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Aim: The aim of the study was to evaluate and compare the periodontal treatment outcomes in patients with periodontitis treated using conventional and microsurgical access flap procedure. Materials and Methods: Fifty chronic periodontitis patients were randomly assigned to conventional (Group I) and microsurgical (Group II) open flap debridement procedure. The parameters measured were probing pocket depth, clinical attachment loss (CAL), gingival recession (GR), bleeding on probing (BOP), wound healing, and postoperative pain. PD, CAL, GR, and BOP were assessed at pretreatment (baseline) and 3 months postoperatively. Wound healing was assessed using Landrey et al. healing index at 7th day and 3 months postoperatively and postoperative pain was assessed using number of analgesics taken for 7 days following surgery. Results: Healing Index score of 4 (very good healing) was found in 40% of sites of Group I and 95% of sites of Group II. Comparison of number of analgesics taken between groups on day 7 showed a statistically significant difference (P < 0.01), indicating that pain was significantly reduced in Group II compared to Group I. At 3 months postoperatively, there was no significant reduction in PD, CAL, GR, and BOP between the groups. Conclusions: In open flap debridement procedure, a microsurgical approach can substantially improve the early healing and induce less postoperative pain when compared to a conventional macroscopic approach.

Abstract Introduction Total hip arthroplasty (THA) has revolutionized the treatment of hip joint arthritis. With the increased popularity and success of the procedure, research has focused on improving implant survival and reducing surgical complications. Optimal component orientation has been a constant focus with various philosophies proposed. Regardless of the philosophy, achieving an accurate acetabular position for each clinical scenario is crucial. In this paper, we review the recent developments in improving the accuracy and ideal positioning of the acetabular cup in routine primary THA. Methodology A review of the recent scientific literature for acetabular cup placement in primary THA was performed, with available evidence for safe zones, spinopelvic relationship, preoperative planning, patient-specific instrumentation, navigation THA and robotic THA. Conclusion Though the applicability of Lewinnek safe zones has been questioned with an improved understanding of spinopelvic relationships, its role remains in positioning the acetabular cup in a patient with normal spinopelvic alignment and mobility. Evaluation of spinopelvic relationships and accordingly adjusting acetabular anteversion and inclination can significantly reduce the incidence of dislocation in patients with a rigid spine. In using preoperative radiography, the acetabular inclination, anteversion and intraoperative pelvic position should be evaluated. With improving technology and the advent of artificial intelligence, superior and more accurate preoperative planning is possible. Patient-specific instrumentation, navigated and robotic THA have been reported to improve accuracy in acetabular cup positioning as decided preoperatively but any significant clinical advantage over conventional THA is yet to be elucidated.

Background: Intracranial meningiomas consist of a heterogenous group of histological subtypes, some of which are rare. Data that may play an important role in neurosurgical decision-making regarding the incidence and MRI features of these histological subtypes in the South African population groups, are lacking. Objectives: This study aimed to assess the spectrum of MRI findings and histological subtypes of meningiomas in the South African context, with the goal of improving the paucity of literature on the topic. Method: A retrospective review of the MRI features of 41 cases of histologically confirmed intracranial meningiomas was performed at a tertiary hospital level. Imaging features were audited and correlated with histological subtypes during statistical analysis. Results: Eleven different histological subtypes of meningioma were encountered. World Health Organization (WHO) Grade I meningothelial meningiomas were the most common histological subgroup. Overall, meningiomas were found to be predominantly isointense to grey matter on T1-weighted imaging, irrespective of the histological subtype, with greater signal variability on T2-weighted imaging. Morphologies of specific subtypes are in keeping with the literature. Conclusion: Analysis of this series of intracranial meningiomas did not demonstrate statistically significant differences in MRI features between histological subtypes to allow for accurate preoperative prediction of meningioma subtype or WHO grade. This highlights the importance of definitive histopathological diagnosis rather than over-reliance on presumed benign imaging features. Contribution: This original research article discusses the impact of histological subtype on the MRI appearance of intracranial meningiomas, with the aim to improve the paucity of literature on the subject in the context of the South African population.

Category: Hindfoot; Ankle Introduction/Purpose: Osteochondral lesions of the talus (OLT) peak in incidence during childhood, yet there exists a paucity of research on treatment among skeletally immature populations due to their high potential for spontaneous recovery without interventions. Unfortunately for patients who do require treatment, existing guidelines are based on adult studies, which likely differ in prognoses and outcomes due to varying capacity for regeneration. This paper compares outcomes across conservative and various surgical interventions for pediatric OLTs, with the synthesized evidence forming the basis of a treatment algorithm. Methods: An electronic literature search was conducted across PubMed, EMBASE, and MEDLINE databases for primary studies published prior to January 2022. Pediatric status in OLTs was defined as age < 18 at diagnosis, since many studies did not assess skeletal maturity. The main outcomes were clinical and radiological success rates, defined as achievement of good or fair outcomes according to measures used by individual studies. Articles were categorized by treatment method, and outcome rates were obtained via simple pooling. Results: 35 studies involving 714 lesions were included. Studies were categorized into five overarching treatment methods – (1) conservative treatment, (2) bone marrow stimulation, (3) retrograde drilling, (4) fixation, and (5) osteochondral transplantation. These interventions had pooled clinical success rates of (1) 45%, (2) 85%, (2) 90%, (4) 82%, and (5) 74%, respectively. The pooled radiological success rates were (1) 58%, (2) 85%, (3) 55%, (4) 89%, and (5) 81%. Escalation from conservative to surgical treatment occurred at a rate of 62% among studies in which this was reported. Articles were heterogeneous in measurement tools and pre- treatment characteristics; average baseline lesion size was (1) 129.8, (2) 131.0, (3) 87.8, (4) 137.8, and (5) 237.5mm^2 across the five treatment methods, and initial Berndt-Harty staging was likewise disparate. Conclusion: Conservative treatments yielded lower clinical and radiological success rates than surgical interventions, but warrant an initial trial in stable lesions due to their cost-effective and non-invasive nature. Surgery should be indicated for unstable lesions, or failed conservative treatment. Drilling and bone marrow stimulation are effective in lower grade lesions, while fixation should be considered for loosened fragments, and transplantation for large, non-salvageable lesions. Future research utilizing more robust methodology and reporting outcomes according to baseline lesion characteristics will consolidate these guidelines.

Background: This study has employed the multidimensional and flexible index that is the Multidimensional Poverty Index (MPI) in achieving the objective of this study. Aims and Objectives: This study intends to assess and quantify the poverty levels of India using MPI. Materials and Methods: This study has selected eight indicators across three dimensions – health, education and social capital, and standard of living – in the estimation and applied the MPI method of cross-dimensional cut off across the indicators. Results: Upon completion, this study showed that India faces multidimensional poverty with an MPI of 0.4328. Conclusion: Estimation of multidimensional poverty can be done by even health-care professionals/institutes, notwithstanding constraints of data availability, to be used for policy considerations.

A comprehensive understanding of molecular and biochemical changes during sperm capacitation is critical to the success of assisted reproductive technologies. We reported involvement of the testis-specific isoform of Angiotensin Converting Enzyme (tACE) in bovine sperm capacitation. The objective of this study was to characterize the tACE interactome in fresh and heparin-capacitated bovine sperm through immunoprecipitation coupled with mass spectrometry. These interactions were validated by co-localization of tACE with beta-tubulin as an identified interactome constituent. Although interactions between tACE and several proteins remained unchanged in fresh and capacitated sperm, mitochondrial aldehyde dehydrogenase 2 (ALDH2), inactive serine/threonine protein-kinase 3 (VRK3), tubulin-beta-4B chain (TUBB4B), and tubulin-alpha-8 chain (TUBA8) were recruited during capacitation, with implications for cytoskeletal and membrane reorganization, vesicle-mediated transport, GTP-binding, and redox regulation. A proposed tACE interactional network with identified interactome constituents was generated. Despite tACE function being integral to capacitation, the relevance of interactions with its binding partners during capacitation and subsequent events leading to fertilization remains to be elucidated.

[This corrects the article DOI: 10.1371/journal.pone.0049548.].

Medial collateral ligament (MCL) injuries are commonly encountered alongside anterior cruciate ligament injuries. Treatment modalities have ranged from conservative management to surgical repair, augmentation, and reconstruction. Various reports have reported residual valgus instability, especially in higher-grade injuries that have been treated conservatively. The MCL provides valgus stability but also is an element of anterior stability to the tibia in addition to the anterior cruciate ligament. In addition, meniscal “lift-off” and “floating” have been described as consequences after MCL injuries, and meniscal dysfunction has been shown to lead to accelerated joint degeneration; therefore, all efforts should be made to treat these injuries adequately. We describe a simple, minimally invasive technique that involves suturing the deep MCL to the medial joint capsule, allowing better MCL healing, causing less soft-tissue scarring, and preventing meniscal extrusion.

Spontaneous or self-induced pneumoparotid, which usually manifests as acute unilateral gland enlargement, is caused by insufflation of air from the oral cavity via Stensen’s duct. A 9-year-old patient, with known Down’s syndrome, presented with a progressively enlarging, painless, spontaneous, left neck mass. Computed tomography showed features consistent with pneumoparotid, without underlying associated pathology. Identification of true cases of spontaneous pneumoparotid is crucial, as these require a holistic management approach to prevent recurrence and complications.

Hepatic mesenchymal hamartoma is a rare hepatic tumour seen in the paediatric population. Although this entity has a variable imaging appearance, it has a favourable prognosis if diagnosed and managed correctly. This case presents the ultrasound and computed tomography findings of an 11-month-old patient who presented with a history of progressive abdominal distension and an elevated alfa fetoprotein level on biochemistry. The case describes how a confident perioperative diagnosis could be made on the basis of characteristic imaging features.

An amniocele, or contained uterine rupture, is a phenomenon in which there is herniation of the amniotic sac through a uterine defect, secondary to various causes. It is associated with severe morbidity and mortality. This case presents the findings in a 36-year-old female at 29 weeks gestation who was initially managed as antepartum haemorrhage secondary to placenta previa, based on ultrasound. Upon further imaging, an amniocele was diagnosed. This case report illustrates the importance of early identification of this life-threatening condition.

Page kidney is a rare phenomenon that can present with hypertension. The presence of a subcapsular perirenal collection causes parenchymal compression leading to renal hypoperfusion. Subsequent activation of the renin–angiotensin–aldosterone system results in an increase in systemic blood pressure. The causes of renal subcapsular collections are varied, with most cases being secondary to post-traumatic haematomas. We present the case of a young hypertensive patient, treated as primary hypertension with persistently uncontrolled blood pressures. This was despite good treatment adherence. On further investigation, imaging identified the presence of bilateral subcapsular collections. This case illustrates the importance of a thorough workup in a young hypertensive patient with refractory hypertension. Given that Page kidney is curable, timeous intervention can save the patient from unnecessary medications and the morbidity of uncontrolled blood pressures.

BACKGROUND: Mycobacterium tuberculosis, a causative agent of chronic tuberculosis disease, is widespread among some animal species too. There is paucity of information on the distribution, prevalence and true disease status of tuberculosis in Asian elephants (Elephas maximus). The aim of this study was to estimate the sensitivity and specificity of serological tests to diagnose M. tuberculosis infection in captive elephants in southern India while simultaneously estimating sero-prevalence. METHODOLOGY/PRINCIPAL FINDINGS: Health assessment of 600 elephants was carried out and their sera screened with a commercially available rapid serum test. Trunk wash culture of select rapid serum test positive animals yielded no animal positive for M. tuberculosis isolation. Under Indian field conditions where the true disease status is unknown, we used a latent class model to estimate the diagnostic characteristics of an existing (rapid serum test) and new (four in-house ELISA) tests. One hundred and seventy nine sera were randomly selected for screening in the five tests. Diagnostic sensitivities of the four ELISAs were 91.3-97.6% (95% Credible Interval (CI): 74.8-99.9) and diagnostic specificity were 89.6-98.5% (95% CI: 79.4-99.9) based on the model we assumed. We estimate that 53.6% (95% CI: 44.6-62.8) of the samples tested were free from infection with M. tuberculosis and 15.9% (97.5% CI: 9.8 - to 24.0) tested positive on all five tests. CONCLUSIONS/SIGNIFICANCE: Our results provide evidence for high prevalence of asymptomatic M. tuberculosis infection in Asian elephants in a captive Indian setting. Further validation of these tests would be important in formulating area-specific effective surveillance and control measures.

Scapuloiliac dysostosis, also known as pelvis-shoulder dysplasia and Kosenow syndrome, is a rare skeletal dysplasia described first by Kosenow et al. in 1970. The main components of the syndrome are varying degrees of bilateral iliac and scapular hypoplasia. Various other skeletal abnormalities including exaggerated lumbar lordosis, and clavicular, vertebral, rib and long bone anomalies and extra-skeletal abnormalities, most commonly those of eye and ear, have also been reported. We report the plain radiography, CT and MRI findings of an interesting case of the syndrome.

Abstract Background Cupriavidus strain STM 6070 was isolated from nickel-rich soil collected near Koniambo massif, New Caledonia, using the invasive legume trap host Mimosa pudica. STM 6070 is a heavy metal-tolerant strain that is highly effective at fixing nitrogen with M. pudica. Here we have provided an updated taxonomy for STM 6070 and described salient features of the annotated genome, focusing on heavy metal resistance (HMR) loci and heavy metal efflux (HME) systems. Results The 6,771,773 bp high-quality-draft genome consists of 107 scaffolds containing 6118 protein-coding genes. ANI values show that STM 6070 is a new species of Cupriavidus. The STM 6070 symbiotic region was syntenic with that of the M. pudica-nodulating Cupriavidus taiwanensis LMG 19424T. In contrast to the nickel and zinc sensitivity of C. taiwanensis strains, STM 6070 grew at high Ni2+ and Zn2+ concentrations. The STM 6070 genome contains 55 genes, located in 12 clusters, that encode HMR structural proteins belonging to the RND, MFS, CHR, ARC3, CDF and P-ATPase protein superfamilies. These HMR molecular determinants are putatively involved in arsenic (ars), chromium (chr), cobalt-zinc-cadmium (czc), copper (cop, cup), nickel (nie and nre), and silver and/or copper (sil) resistance. Seven of these HMR clusters were common to symbiotic and non-symbiotic Cupriavidus species, while four clusters were specific to STM 6070, with three of these being associated with insertion sequences. Within the specific STM 6070 HMR clusters, three novel HME-RND systems (nieIC cep nieBA, czcC2B2A2, and hmxB zneAC zneR hmxS) were identified, which constitute new candidate genes for nickel and zinc resistance. Conclusions STM 6070 belongs to a new Cupriavidus species, for which we have proposed the name Cupriavidus neocaledonicus sp. nov.. STM6070 harbours a pSym with a high degree of gene conservation to the pSyms of M. pudica-nodulating C. taiwanensis strains, probably as a result of recent horizontal transfer. The presence of specific HMR clusters, associated with transposase genes, suggests that the selection pressure of the New Caledonian ultramafic soils has driven the specific adaptation of STM 6070 to heavy-metal-rich soils via horizontal gene transfer.