively. GQSC, TEARS, and VPI were found to be 1.70 ± 0.82, 4.17 ± 2.62, and 769,936.9 ± 6,538,851.37., Conclusion: Most of the videos were educational and physicians were targeted. The USA was the major contributor to such videos. The reliability and quality of these videos were found to be of poor quality. The video popularity was however found to be relatively high. The inter-observer reliability was good. Based on the findings, we conclude that the videos are not reliable and could not be used for learning., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of the west African college of surgeons.)

Introduction: Tennis elbow management has primarily been conservative over the years with over 90% of the cases being managed conservatively. Surgical intervention may be necessary only for symptomatic recalcitrant cases of tennis elbow cases. However, there are gaps in the literature when it comes to comparison of the return to pre-operative return to their work and level of activities among patients who undergo arthroscopic management and those who receive conservative management., Methods: A retrospective observational study was conducted to compare 23 patients receiving continued intensive conservative (CIC) management in group 1 with 24 patients undergoing arthroscopic release of the extensor carpi radialis brevis and lateral epicondyle decortication (ARD) in group 2. The study had a minimum follow-up period of 3.5 years. The researchers compared the groups in terms of return to work (RTW) at the same intensity or lower level and any changes in their previous work. Objective grip strength and patient-reported outcome measures, such as post-intervention satisfaction level (rated on a scale of 0-100) and visual analog scale (VAS) for residual elbow pain, were also compared between the two groups., Results: Return to work (RTW) occurred significantly earlier in group 2 (mean 6.13 months) compared to group 1 (mean 4.64 months), and a greater number of patients in group 2 (13/24, 54.2%) were able to return to the same of work. Although not statistically significant, the ARD group exhibited comparable patient satisfaction (p = 0.62) and visual analog scale (VAS) scores for residual elbow pain (p = 0.67). Grip strength was comparable (p = 0.084, 0.121) between the affected and unaffected sides of the bilateral upper extremities and among both groups of patients., Conclusion: The use of ARD for RTE (recalcitrant tennis elbow) indicates a significantly earlier return to work (RTW) at the same or lower intensity level compared to the standard CIC therapy protocol. Objective grip strength was comparable to the non-affected side and among the two groups of patients receiving two different management modalities. Comparable patient-reported satisfaction and residual lateral elbow pain were also noted among both the groups., Level of Evidence: Retrospective, comparative study, level III., (© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Polycyclic aromatic hydrocarbons (PAHs) are pervasive in the atmosphere and are one of the emerging pollutants that cause harmful effects in living systems. There are some natural and anthropogenic sources that can produce PAHs in an uncontrolled way. Several health hazards associated with PAHs like abnormality in the reproductive system, endocrine system as well as immune system have been explained. The mutagenic or carcinogenic effects of hydrocarbons in living systems including algae, vertebrates and invertebrates have been discussed. For controlling PAHs, biodegradation has been suggested as an effective and eco-friendly process. Microalgae-based biosorption and biodegradation resulted in the removal of toxic contaminants. Microalgae both in unialgal form and in consortium (with bacteria or fungi) performed good results in bioaccumulation and biodegradation. In the present review, we highlighted the general information about the PAHs, conventional versus advanced technology for removal. In addition microalgae based removal and toxicity is discussed. Furthermore this work provides an idea on modern scientific applications like genetic and metabolic engineering, nanomaterials-based technologies, artificial neural network (ANN), machine learning (ML) etc. As rapid and effective methods for bioremediation of PAHs. With several pros and cons, biological treatments using microalgae are found to be better for PAH removal than any other conventional technologies., 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 © 2023 Elsevier Ltd. All rights reserved.)

Background: Post-operative physiotherapy is a major component of the effectiveness of knee replacement. Adequate rehabilitation protocols are required for better functional outcomes. With the advent of smartphones and smartwatches, the use of telerehabilitation has increased recently. This study aims to compare tele rehabilitation using various mobile-based applications to conventional rehabilitation protocols., Methods: From Jan 2000 to Jun 2022, all the RCTs from SCOPUS, EMBASE and PUBMED comparing patient-related outcome measures between the smartphone-based app and conventional rehabilitation protocols were scanned and seven studies meeting the eligibility criteria were included in this systematic review and meta-analysis. The quantitative analysis compared outcomes using the knee injury and osteoarthritis outcome score (KOOS), the knee society function score (KSFS), the active range of motion (AROM), Euro-Qol-5D-5L, and MUA. The qualitative analysis compared VAS, NRS, and Time up and go (TUG)., Results: The study shows statistically significant improvement in traditional rehabilitation over app based on KSFS score (M.D.: 6.05, p = 0.05) and AROM on long-term follow-up (12 months) (M.D.: 2.46, p = 0.02). AROM was insignificant on 3 months or less follow-up. NRS and VAS were found to be statistically better in app-based groups. No statistically significant results were seen on KOOS, Euro-Qol-5D-5L, MUA and TUG. 90 days of readmission and a number of physiotherapy visits were more in conventional groups. No difference was seen in single-leg stance and satisfaction rates., Conclusions: The present review highlights improved early pain scores and comparable patient-reported outcome analysis at a short-term follow-up period among patients receiving mobile app-based rehabilitation. However, knee range of motion and KSFS score achieved after surgery is analysed to be better with traditional rehabilitation at the one-year end follow-up period., Competing Interests: None among the authors are declared., (© 2023 Published by Elsevier B.V. on behalf of Professor P K Surendran Memorial Education Foundation.)

Background: Implant designs for total knee arthroplasties (TKA) are continuously evolving to improve outcomes and satisfaction rates after TKA. The present systematic review and meta-analysis aimed to explore the evidence in the literature regarding the outcomes of the Attune knee system over the PFC Sigma knee design and investigate the advantage of one over the other., Methods: A systematic review and meta-analysis of published studies till August 2021 was performed using the defined eligibility criteria. This was a systematic review of the literature published in the Cochrane Central Register of Controlled Trials (CENTRAL) Library, PUBMED, and EMBASE. The analysis included prospective and retrospective comparative trials comparing TKA by PFC sigma or Attune posterior stabilized (PS) or cruciate-retaining (CR), fixed bearing, or rotating platform systems. Patient-reported outcome measures (PROM) and postoperative patellar complications were analysed in the studies utilizing attune knee system (modern implants) to its counterpart PFC sigma (traditional implants) for TKA. Quality assessment was conducted using NIH Quality Assessment Tool for controlled intervention studies (RCTs and case-control studies)., Results: This review included 3 RCTs and the rest, 10 of which were non-RCT, including 5852 patients. ATTUNE designs suggested a statistically significant improvement in KSS over PFC Sigma designs. Other PROMs such as OKS and WOMAC scores yielded comparable results between the two groups. ATTUNE knee prosthesis did not result in better knee range of motion, patient satisfaction, or radiological outcomes than the PFC design. Regarding the complications, attune knee prosthesis demonstrated favourable results over PFC Sigma for anterior knee pain and patellofemoral (PF) crepitus., Conclusions: The present systematic review highlights better KSS and lesser chances of PF complications favouring a modern implant design over its traditional counterpart. Other patient-reported outcome analyses at a short-term follow-up period were comparable among patients undergoing total knee replacements with two different implant designs. Radiological outcomes for component positioning also suggested similar results among the two groups., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The neurotransmitter histamine exists in two isomeric forms and could be an interesting ligand due to three nitrogen atoms with the possibility of binding to metals in different ways besides its crucial role in biological systems. However, no metal-histamine interaction is known in the literature. Therefore, two histamine-bound magnesium porphyrins [MgT(4-Cl)PP(hist) 2 ] 1 and [MgT(4-Br)PP(hist)] 2 have been synthesized and structurally characterized. Interestingly, 1 is a hexa-coordinated magnesium porphyrin due to the axial coordination of two histamine molecules via the nitrogen of the aliphatic amino group with the Mg-N histamine distance of 2.300 Å, while 2 is penta-coordinated due to the axial coordination of one histamine molecule through the imidazole nitrogen atom with the Mg-N histamine distance of 2.145 Å. The diverse coordination modes of this unique ligand are explored for the first time. Theoretical studies at the level of DFT supported the binding of histamine via imidazole nitrogen atoms for complex 2. Histamine-bound magnesium porphyrins are found to be stable against the photodegradation of magnesium porphyrin in the presence of light and oxygen. Freshly isolated chlorophyll a from spinach showed similar resistivity against photodegradation. Moreover, the histamine-bound complexes showed higher antioxidant activity for 1 (92.45%) compared to the free base porphyrin (73.11%) and MgT(4-Cl)PP (75.89%).

Introduction: Medial patellofemoral ligament (MPFL) prevents lateral dislocation of the patella and acts as a major stabilizer. The tear could be associated with osteochondral avulsion fractures; however, intra-articular split fractures are not seen. Here, we present one unusual case of such a presentation., Case Report: A 16-year-old male presented with a history of recurrent patellar dislocation and inability to bear weight following the last episode. The patient was diagnosed with an MPFL tear with an unusual intra-articular femoral condyle split fracture. The case had significant improvement in functional scores post-surgery., Conclusion: In physically active populations, twisting of the knee could result in an MPFL tear, leading to recurrent patellar dislocation. The treatment remains ligament reconstruction, open, or arthroscopic. Associated intra-articular fractures are very rare with such injuries and need to be addressed due to the high rate of non-union., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Background and Aims: Early identification of non-response to steroids is critical in patients with autoimmune hepatitis (AIH) causing acute-on-chronic liver failure (ACLF). We assessed if this non-response can be accurately identified within first few days of treatment., Methods: Patients with AIH-ACLF without baseline infection/hepatic encephalopathy were identified from APASL ACLF research consortium (AARC) database. Diagnosis of AIH-ACLF was based mainly on histology. Those treated with steroids were assessed for non-response (defined as death or liver transplant at 90 days for present study). Laboratory parameters, AARC, and model for end-stage liver disease (MELD) scores were assessed at baseline and day 3 to identify early non-response. Utility of dynamic SURFASA score [- 6.80 + 1.92*(D0-INR) + 1.94*(∆%3-INR) + 1.64*(∆%3-bilirubin)] was also evaluated. The performance of early predictors was compared with changes in MELD score at 2 weeks., Results: Fifty-five out of one hundred and sixty-five patients (age-38.2 ± 15.0 years, 67.2% females) with AIH-ACLF [median MELD 24 (IQR: 22-27); median AARC score 7 (6-9)] given oral prednisolone 40 (20-40) mg per day were analyzed. The 90 day transplant-free survival in this cohort was 45.7% with worse outcomes in those with incident infections (56% vs 28.0%, p = 0.03). The AUROC of pre-therapy AARC score [0.842 (95% CI 0.754-0.93)], MELD [0.837 (95% CI 0.733-0.94)] score and SURFASA score [0.795 (95% CI 0.678-0.911)] were as accurate as ∆MELD at 2 weeks [0.770 (95% CI 0.687-0.845), p = 0.526] and better than ∆MELD at 3 days [0.541 (95% CI 0.395, 0.687), p < 0.001] to predict non-response. Combination of AARC score > 6, MELD score > 24 with SURFASA score ≥ - 1.2, could identify non-responders at day 3 (concomitant- 75% vs either - 42%, p < 0.001)., Conclusion: Baseline AARC score, MELD score, and the dynamic SURFASA score on day 3 can accurately identify early non-response to steroids in AIH-ACLF., (© 2023. Asian Pacific Association for the Study of the Liver.)

Mangrove ecoregions of the Indian Sundarbans (IS) are highly productive ecosystems in the Bengal delta of the Indian subcontinent. These mangroves are crucial in reducing the negative consequences of extreme environmental events like excessive wave movements and periodic storm surges, in addition to serving as an important habitat for a variety of distinct flora and animals. The Bay of Bengal has been increasingly affected by climatic changes like increase in sea surface temperature (SST), salinization, and sediment loads, a decrease in freshwater intake, and sea level rise. In the last two decades (2000-2020), these climatic phenomena have increased the frequency of tropical cyclones. From 2000 to 2020, the loss of landmass has been attributed to exposure to these climate changes. According to open-source satellite imaging data, such losses in land area have also led to a decrease in the amount of mangrove vegetation. Thus, to monitor the health of mangrove vegetation, Landsat-based health indicators like normalized difference vegetation index (NDVI), enhanced vegetation index (EVI), and combined mangrove recognition index (CMRI) have been considered in this study. CMRI, as a mangrove-specific index, was measured on the basis of the difference of NDVI and normalized difference water index for remote sensing of vegetation liquid water from space (NDWI&#95;Gao). Furthermore, datasets for abiotic variables have been extrapolated from remotely sensed data for the said period using specific formulae. Both long-term and short-term temporal trends have been considered to better envisage the impact of episodic cyclonic events on mangrove health (1990-2020). Our findings indicate that cyclones altered the habitat with respect to land area and salinization status which would possibly render the dominance of more halotolerant forms with loss of freshwater mangrove biodiversity. Even though plantation efforts have shown the recovery of mangroves in this area, sudden storm surges and concomitant salinization of habitat put the plantation efforts in vain. A combination of factors like salinization, rise in SST, rainfall reduction in pre- and post-monsoon periods and episodic cyclonic events would probably lead to further deterioration of mangrove health in this area. Since the IS is suffering the most from climatic change and intermittent cyclonic occurrences, it is crucial to consider this when making policy decisions. Appropriate actions must be taken along with stronger conservation techniques, to protect this vulnerable environment. Better conservation tactics and ongoing plantation efforts would stop the loss of mangrove vegetation and its habitat, even though the growing frequency of episodic storm occurrences cannot be stopped., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)