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Synovial chondromatosis is a rare, benign condition occurring due to metaplasia of synovium. A 65-year-old woman presented with pain in her right hip for 6 years. On examination, a swelling was palpable at the base of scarpa’s triangle and her right hip movements were restricted. Imaging modalities showed ossified nodules in the antero-inferior aspect of the hip joint, joint effusion and arthritic changes. We diagnosed the patient to have synovial chondromatosis with secondary arthritis of the hip joint. We performed a total hip arthroplasty with simultaneous synovectomy and extraction of the osteochondral loose bodies, 5 of which were about 2×2 cm in size. We found that excessive acetabular reaming was required due to craters, the osteochondral masses formed on the acetabular surface. Histopathological analysis confirmed the diagnosis. The patient had an excellent functional outcome and no recurrence 5 years following the surgery.

An 11-year-old girl was brought to us with complaints of restriction of movements of the left shoulder and a deformity of the back for the past 1 year, which had gradually progressed over 1 year. The child was yet to attain menarche. On examination, her physical development was found to be Tanner

The aim of this study was to develop and validate a questionnaire assessing knowledge of signs and symptoms of relative energy deficiency in sport among healthcareprofessionals and physically active individuals.Cross-sectional study.The questionnaire was created in two phases: 1)Item development was established through a literature review, expert review (n = 4), and pre-testing among healthcare professionals, dietetic students, and the general population (n = 35). 2) Validity (item analysis, construct validity) and internal reliability were assessed by administrating the questionnaire to healthcare professionals (n = 97) and physically active individuals who engaged in moderate to intense physical activity (n=77). The questionnaire was re-administered in a subset of the same groups (n = 88) for test-retest reliability.The expert responses showed80% acceptability and pretesting through interviews indicated good content and face validity. Item response analysis resulted in removal of 6 items due to low discrimination ability. Significantly higher knowledge scores in health professionals compared with non-health professionals (mean difference (95% CI) = 2.8 (1.9, 3.7)) confirmed construct validity. Internal consistency, assessed using Cronbach's alpha (α = 0.79), and test-retest reliability using intra-class correlation coefficients (intra-class correlation coefficients = 0.80; Spearman's correlation = 0.84, p 0.001) were good. The final questionnaire had 18 items assessing knowledge of signs and symptoms of Relative Energy Deficiency in Sport.The questionnaire provides a valid and reliable tool to assess knowledge of signs and symptoms of Relative Energy Deficiency in Sport among health professionals and physically active individuals, which could guide future education requirements by assessing current knowledge.

Computer vision techniques are an emerging trend today. Digital image processing is gaining popularity because of the significant upsurge in the usage of digital images over the internet. Digital image processing is a practice that can help in designing sophisticated high-end machines, which can hold the ophthalmic functionality of the human eye. In agriculture, leaf examination is important for disease identification and fair warning for any deficiency within the plant. Many prominent plant species are facing extinction because of a lack of knowledge. A proper realization of computer vision techniques aid in extracting a significant amount of information from leaf image. This necessitates the requirement of an automatic leaf disease detection method to diagnose disease occurrences and severity, for timely crop management, by spraying pesticides. This study focuses on techniques of digital image processing and machine learning rendered in plant leaf disease detection, which has great potential in precision agriculture. To support this study, techniques exercised by various researchers in recent years are tabulated.

Introduction: Osteosarcoma is a malignant tumor, the treatment of which is controversial between amputation and limb salvage surgery. Osteosarcoma occurring in a child is a challenge to manage due to the arrest of limb and the resultant limb length discrepancy. The management options for a child less than eight years of age are very limited. Case report: We present a case of a six year old child who was diagnosed to have osteosarcoma of proximal tibia. She was started on neoadjuvant chemotherapy, after which, she underwent wide resection and reconstruction with free vascularised fibular graft. The joint was fused using a locking compression plate and screws. The locking screws were inserted avoiding the distal femoral physis, enabling growth of the physis in future. Adjuvant chemotherapy was then given. Follow up radiographs showed Harris growth lines indicating growth to be occurring at the distal femoral physis. She was not found to have recurrence on last follow up four years after surgery. Conclusion: We found reconstruction using free fibular graft and arthrodesis using plate and screws, provided satisfactory results. An attempt can be made to preserve the distal femur physis.

Introduction:Osteoid osteoma is a benign, bone forming tumor which accounts for nearly 10% of all benign bone tumors. The foot is very rarely involved, with only around 2% of osteoid osteomas being reported to occur in bones of the foot. Osteoid osteoma of the talus could present as symptoms mimicking monoarticular arthritis of the ankle. We present a case of osteoid osteoma occurring in the neck of talus, presenting such a diagnostic dilemma. Case Report:A 13-year-old male child had complaints of pain and swelling in his right ankle since 1 year. The pain was predominantly aggravated at night and partially relieved by non-steroidal anti-inflammatory drugs. On examination, we found a diffuse, ill-defined, and soft swelling over the anteromedial aspect of the right ankle, which was anterior and inferior to the medial malleolus. The movements at the ankle joint were restricted and painful. Lateral radiograph of ankle revealed a solitary, osteolytic, and circular lesion involving the neck of the talus. Computed tomography (CT) scan showed a well-defined, lucent, and intramedullary lesion with a sclerotic rim in the neck of talus. The child was diagnosed to have osteoid osteoma of the neck of talus. We performed percutaneous CT-guided radiofrequency ablation (RFA) of the lesion. The child had complete relief of pain after the procedure. The child was followed up for 3 years and had no complaints of pain. Conclusion:Osteoid osteoma very rarely occurs in the talus. It can present as monoarticular arthritis involving the ankle joint and requires a high degree of suspicion to be identified. A CT scan remains the most accurate investigation to confirm the diagnosis. We found percutaneous CT-guided RFA to have yielded good outcome without recurrence. Keywords:Osteoid osteoma, ankle arthritis, talus, radiofrequency ablation.

Introduction: Aneurysmal bone cyst (ABC) is a rare, benign, and cystic lesion. The most common sites are the femur, tibia, humerus, and spine. It is more common in females and usually occurs during the second decade of life. Case Report:A 5-year-old female child had a trivial fall, following which she developed pain in her left hip. Radiographs revealed an expansile, lytic lesion in the metaphysis of the left proximal femur. Cortical breach was present resulting in a pathological fracture. Biopsy of the lesion showed blood filled cystic spaces confirming the diagnosis of ABC. We performed an extended curettage of the lesion, bone grafting, and angle blade plate fixation. The angle blade plate was removed 1 year after the surgery. Two years later, she complained of pain in the left hip. Radiographs showed a geographic lytic lesion surrounding the previously inserted bone graft. Magnetic resonance imaging revealed multiple blood fluid levels. We performed an extended curettage with high speed burr. We filled the cavity with bone substitute and stabilized the region using a proximal humerus internal locking system plate. The histopathological examination of intraoperative samples confirmed the diagnosis of recurrence of ABC. We found no further recurrence of the tumor after 3 years of follow-up. Conclusion:ABCs can present with pathological fractures and requires management of the cyst and stabilization of the bone. Recurrent ABCs can be managed by re-curettage of the lesion and prophylactic internal fixation. The curettage has to be extensive through a large cortical window and using a high speed burr. Keywords:Aneurysmal bone cyst, recurrence, pathological fracture, treatment.

INTRODUCTION Lipoma Arborescens is an extremely rare, benign lesion effecting the synovial tissue of joints. It is characterized by villous lipomatous proliferation of the synovial tissue. The aim of our study was to evaluate its diagnostic features and analyse the functional outcome of arthroscopic management. METHODS We studied 13 patients who were diagnosed to have lipoma arborescens at our institution during the period from October 2005 to October 2019. All patients underwent arthroscopic synovectomy. Histopathological examination confirmed the diagnosis. Pre-operative and post-operative functional assessment was done using Tegner Lysholm score. RESULTS Mean age was 46.6 years. All patients presented with progressive swelling of knee joint, while 6 patients also complained of pain. Average duration of symptoms was 34 months. All the patients were diagnosed based on MRI findings. Tegner Lysholm scoring at last follow up visit, had 11 patients with excellent outcome, 1 patient with good outcome, and 1 patient with fair outcome. None of the patients had recurrence, nor underwent any subsequent procedure of the operated joint. CONCLUSIONS Lipoma arborescens is a rare condition which should be a differential in patients with mono-articular swelling of the knee joint, and can be confirmed with MRI. It should not be misdiagnosed or missed at early stages as prolonged duration of symptoms and delay in treatment is likely to lead to development of secondary arthritis of the joint. Arthroscopic synovectomy showed good functional outcome and no recurrence.

Thirty-five ‘apparently’ recrystallized specimens were produced through a combination of cold rolling and recrystallization annealing. They had a range of average grain size (dav:18-467 μm), grain orientation spread (GOS: 0.31 to 1.24 deg) and volume fraction of ND|| ( $${V}_{f}^{ND|| }$$ : 0.15-0.69). The GOS value, for individual grains or for an entire specimen, represented presence of ‘remnant’ cold work – existence of geometrically necessary dislocations and ‘minor’ orientation gradients. The resistance to aqueous corrosion was determined by this ‘remnant’ cold work, and not by average grain size or crystallographic texture. The role of mesoscopic distribution in plastic deformation, and the features of deformed microstructure, were then explored on the resistance to aqueous corrosion. Progressive plastic deformation, through laboratory cold rolling, brought reproducible non-monotonic corrosion responses. In particular, an increase in corrosion resistance (0 to 30 pct rolled) was followed by a drop (30-40 pct) and then an increase (> 40 pct rolling). These changes originated from the evolution in deformed microstructures: formation of near boundary orientation gradients and creation of low and high angle boundaries, respectively. A combination of microtexture and non-contact profilometry clearly established that deformation induced near boundary orientation gradients and grain-interior high angle grain boundaries provided resistance to aqueous corrosion, while low angle boundaries were detrimental.

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are commonly performed surgeries worldwide. The number of joint replacement surgeries being performed has increased considerably over the past two decades, but it has also seen an increase in litigation associated with it. The purpose of our study was to review and consolidate literature regarding medico-legal issues pertaining to THA and TKA cases. We looked at the causes of litigation, medico legal aspects of pre-operative requirements, optimisation of medical condition, indications and contraindications for arthroplasty, informed consent, implants, mixing of components from different manufacturers and post-operative rehabilitation. We also wanted to analyse available literature and legal proceedings regarding these cases in India specifically.

Background It is estimated that around 20–25% of world's adult population have metabolic syndrome. Moreover, the prevalence is also high among south Asians and Indians and about one third of the urban population in large cities has varying degrees of Metabolic Syndrome.5 Objectives To study the prevalence among adults who are at risk of metabolic syndrome, gender difference of the same. To study the association of socio-demographic factors, family history and personal history, biochemical parameters, lifestyle addictions, dietary pattern and adequacy with the risk of metabolic syndrome. Methodology A descriptive study was undertaken in Udupi District, Karnataka, India in which a total of 420 adults (aged >20 years) from the general population were studied. Anthropometric measurement like height, weight, waist circumference, BMI waist hip ratio (WHR) was measured. Biochemical parameters like Blood Pressure, Fasting Glucose level, Post Prandial, HDL, LDL, TG, Triglyceride level from the existing records was recorded. Lifestyle addictions/habits like smoking, alcohol, Tobacco chewing and Drugs was assessed. Dietary assessment was done using 24-h recall in the diet software. Chi-square test, Correlation analysis and Paired t-test were used when appropriate using SPSS package. Results and discussion On the basis of metabolic syndrome risk assessment score of biochemical parameters, 50% of the samples are at moderate/at risk category, while 46.4% of the samples are at low/no risk and 3.6% of the samples showed the prevalence of metabolic syndrome. On the basis of lifestyle addiction, 73.1% of the samples were at moderate risk of metabolic syndrome while 13.8% were at high risk and 13.1% were at no/low risk of metabolic syndrome. This explains that more than 50% of the samples are at moderate risk group. The statistically significant risk factor for metabolic syndrome were females (p = 0.000), advancing age (p Conclusion With urbanization and economic development, a nutritional transition characterized by improved dietary habits, improvements in socio-economic status and increasingly sedentary lifestyles have been observed which has contributed to the increasing prevalence of risk of metabolic syndrome among the population of Udupi, Karnataka.

Tibial periprosthetic fractures are rare but present a complicated problem for orthopaedic surgeons. Literature in relation to combination-type periprosthetic fractures is extremely scarce, and there is limited guidance available on its treatment. We report the case of a woman in her 60s, whose radiographs revealed a periprosthetic fracture of the tibia, which was a Felix type (II+IV)A fracture. The tibial tuberosity fragment was fixed with a cannulated cancellous screw. The fracture adjacent to the stem was managed conservatively as the prosthesis was stable. Follow-up radiographs revealed both fractures to have healed completely by 12 weeks. The patient returned to preinjury functional levels by 4 months. Our demonstrated treatment of a Felix type II+IV periprosthetic fracture could be a viable treatment option for such fractures.

The structural property of the search graph plays an important role in the success of local search-based metaheuristic algorithms. Magnification is one of the structural properties of the search graph. This study builds the relationship between the magnification of a search graph and the mixing time of Markov Chain (MC) induced by the local search-based metaheuristics on that search space. The result shows that the ergodic reversible Markov chain induced by the local search-based metaheuristics is inversely proportional to magnification. This result indicates that it is desirable to use a search space with large magnification for the optimization problem in hand rather than using any search spaces. The performance of local search-based metaheuristics may be good on such search spaces since the mixing time of the underlying Markov chain is inversely proportional to the magnification of search space. Using these relations, this work shows that MC induced by the Metropolis Algorithm (MA) mixes rapidly if the search graph has a large magnification. This indicates that for any combinatorial optimization problem, the Markov chains associated with the MA mix rapidly i.e., in polynomial time if the underlying search graph has large magnification. The usefulness of the obtained results is illustrated using the 0/1-Knapsack Problem, which is a well-studied combinatorial optimization problem in the literature and is NP-Complete. Using the theoretical results obtained, this work shows that Markov Chains (MCs) associated with the local search-based metaheuristics like random walk and MA for 0/1-Knapsack Problem mixes rapidly.

An increasing volume of malicious spam calls has ushered an urgent need for a system that can automatically detect them. A robust spam call detection system must identify and block spam calls with high accuracy. Unlike current techniques that use crowd sourcing and are prone to phone number spoofing, this paper proposes a novel deep learning-based approach to classify phone calls, as spam or ham, based on the generated call transcript. This paper proposes a means of classification using embedded features with a 2-Path Hybrid Model (2PHM), comprising of a Long Short Term Memory Network (LSTM) and a Sentence Similarity Network. The 2PHM uses the transcript generated from the call by converting it into feature vectors, embedded in a high dimensional latent space, using the Universal Sentence Encoder embedding technique. Both paths of the hybrid model generate results that are weighed in an 85:15 ratio to finally generate a classification. The proposed system has been tested against Machine Learning models like Naive Bayes, K-Nearest Neighbors, Random Forests and Support Vector Machines and performs better than them, with an overall classification accuracy of 93% and a latency of 3 s.

Background Transitioning from pediatric to adult health care is associated with significant psychosocial and clinical morbidity. Adolescents not only transition their medical care, but also experience vast changes in the physical, social, and psychological spheres of their lives. The medical team must help navigate these changes to provide optimal care. IBD in adolescence is associated with increased hospitalizations and surgery. This is due to several factors, including medication non-adherence and a failure to attend medical appointments. There has been a greater focus on improving care for this unique population. McMaster Children’s Hospital has integrated the AYA IBD clinic for patients between the ages of 16 and 22. The goal is to transition patients using a developmentally appropriate framework to facilitate self-efficacy and help identify comorbid mental health conditions while building resilience. Aims To explore the impact of the implementation of a dedicated transition clinic on attendance at medical visits for AYA patients with IBD. Methods The total numbers of patients booked in the AYA IBD Clinic was compared to an age matched subset of the patients in the adult McMaster Complex IBD (CIBD) Clinic. These visits were assessed based on whether the visit was: attended, cancelled, or no showed. Visits were then stratified between in-person and virtual visits. Unpaired t tests was performed to compare the AYA IBD clinic and the CIBD clinic. Findings were deemed significant based on p-values Results The percentages of patients that attended visits (in-person or virtually) was similar between both clinics at 86% versus 79% Year 1 (Y1) and 76% versus 81% Year 2 (Y2). The number of patients seen in the AYA clinic increased from Y1 (n=92) to Y2 (n=131). The CIBD clinic saw fewer patients between Y1 (n=202) and Y2 (n=79). There were a higher number of patients who cancelled or no showed in Y2 versus Y1 for the AYA virtual visits (13 versus 8) compared to the CIBD clinic (Y2,1 versus Y1,1). Conclusions Our results highlight the challenges of transitioning adolescent patients with IBD. Our retrospective study was not powered to show significance. Given the increase in cancellation and no-show rates in Y2, the AYA clinic has incorporated a patient navigator to issue reminder phone calls and facilitate communication with patients between clinics. Future studies will re-assess how the presence of a patient navigator impacts attendance and cancellation rates. Future studies will also assess how the AYA clinic impacts transition readiness and self-efficacy, which is being measured through validated questionnaires in our clinic. Funding Agencies Grants-In-Aid

The treatment and outcome of tibial stress fractures concomitant with knee osteoarthritis (OA) are complicated. The aim of this study was to evaluate the functional and radiological outcome of total knee arthroplasty with long tibial stem as a treatment for patients having knee OA and tibial stress fracture.Patients who were diagnosed to have proximal tibia stress fracture along with knee OA at our institution between June 2013 and November 2018 were included in our study. All patients underwent total knee arthroplasty with long tibial stem. Preoperative and postoperative functional assessments were done according to range of movement of the knee joint, knee society score and knee injury and OA outcome score. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables.Twelve patients were included in the study. All patients were found to have stress fractures in the proximal half of tibia and extra-arthrosis. Four patients had non-union/delayed union, and 8 patients had acute fractures. The average preoperative range of movement was 88.1°, which improved to 116.3° at 3 months following surgery. It was found that the fracture has healed in all cases. Mean knee society score improved from 32.9 preoperatively to 89.3 at 1 year follow-up. Knee injury and OA outcome score improved from a mean score of 28.3 preoperatively to 81.1 at 1 year follow-up.Stress fractures can occur in the proximal tibia in patients with knee OA. Total knee arthroplasty with tibial stem provides a suitable solution for both conditions. Additional plating or bone graft is unlikely to be required.

India is one of the major chickpea-producing countries in the world. An estimate of almost 71 % of the world's chickpea production is done here. This paper presents an approach to classify Indian chickpeas using a computer vision technique. For this work image processing and eight different machine learning algorithms are used. The features considered are first of their kind. Based on these features the performance of machine learning algorithms is studied for the classification of the chickpea. Out of eight different algorithms lib Support Vector Machine and multilinear perceptron provided high accuracy of 86.07% and 84.90%.