Publications by authors named "Marathe N"

123 Publications

Incidence and Outcome Analysis of Vertebral Artery Injury in Posttraumatic Cervical Spine.

Asian J Neurosurg 2020 Jul-Sep;15(3):644-647. Epub 2020 Aug 28.

Department of Orthopaedics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India.

Objective: Vertebral artery injury (VAI) after cervical spine trauma often remains undiagnosed. Despite various clinical studies suggesting simultaneous occurrence of VAI with cervical spine trauma, guidelines regarding screening and management of posttraumatic VAI are yet to be formulated. The primary objective of the current study was to formulate a low-cost screening protocol for posttraumatic VAI, thereby reducing the incidence of missed VAI in developing countries.

Materials And Methods: This was a single-center prospective study performed on 61 patients using plain magnetic resonance imaging (MRI) as a screening tool to assess the frequency of VAI and routine X-ray to detect morphological fracture patterns associated with the VAI in posttraumatic cervical spine cases. If the MRI study showed any evidence of vascular disruption, then further investigation in the form of computed tomography angiography was done to confirm the diagnosis.

Results: This study showed the incidence of VAI was 14.75% (9/61). Of 61 patients, 16 had supraaxial, and 45 patients sustained subaxial cervical spine fractures. In the cohort of nine cases of VAI, eight patients had subaxial cervical spine injuries, of which seven were due to flexion-distraction injury. C5-C6 flexion-distraction injury was most commonly associated with VAI (4 cases). Of the nine cases, five succumbed to injury (mortality 55.55%), and 19 patients from the non-VAI group succumbed to injury (mortality 36.53%). From surviving four cases with VAI, two had improvement in the American Spinal Injury Association scale by Grade 1.

Conclusion: VAI in cervical spine trauma is an underrecognized phenomenon. Plain MRI axial imaging sequence can be an instrumental low-cost screening tool in resource-deficient parts of the world. VAI has tendency to occur with high-velocity trauma like bi-facetal dislocation, which has a high mortality and poor neurological recovery.
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http://dx.doi.org/10.4103/ajns.AJNS_45_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591224PMC
August 2020

Spinal osteoid osteoma: Surgical resection and review of literature.

Surg Neurol Int 2020 25;11:308. Epub 2020 Sep 25.

Spine Services, Indian Spinal Injuries Centre, New Delhi, India.

Background: Osteoid osteoma (OO) is a rare benign tumor of the spine that involves the posterior elements with 75% tumors involving the neural arch. The common presenting symptoms include back pain, deformity like scoliosis, and rarely radiculopathy.

Methods: From 2011 to 2017, we evaluated cases of OO managed by posterior surgical resection while also reviewing the appropriate literature.

Results: We assessed five patients (three males and two females) averaging 36.60 years of age diagnosed with spinal OOs. Two involved the lumbar posterior elements, two were thoracic, and one was in the C3 lateral mass. All patients underwent histopathological confirmation of OO. They were managed by posterior surgical resection with/without stabilization. No lesions recurred over the minimum follow-up period of 24 months.

Conclusion: Surgical excision is the optimal treatment modality for treating spinal OOs. The five patients in this study demonstrated good functional outcomes without recurrences. Further, the literature confirms that the optimal approach to these tumors is complete surgical excision with/without radiofrequency ablation.
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http://dx.doi.org/10.25259/SNI_510_2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7568094PMC
September 2020

Mini-open thoracoscopic-assisted spinal thoracotomy for traumatic injuries: A technical note.

Surg Neurol Int 2020 29;11:265. Epub 2020 Aug 29.

Spine Services, Indian Spinal Injuries Centre, New Delhi, India.

Background: Mini-open thoracoscopic-assisted thoracotomy (MOTA) has been introduced to mitigate disadvantages of conventional open anterior or conventional posterior only thoracoscopic procedures. Here, we evaluated the results of utilizing the MOTA technique to perform anterior decompression/fusion for 22 traumatic thoracic fractures.

Methods: There were 22 patients with unstable thoracic burst fractures (TBF) who underwent surgery utilizing the MOTA thoracotomy technique. Multiple variables were studied including; the neurological status of the patient preoperatively/postoperatively, the level and type of fracture, associated injuries, operative time, estimated blood loss, chest tube drainage (intercostal drainage), length of hospital stay (LOS), and complication rate.

Results: In 22 patients (averaging 35.5 years of age), T9 and T12 vertebral fractures were most frequently encountered. There were 20 patients who had single level and 2 patients who had two-level fractures warranting corpectomies. Average operating time and blood loss for single-level corpectomy were 91.5 ± 14.5 min and 311 ml and 150 ± 18.6 min and 550 ml for two levels, respectively. Mean hospital stay was 5 days. About 95.45% of cases showed fusion at latest follow-up. Average preoperative kyphotic angle corrected from 34.2 ± 3.5° to 20.5 ± 1.0° postoperatively with an average correction of 41.1% and correction loss of 2.4%.

Conclusion: We concluded that utilization of the MOTA technique was safe and effective for providing decompression/fusion of traumatic TBF.
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http://dx.doi.org/10.25259/SNI_435_2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533086PMC
August 2020

Posterior Stabilization Without Neural Decompression in Osteoporotic Thoracolumbar Fractures With Dynamic Cord Compression Causing Incomplete Neurological Deficits.

Global Spine J 2020 Oct 6:2192568220956954. Epub 2020 Oct 6.

Indian Spinal Injuries Centre, New Delhi, India.

Study Design: Prospective cohort study.

Objectives: Management of osteoporotic vertebral compression fracture (OVCF) remains an unsolved problem for a spine surgeon. We hypothesize that instability at the fracture site rather than neural compression is the main factor leading to a neurological deficit in patients with OVCF.

Methods: In this study, the prospective data of patients with osteoporotic fractures with incomplete neurological deficits from January 2015 to December 2017 was analyzed in those who underwent posterior instrumented fusion without neural decompression.

Results: A total of 61 patients received posterior indirect decompression via ligamentotaxis and stabilization only. Of these 17 patients had polymethylmethacrylate (PMMA) augmented screws and in 44 patients no PMMA augmentation was done. The mean preoperative kyphosis was 27.12° ± 9.63°, there was an improvement of 13.5° ± 6.87° in the immediate postoperative period and at the final follow-up, kyphosis was 13.7° ± 7.29° with a loss of correction by 2.85° ± 3.7°. The height restoration at the final follow-up was 45.4% ± 18.29%. In all patients, back pain was relieved, and neurological improvement was obtained by at least 1 American Spinal Injury Association Impairment Scale in all except 3 patients.

Conclusion: We propose that neural decompression of the spinal cord is not always necessary for the treatment of neurological impairment in patients with osteoporotic vertebral collapse with dynamic mobility. Dynamic magnetic resonance imaging is a valuable tool to make an accurate diagnosis and determine precise surgical plan and improving the surgical strategy of OVCF.
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http://dx.doi.org/10.1177/2192568220956954DOI Listing
October 2020

Small Cell Prostate Cancer with Atypical Presentation -A Case Report and Review of Literature.

J Orthop Case Rep 2020 ;10(2):50-53

Department of Orthopaedics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India.

Introduction: Prostate cancer is one of the leading causes of death due to carcinoma in developed countries due to metastasis. Most of the patient at the time of diagnosis has shown metastasis. Metastasis to bone leads to various skeletal-related events such as fracture and neural compression leading to increase morbidity in such patients. An early diagnosis leads to favorable outcomes. Skeletal metastasis is usually presented as osteoblastic localized lesion in the spine or pelvis. Here, we like to present a case of prostatic metastasis in a patient with widespread metastasis making the diagnosis in such condition a challenging issue.

Case Report: A 61-year-old male comes with a complaint of right hip pain who has been diagnosed in some other clinic as a case of osteopoikilosis after an X-ray of the pelvis with both hips. However, on the further skeletal analysis found to involve most of the skeletal system with the diffuse osteolytic lesion. A bone scan, lab investigations helped in the arrival of diagnosis of atypical prostatic metastasis.

Conclusion: Prostate cancer is less likely to present as widespread osteolytic lesions. A very few case reports have been found in the literature regarding such presentation. This case demonstrates how to differentiate between metastasis and other common condition showing such presentation leading to an early diagnosis and thus improving the overall mortality and morbidity of the patients.
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http://dx.doi.org/10.13107/jocr.2020.v10.i02.1692DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476697PMC
January 2020

Prevalence of Vitamin D Deficiency Amongst Indian Orthopaedic Surgeons.

Indian J Orthop 2020 Sep 14;54(Suppl 1):183-187. Epub 2020 May 14.

Department of Orthopedics, MS (ORTHO), 6th Floor, Multistorey Building, Seth G.S Medical College and King Edward Memorial Hospital, Parel, Mumbai, 400012 India.

Background: Vitamin D deficiency is a widely prevalent condition with patients in both symptomatic and asymptomatic spectrum. With the lack of routine screening there exists an unknown population of Indian Orthopaedic surgeons who are deficient in Vitamin D and lead to an unexplained loss of quality of work and increased susceptibility to various other diseases. The easiest access to resources for supplementation is available to this group of treating physicians however its use for their personal cure is rarely recognised. This study aims to highlight this endemic disease and to find out its correlation with other parameters.

Methods: It is a prospective observational study including 150 practicing orthopaedic surgeons from entire India who visited our centre during 3 months duration for various educational meetings. Venous sample was collected after due informed consent and analysed at a single laboratory for 25-OH Cholecalciferol levels by a chemiluminescent assay. All the samples were analysed and a questionnaire was sent to the participants via google forms regarding various parameters under study.

Results: The mean serum Vitamin D levels were 18.6 ± 9.67 ng/ml in the sample studied. 17 out of 150 participants (11.3%) were found to have sufficient serum levels of 25(OH) Cholecalciferol. 105 participants (70%) were having deficient levels and 28 (18.7%) had insufficient levels of Vitamin D. Overall 88.7% participants had Vitamin D deficiency among the sample studied.

Conclusion: This widespread prevalence of Vitamin D deficiency warrants frequent screening and routine supplementation of Vitamin D in orthopaedic surgeons thereby providing a low cost solution to improve the troublesome situation among healthcare providers.
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http://dx.doi.org/10.1007/s43465-020-00134-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7474029PMC
September 2020

Does kyphosis in healed subaxial cervical spine tuberculosis equate to a poor functional outcome?

J Craniovertebr Junction Spine 2020 Apr-Jun;11(2):86-92. Epub 2020 Jun 5.

Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.

Introduction: Tuberculosis (TB) of the subaxial cervical spine has a high percentage of morbidity. It accounts for about 10% of cases with the major concerns being quadriparesis and localized kyphosis.

Aim: The study aims to provide an insight in the management of subaxial cervical spine TB treated by multiple modalities.

Materials And Methods: A retrospective analysis of 91 patients with subaxial cervical (C3-C7) TB was performed. Neurology was assessed by Nurick's grading and pain using the visual analog scale (VAS) (in mm). Radiological evaluation was done with standard anteroposterior and lateral view of the cervical spine at presentation and 3 monthly intervals after intervention. Magnetic resonance imaging was done in all patients. Angle of kyphosis (K angle) was calculated from plain radiographs.

Results: Mean age of the patients was 31.5 years. Neurological status was Nurick's Grade 5 in 8, Grade 4 in 15, Grade 3 in 28, Grade 2 in 22, Grade 1 in 7, and further 11 had Nurick's Grade 0. Operative intervention was either anterior, or posterior, or a combination of both depending on extent of vertebral destruction. All patients with Nurick's 5 and 4 improved to 3 or less at final follow-up. The kyphosis angle at presentation ranged from 2° to 58° of with an average kyphosis of 16.05°. The postoperative kyphosis was graded as mild (loss of lordosis to 10° kyphosis), moderate (10°-30°), and severe (>30°). Ten patients had mild kyphosis and 6 patients had moderate kyphosis. Mean VAS score at presentation was 45.5 mm which improved to 14.48 mm at follow-up. Patients with mild and moderate kyphosis remained asymptomatic till the last follow-up.

Conclusion: Healing of subaxial cervical TB in kyphosis does not necessitate a poor clinical outcome as most patients remain asymptomatic.
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http://dx.doi.org/10.4103/jcvjs.JCVJS_53_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7462136PMC
June 2020

Anterior Distraction and Reduction with Posterior Stabilization for Basilar Invagination: A Novel Technique.

World Neurosurg 2021 01 3;145:19-24. Epub 2020 Sep 3.

Department of Orthopaedics, Indian Spinal Injuries Centre, New Delhi, India.

Background: Introduction of a posterior spacer for atlantoaxial joint distraction followed by posterior stabilization is a commonly performed procedure for irreducible atlantoaxial dislocation. We present a unique case in which posterior distraction was associated with increased risk of injury to the vertebral artery (VA) owing to its anomalous course, and hence a novel anterior distraction technique was used.

Case Description: A 45-year-old woman presented with severe neck pain for 1 month with gait imbalance and history of occipital headache for 1 year. Clinical examination revealed upper motor neuron-type findings. Hoffmann sign was positive bilaterally. Clinically, the patient had Nurick grade 4 cervical myelopathy. Magnetic resonance imaging showed basilar invagination along with Arnold-Chiari malformation and syrinx formation at C3-C4 vertebral levels. CT angiography revealed anomalous VAs directly overlying the atlanto-occipital joint. Owing to the anomalous route of the VA and unfavorable slope of facet joints, a 2-step anterior reduction followed by posterior stabilization surgery was planned. We achieved complete reduction using a 10-mm titanium cage inserted via a retropharyngeal approach. Following anterior reduction, instrumented in situ occipitocervical fusion was performed using a plate and screw construct. At 2-year follow-up, the patient is ambulating independently without gait imbalance and with successful radiologic fusion.

Conclusions: The craniovertebral junction has a unique pathoanatomy, and the course of the vertebral artery is variable. Appropriate investigations, including computed tomography angiography, with adequate surgical planning will provide a desirable long-term outcome. Our novel technique has the potential to add a new dimension to the management of irreducible atlantoaxial dislocation.
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http://dx.doi.org/10.1016/j.wneu.2020.08.220DOI Listing
January 2021

Rosai Dorfman disease of the spine causing lumbosacral radiculopathy: A case report.

J Clin Orthop Trauma 2020 Sep-Oct;11(5):947-951. Epub 2020 Jan 24.

Indore Spine Centre and Global SNG Hospital, Indore, India.

Rosai Dorfman disease (RDD) also known as sinus histiocytosis with massive lymphadenopathy (SHML) is a rare non-malignant proliferative disorder of unknown etiology. Here we present a case of Rosai Dorfman disease of the spine causing lumbo-sacral radiculopathy. CT and MRI revealed lytic expansile lesion in the left half of L4 vertebra mainly involving posterior aspect involving left pedicle and transverse process. Patient underwent surgery at L3-4 level by left fenestration. Histological examination confirmed the diagnosis of Rosai Dorfman disease. Skeletal involvement is a very rare presentation seen in 2% case with involvement of long bones including tibia, femur, humerus, clavicle and bones of hand. RDD affecting the spine has been rarely reported in literature. A team approach involving the radiologist, spine surgeon, pathologist and oncologist will lead to the early diagnosis and appropriate management of this rare clinical entity.
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http://dx.doi.org/10.1016/j.jcot.2020.01.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452285PMC
January 2020

Measurement of spinopelvic parameters in healthy adults of Indian origin - A cross sectional study.

J Clin Orthop Trauma 2020 Sep-Oct;11(5):883-888. Epub 2019 Jul 23.

Department of Orthopedics, Seth GS Medical College and KEM Hospital, India.

Background: Restoration of spinopelvic balance during spinal surgery is very important to ensure a good outcome. Many studies have been conducted to define the normal ranges, examining the correlation between these individual parameters and their relation with spinal parameters of thoracic kyphosis and lumbar lordosis. The ranges, specific to individual ethnicities, is very essential to restore the sagittal balance in patients suffering from spinal degenerative conditions. Hence this study aims to define the average ranges of relevant spinopelvic parameters in the adult population of Indian origin.

Methods: A observational cross sectional study was conducted in 130 healthy volunteers in Mumbai without having any spine, hip or pelvis pathology. Spinopelvic parameters like Pelvic Incidence(PI), Sacral Slope(SS) and Pelvic Tilt(PT) were studied and compared between various other similar studies with patients of different ethnicities. The correlation of those parameters with each other was also evaluated.

Results: The mean value of PI was 51.50(±6.85°), that of SS was 39.17° (±6.26°) and for PT it was 12.32°(±5.41°). These values were statistically significant between both sexes for PI and PT. The strongest positive correlation among the parameters was between pelvic incidence and sacral slope, with a r-value of 0.668. Comparison of our study with similar studies within the country (Chennai, Delhi and Surat) showed statistically significant differences in PT and SS of all three studies while PI was not significant when compared with the Surat study.

Conclusion: There appears to be considerable variation of the values of the spinopelvic parameters as determined by various studies due to ethnic variations. Further studies should be done with larger samples and directed towards early detection of individuals at risk of developing degenerative spinal disorders with sagittal imbalance, so that interventions can be made at an earlier stage.
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http://dx.doi.org/10.1016/j.jcot.2019.07.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452199PMC
July 2019

Degenerative cervical myelopathy: Recent updates and future directions.

J Clin Orthop Trauma 2020 Sep-Oct;11(5):822-829. Epub 2020 Jul 21.

Indian Spinal Injuries Center, Sector C, Vasant Kunj, New Delhi, 110070, India.

Advances in patient selection, surgical techniques, and postoperative care have facilitated spine surgeons to manage complex spine cases with shorter operative times, reduced hospital stay and improved outcomes. We focus this article on a few areas which have shown maximum developments in management of degenerative cervical myelopathy and also throw a glimpse into the future ahead. Imaging modalities, surgical decision making, robotics and neuro-navigation, minimally invasive spinal surgery, motion preservation, use of biologics are few of them. Through this review article, we hope to provide the readers with an insight into the present state of art in cervical myelopathy and what the future has in store for us.
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http://dx.doi.org/10.1016/j.jcot.2020.07.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452218PMC
July 2020

Evolution of casting techniques in early-onset and congenital scoliosis.

J Clin Orthop Trauma 2020 Sep-Oct;11(5):810-815. Epub 2020 Jul 8.

Department of Spine Services, Indian Spinal Injuries Centre, Sector C, Vasant Kunj, New Delhi, 110070, India.

Casting is being utilized as a therapeutic strategy in some mild to moderate cases obviating surgical intervention for management of early-onset scoliosis (EOS). Bracing, another conservative modality, applies comparable correcting forces on chest wall and axial skeleton. But cast application carries additional advantage of sustained restorative force which bypasses issue of compliance seen with brace wear. There is no specific blanket treatment, conservative or surgical, for the early-onset spinal deformities. Serial cast application provides near total correction of less severe curves (less than 50 to 60) if treatment is initiated before age of 2 yrs. In this review article, we will assess the evolution of plaster cast application in management of EOS and also describe technique of EDF (Elongation- Derotation- Flexion) casting.
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http://dx.doi.org/10.1016/j.jcot.2020.06.034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452255PMC
July 2020

Prospective Randomized Controlled Trial to Study the Effect of Local Steroids in the Retropharyngeal Space After Anterior Cervical Discectomy and Fusion.

Global Spine J 2021 Jul 29;11(6):826-832. Epub 2020 May 29.

29549Seth G. S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India.

Study Design: Prospective randomized controlled trial.

Objective: To study the effect of local steroids in the retropharyngeal space after anterior cervical discectomy and fusion (ACDF) in reducing prevertebral soft-tissue swelling (PSTS) and complications associated with it.

Methods: A total of 50 consecutive patients operated with ACDF were double-blinded randomized into 2 groups: steroids (25) and control (25). Triamcinolone in collagen sponge was used in the steroid group and normal saline in gelatin sponge in the control group. Patients' lateral radiographs were taken on the immediate postoperative day; days 2, 4, and 6; at 2 weeks; and 2 and 6 months postoperatively. The PSTS ratio at C3 to C7 and PSTS index were calculated. Patients were clinically evaluated using the Visual Analogue Scale (VAS) score for odynophagia and radiating pain, modified Japanese Orthopedic Association Score (mJOA), and Neck Disability Index (NDI).

Results: PSTS showed a significant reduction in the steroid group as compared with the control group on the immediate postoperative day; days 2, 4, and 6; and at 2 weeks. However, at 2 and 6 months, PSTS remained the same. VAS score for odynophagia also showed a significant difference between the 2 groups on the immediate postoperative day; days 2, 4, and 6; and 2 weeks postoperatively, with no significant difference at the 2- and 6-month follow-up. mJOA and NDI showed no significant difference between the 2 groups at the 2- and 6-month follow-up.

Conclusion: Use of retropharyngeal steroids helps in reducing the postoperative odynophagia on a short-term basis without any complication.
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http://dx.doi.org/10.1177/2192568220925782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258804PMC
July 2021

It's Never Too Late: Neurological Outcome of Delayed Decompression in Tuberculosis of Spine.

Global Spine J 2021 Jun 19;11(5):716-721. Epub 2020 May 19.

Department of Orthopaedics, 29549Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.

Study Design: Retrospective observational study.

Objective: To study the neurological recovery in patients with progressive neurological deficit undergoing delayed decompression and fixation in tuberculosis of spine.

Methods: Retrospective analysis of 50 cases with thoracolumbar tuberculosis of spine, undergoing posterior decompression and instrumentation was done. Parameters like time interval between appearance of neurological deficit to decompression surgery, maximal spinal cord compression, neurology on admission, presence of drug resistance, and number of vertebrae involved were evaluated. The subjects were divided into 2 groups depending on neurological improvement measured with LEMS (Lower Extremity Motor Score) at the end of 1-year follow-up.

Results: The mean LEMS score on admission was 27.72 (SD 12.88), which improved to 40.80 (SD 10.46) at the end of 1 year ( < .001). A total of 26 (52%) subjects were categorized into "Satisfactory" outcome (LEMS >10) group and remaining 24 subjects formed the "nonsatisfactory" outcome group. The median time interval between the appearance of neurological deficit and decompression surgery was 23.50 days in the satisfactory group and 29.50 days ( = .110) in the nonsatisfactory group. Maximal spinal cord compression was 0.370 in satisfactory group and 0.357 in nonsatisfactory group ( = .754). The mean preoperative LEMS score was 34.62 in the satisfactory outcome group while that in the nonsatisfactory outcome group was 20.25 ( < .001).

Conclusion: There is significant scope for neurological improvement even after delayed decompression and fixation in cases of tuberculosis of spine with progressive neurological deficits. Preoperative neurological status was found to be the most significant determinant of postoperative neurological outcome.
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http://dx.doi.org/10.1177/2192568220922209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165910PMC
June 2021

Marine Plastics from Norwegian West Coast Carry Potentially Virulent Fish Pathogens and Opportunistic Human Pathogens Harboring New Variants of Antibiotic Resistance Genes.

Microorganisms 2020 Aug 7;8(8). Epub 2020 Aug 7.

Institute of Marine Research, 5005 Bergen, Norway.

To our best knowledge this is the first study characterizing fish pathogens isolated from marine plastics from the West coast of Norway for their potential for pathogenicity using whole genome sequencing. Marine plastic polymers identified as polyethylene, polyethylene/ethylene vinyl acetate copolymer and polypropylene, yielded a total of 37 bacterial isolates dominated by spp. (70%). Six isolates representing either fish pathogens or opportunistic human pathogens were selected for whole genome sequencing (WGS). These included four isolates belonging to spp., one isolate and one isolate. Three isolates were potentially virulent and carried virulence factors involved in attachment, type II and type VI secretion systems as well as toxins such as and and carried new variants of antibiotic resistance genes (ARGs) such as β-lactamases and chloramphenicol acetyltransferase (), whereas carried several clinically relevant ARGs. Our study shows that marine plastics carry not only potentially virulent fish pathogens but also multidrug resistant opportunistic human pathogens like and may serve as vectors for transport of these pathogens in the marine environment.
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http://dx.doi.org/10.3390/microorganisms8081200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7464100PMC
August 2020

Clinicoradiological outcomes of Goel and Harms fixation for atlantoaxial instability: An institutional experience.

Surg Neurol Int 2020 11;11:189. Epub 2020 Jul 11.

Department of Spine Service, Indian Spinal Injuries Center, New Delhi, India.

Background: Few studies have reported on the long-term outcomes of Goel and Harms C1-C2 fusions in the Asian population.

Methods: This was a retrospective analysis of 53 patients undergoing Goel and Harms fixation (2010 -2018). Clinical outcomes were assessed utilizing the neck disability index (NDI), Japanese Orthopedic Association (JOA) score, and visual analog scale (VAS). Outcomes were then correlated with fusion rates (using dynamic X-rays), atlanto-dens interval (ADI), and space available for cord (SAC) data.

Results: The study's 53 patients averaged 49.98 years of age and included 42 males and 11 females. The mean preoperative versus postoperative scores on multiple outcome measures showed NDI 31.62 ± 11.05 versus decreased to 8.68 ± 3.76 post, mean JOA score (e.g., in 41 patients with myelopathy) improved from 13.20 ± 3.96 to 15.2 ± 2.17, and the mean VAS decreased from 4.85 ± 1.03 to 1.02 ± 0.87 and showed restoration of the ADI (1.96 ± 0.35 mm) and SAC (20.42 ± 0.35 mm). A 98.13% rate of C1-C2 fusion was achieved at 12 postoperative months.

Conclusion: Goel and Harms technique for C1-C2 fusion resulted in both good clinical and radiological outcomes.
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http://dx.doi.org/10.25259/SNI_350_2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395524PMC
July 2020

Tuberculosis-The Great Mimicker: A Case of Traumatic Drainage of Cold Abscess.

World Neurosurg 2020 11 27;143:163-167. Epub 2020 Jul 27.

Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, India.

Background: Tuberculosis is characterized by cold abscess, which classically lacks the usual signs and symptoms of inflammation. This case report highlights an atypical presentation of tuberculous cold abscess in the form of appearance of massive swelling in the back overnight after a blunt trauma, mimicking post-traumatic hematoma.

Case Description: A 32-year-old man came to our outpatient department with sudden swelling over the right side of the upper back (25 × 8 × 8 cm) and loin (10 × 4 × 4 cm) after a fall from 1.5 to 2 m height the previous night. The possible differential diagnosis of a traumatic pathology, complicated by a bleeding disorder, resulting in massive hematoma was initially made. However, hematologic investigations were within normal limits. Magnetic resonance imaging suggested an anterior subligamentous abscess at the C7-T1 level tracking through the paraspinal muscles and communicating with the subcutaneous abscess, and at the L3 level, paraspinal abscess tracking to the subcutaneous plane. There was no cord compression or signal changes in the cord. Both the abscesses were pigtailed in antigravity fashion, and material was sent for culture, which proved to be tuberculosis. The patient was treated with antituberculosis treatment for 18 months and improved over the course with complete resolution of symptoms. At 4-year follow-up, the patient is asymptomatic with no evidence of recurrence.

Conclusions: Appearance of massive swelling overnight in patients with cold abscess has not been described in the literature. While evaluating an atypical presentation such as sudden post-traumatic swelling over the thoracolumbar area, the clinician should keep a differential diagnosis of tuberculous abscess and investigate clinicoradiologically to rule out tuberculosis, especially in developing countries.
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http://dx.doi.org/10.1016/j.wneu.2020.07.142DOI Listing
November 2020

A rare case of posterior interosseous nerve palsy due to ganglion cyst arising from supinator muscle.

J Clin Orthop Trauma 2020 Jul-Aug;11(4):665-667. Epub 2020 Jan 30.

Department of Orthopedics, 6th Floor, Multistorey Building, Seth G.S Medical College & King Edward Memorial Hospital, Parel, Mumbai, 400012, India.

Here we present a rare case of ganglion cyst of the elbow joint arising from supinator muscle causing posterior interosseous nerve (PIN) palsy in a 40-year-old female who presented with weakness in finger extension and carrying out routine activities with right hand since 2 weeks. Patient had pain over the right forearm radiating to the right hand since 3 months. She also noted a swelling in the right forearm, which was gradually increasing in size since last 1 month. Atraumatic PIN compression is uncommon and is usually caused by compression of PIN in the arcade of Frohse, by radial recurrent artery, and fibrous band around the radiocapitellar joint. Reports of PIN palsy caused by ganglionic cyst in the elbow joint are rare and case reports regarding the same are sparingly reported. Here we report a case of PIN palsy secondary to ganglion cyst arising from supinator muscle, which recovered completely after excision of the ganglion cyst.
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http://dx.doi.org/10.1016/j.jcot.2020.01.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355069PMC
January 2020

Management of congenital craniovertebral anomalies: a single-centre experience of 71 cases by an algorithmic approach.

Eur Spine J 2020 11 16;29(11):2758-2768. Epub 2020 Jul 16.

Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, 6th Floor MSB, Parel, Mumbai, 400 012, India.

Study Design: Retrospective study.

Objective: Congenital craniovertebral (CV) anomalies include a wide variety of conditions involving basilar invagination (BI), atlantoaxial dislocation (AAD), bony congenital anomalies and Chiari malformation. The management of these disorders is more surgeon dependent rather than based on clear guidelines. This study aims to provide a step-by-step algorithmic approach to the management of congenital CV anomalies to achieve good CV alignment, neural recovery and long lasting stability.

Materials: The study retrospectively analyses 71 patients of congenital CV anomalies treated by our algorithmic approach. Clinical assessment was done with the help of Nurick's grading pre- and post-operatively. Radiological outcome was assessed by plain radiographs, and computed tomographic scan was done at 12-month follow-up.

Results: Mean age at presentation was 17.9 years (6-41 years). Mean Nurick score pre-operatively was 3.8 which was reduced to 1.3 at a mean follow-up of 13.6 months. Sixty-one patients had type I BI, 6 had type II BI, and 4 patients had os odontoideum. Most common symptom at presentation was weakness in limbs, neck pain and difficulty in walking. Patients of isolated AAD with os odontoideum required posterior atlantoaxial fixation and fusion only. Thirty-two patients of type I BI and 4 patients of type II BI required anterior release procedures prior to occipitocervical instrumentation. Bony fusion was achieved in 96% (68) cases with the help of autologous bone grafting. Three patients of occipitocervical fusion developed pseudoarthrosis.

Conclusion: Our retrospective analysis demonstrates that the algorithm is effective in ensuring long lasting results in all types congenital CV anomalies.
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http://dx.doi.org/10.1007/s00586-020-06522-4DOI Listing
November 2020

Surgical Management of Hirayama Disease: A Rare Entity with Unusual Clinical Features.

Asian J Neurosurg 2020 Apr-Jun;15(2):405-408. Epub 2020 May 29.

Department of Orthopedics, LTMMC and General Hospital, Mumbai, Maharashtra, India.

Hirayama disease (HD) is a rare type of cervical myelopathy in young males due to neck flexion causing cervical cord atrophy and asymmetric flattening with preferential involvement of anterior horn cells of the spinal cord. This is due to forward displacement of the cord during neck flexion getting compressed between the posterior part of the vertebral body and the posterior dura. The spinal cord involvement occurs due to repeated flexion and extension motion of the neck leading to selective spinal cells injury and atrophy. Most cases report an asymmetric lower motor neuron type of weakness predominantly involving the forearm and hand muscles. We report here a case of HD in an 18-year-old male who presented to us with weakness and wasting in the right hand. The patient was progressively symptomatic over a period of 1 year before presentation. The etiology and the exact cause of HD largely remain debatable and rely on the understanding of few theories which have been put forward. The natural history of this disease reaches a plateau in terms of neurological involvement after 2-5 years and is considered a self-remitting disorder. The patient was initially managed with a cervical collar immobilization but symptoms were largely not improving which was attributed to poor brace compliance. The patient was then managed surgically with a posterior lateral mass instrumentation without fusion in a lordotic alignment at the levels of maximal dural shift anteriorly. The patient improved neurologically following the surgery and maintained the intact status at the last follow-up.
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http://dx.doi.org/10.4103/ajns.AJNS_291_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335119PMC
May 2020

Golden Wires and Rectangle: A Cost-Effective Treatment for Tuberculosis of the Thoracic Spine.

Asian J Neurosurg 2020 Apr-Jun;15(2):328-332. Epub 2020 May 29.

Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.

Study Design: This was a retrospective study.

Purpose: The purpose of this study was to compare the functional outcome and cost of surgery for tuberculosis (TB) of the thoracic spine between two commonly used fixation modalities "pedicular screws and rods" and "Hartshill loop rectangle and sublaminar wires."

Overview Of Literature: TB is a common ailment in Asia. Surgical indications have remained almost unchanged since the middle-path regimen was advocated by Tuli. Pedicle screws and Hartshill loop rectangle with sublaminar wires are the two common fixation techniques used.

Materials And Methods: This retrospective observational study was performed at a single tertiary center. Patients were divided into two groups depending on the method of fixation (pedicle screw rod/Hartshill loop rectangle and sublaminar wires). All patients were evaluated preoperatively by X-rays and magnetic resonance imaging. Patients were assessed clinically by preoperative and postoperative neurology and Visual Analog Scale score and radiologically assessed by the K angle. These variables were separately compared in both the groups.

Results: The functional outcomes of Hartshill loop rectangle and sublaminar wire fixation and that of pedicular screw fixation were comparable. Hartshill loop rectangle and sublaminar wire fixation was found to be more cost-effective.

Conclusion: Hartshill loop rectangle and sublaminar wire fixation gets purchase over the posterior column structures alone when compared to pedicle screws which have a 3-column hold. However, when combined with meticulous neural decompression and skillful preparation of osteogenic bed with autologous strut grafting and additional onlay grafting, it gives overall adequate stabilization of the column with functional outcome comparable to pedicular screw and rod fixation with additional benefit of cost-effectiveness. Although Hartshill loop rectangle and sublaminar wire fixation is less commonly used now, it has a special place in the management of TB, especially in a resource-poor setting like some countries of Asia.
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http://dx.doi.org/10.4103/ajns.AJNS_335_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335130PMC
May 2020

Functional Outcome of Right-sided Thoracotomy for Tuberculosis of the Dorsal Spine.

Asian J Neurosurg 2020 Apr-Jun;15(2):311-314. Epub 2020 Apr 7.

Department of Orthopaedics, Seth G.S. Medical College and K.E.M Hospital, Mumbai, Maharashtra, India.

Introduction: In pathologies of the spine involving dorsal vertebrae, it is a routine practice to go for left-sided thoracotomy. It is so because in this approach, we encounter the aorta before reaching the concerned dorsal vertebra which is easy to handle as compared to the inferior vena cava on the right-sided approach. This is because the aorta is a structure with thick muscular wall. However, there are conditions which demand right-sided thoracotomy for better outcome such as idiopathic scoliosis and dorsal spine tuberculosis (TB). The selection of side of thoracotomy should be done on case-to-case basis.

Study Design: This was a prospective study of 10-year duration.

Purpose: The purpose of the study was to analyze whether it is more rational to do thoracotomy from the right side than left for dorsal spine TB.

Materials And Methods: The study was performed on 102 dorsal Koch patients with neurological deficit who required surgical decompression. Magnetic resonance imaging of those patients was analyzed. Seventy-two patients had predominant right-sided lesion. Left and central types of predominant results were in 19 and 11 patients, respectively. Among these 102 patients, 82 were operated with right-sided thoracotomy, whereas 20 were operated for left-sided thoracotomy. Preoperative and postoperative kyphosis angle (K angle), average surgical time, mean blood loss, and visual analog scale (VAS) score were calculated. The SPSS 17 software was used for the statistical analysis.

Results: Right thoracic approach turned out to be better approach than left in dorsal Koch spine. The average surgical time and mean blood loss were less in the right thoracotomy than left. Postoperative K angle and VAS were improved in the right thoracic approach as compared to left.

Conclusion: Tubercular debris in the dorsal spine predominantly is on the right side, and right thoracotomy gives better results as there is better decompression of lesion.
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http://dx.doi.org/10.4103/ajns.AJNS_311_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335144PMC
April 2020

Vibrios from the Norwegian marine environment: Characterization of associated antibiotic resistance and virulence genes.

Microbiologyopen 2020 09 17;9(9):e1093. Epub 2020 Jun 17.

Institute of Marine Research, Bergen, Norway.

A total of 116 Vibrio isolates comprising V. alginolyticus (n = 53), V. metschnikovii (n = 38), V. anguillarum (n = 21), V. antiquarius (n = 2), and V. fujianensis (n = 2) were obtained from seawater, fish, or bivalve molluscs from temperate Oceanic and Polar Oceanic area around Norway. Antibiotic sensitivity testing revealed resistance or reduced susceptibility to ampicillin (74%), oxolinic acid (33%), imipenem (21%), aztreonam (19%), and tobramycin (17%). Whole-genome sequence analysis of eighteen drug-resistant isolates revealed the presence of genes like β-lactamases, chloramphenicol-acetyltransferases, and genes conferring tetracycline and quinolone resistance. The strains also carried virulence genes like hlyA, tlh, rtxA to D and aceA, E and F. The genes for cholerae toxin (ctx), thermostable direct hemolysin (tdh), or zonula occludens toxin (zot) were not detected in any of the isolates. The present study shows low prevalence of multidrug resistance and absence of virulence genes of high global concern among environmental vibrios in Norway. However, in the light of climate change, and projected rising sea surface temperatures, even in the cold temperate areas, there is a need for frequent monitoring of resistance and virulence in vibrios to be prepared for future public health challenges.
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http://dx.doi.org/10.1002/mbo3.1093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520990PMC
September 2020

Intradural Disc Herniation in the Lumbar Spine: A Case Report.

JNMA J Nepal Med Assoc 2020 May 30;58(225):345-348. Epub 2020 May 30.

Department of Orthopedics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India.

Intradural disc herniation is a rare presentation of a common pathology, comprising around 0.28-0.3% of all disc herniations. It occurs when disc material related to an intervertebral disc penetrates the spinal dura and lies in an intradural extramedullary location. A 60 years old male patient presented with complaints of low back pain and right lower limb radiculopathy of 2 weeks duration. Neurological examination revealed the weakness of extensor hallucis longus and ankle dorsiflexion with diminished sensation corresponding to fourth and fifth lumbar (L4-L5) dermatome on the right side. Magnetic resonance imaging showed a large sequestered fragment with intradural extensions and posterior longitudinal ligament tear. Intradural nerve root showed significant displacement with severe central canal and right lateral recess stenosis. Discectomy was performed along with the removal of the intradural extension. The postoperative course was uneventful.
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http://dx.doi.org/10.31729/jnma.4798DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654472PMC
May 2020

Learning from Mistakes: Pancreatic Laceration: Devastating Complication During Spine Surgery.

World Neurosurg 2020 09 6;141:81-84. Epub 2020 Jun 6.

Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India.

Background: Posterior decompression and fusion surgery is one of the most commonly performed surgeries for thoracolumbar tuberculosis with destruction of vertebral bodies. Tuberculosis causes gross destruction of the vertebral bodies and surrounding tissue, making them friable.

Case Description: We present an unusual but dreaded complication which we encountered during posterior decompression and instrumentation surgery in a 65-year-old woman with T10-11 tuberculosis of the spine. During surgical exposure, while reflecting posterior paraspinal muscles on the left side, there was an accidental slip of the Cobb elevator around the transverse process to the extent of two-thirds of its length on the left side anteriorly. The instrument was immediately withdrawn. There was no active bleeding in the field. The rest of the surgery was uneventful. In the postoperative period, however, the patient developed severe abdominal pain with abdominal distention. General surgery opinion was immediately taken and the patient was immediately investigated in the form of a computed tomography scan. It was found that there was a traumatic laceration of the pancreas. The patient underwent emergency exploratory laparotomy and repair of the pancreatic laceration. The patient required intensive monitoring and critical care unit stay and ultimately went on to recover fully over the next few weeks.

Conclusions: This case illustrates the possibility of pancreatic injury should always be kept in mind if the patient develops acute abdominal discomfort in the postoperative period. Also, a multidisciplinary approach along with intensive care backup and vigilant postoperative monitoring is of utmost importance, especially when an unusual event has occurred during the surgery.
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http://dx.doi.org/10.1016/j.wneu.2020.05.261DOI Listing
September 2020

Structural and biochemical characterization of the environmental MBLs MYO-1, ECV-1 and SHD-1.

J Antimicrob Chemother 2020 09;75(9):2554-2563

The Norwegian Structural Biology Centre (NorStruct), Department of Chemistry, UiT The Arctic University of Norway, Tromsø, Norway.

Background: MBLs form a large and heterogeneous group of bacterial enzymes conferring resistance to β-lactam antibiotics, including carbapenems. A large environmental reservoir of MBLs has been identified, which can act as a source for transfer into human pathogens. Therefore, structural investigation of environmental and clinically rare MBLs can give new insights into structure-activity relationships to explore the role of catalytic and second shell residues, which are under selective pressure.

Objectives: To investigate the structure and activity of the environmental subclass B1 MBLs MYO-1, SHD-1 and ECV-1.

Methods: The respective genes of these MBLs were cloned into vectors and expressed in Escherichia coli. Purified enzymes were characterized with respect to their catalytic efficiency (kcat/Km). The enzymatic activities and MICs were determined for a panel of different β-lactams, including penicillins, cephalosporins and carbapenems. Thermostability was measured and structures were solved using X-ray crystallography (MYO-1 and ECV-1) or generated by homology modelling (SHD-1).

Results: Expression of the environmental MBLs in E. coli resulted in the characteristic MBL profile, not affecting aztreonam susceptibility and decreasing susceptibility to carbapenems, cephalosporins and penicillins. The purified enzymes showed variable catalytic activity in the order of <5% to ∼70% compared with the clinically widespread NDM-1. The thermostability of ECV-1 and SHD-1 was up to 8°C higher than that of MYO-1 and NDM-1. Using solved structures and molecular modelling, we identified differences in their second shell composition, possibly responsible for their relatively low hydrolytic activity.

Conclusions: These results show the importance of environmental species acting as reservoirs for MBL-encoding genes.
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http://dx.doi.org/10.1093/jac/dkaa175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443720PMC
September 2020

Nanopore sequencing reveals genomic map of CTX-M-type extended-spectrum β-lactamases carried by Escherichia coli strains isolated from blue mussels (Mytilus edulis) in Norway.

BMC Microbiol 2020 05 25;20(1):134. Epub 2020 May 25.

Department of Contaminants and Biohazards, Institute of Marine Research (IMR), Bergen, Norway.

Background: Environmental surveillance of antibiotic resistance can contribute towards better understanding and management of human and environmental health. This study applied a combination of long-read Oxford Nanopore MinION and short-read Illumina MiSeq-based sequencing to obtain closed complete genome sequences of two CTX-M-producing multidrug-resistant Escherichia coli strains isolated from blue mussels (Mytilus edulis) in Norway, in order to understand the potential for mobility of the detected antibiotic resistance genes (ARGs).

Results: The complete genome sequence of strain 631 (E. coli sequence type 38) was assembled into a circular chromosome of 5.19 Mb and five plasmids (between 98 kb and 5 kb). The majority of ARGs cluster in close proximity to each other on the chromosome within two separate multidrug-resistance determining regions (MDRs), each flanked by IS26 transposases. MDR-1 carries bla, tmrB, aac(3)-IId, aadA5, mph(A), mrx, sul1, qacEΔ1 and dfrA17; while MDR-2 harbors aph(3″)-Ib, aph(6)-Id, bla, catA1, tet(D) and sul2. Four identical chromosomal copies of bla are located outside these regions, flanked by ISEc9 transposases. Strain 1500 (E. coli sequence type 191) exhibited a circular chromosome of 4.73 Mb and two plasmids (91 kb and 4 kb). The 91 kb conjugative plasmid belonging to IncI1 group carries bla and bla genes.

Conclusion: This study confirms the efficacy of combining Nanopore long-read and Illumina short-read sequencing for determining complete bacterial genome sequences, enabling detection and characterization of clinically important ARGs in the marine environment in Norway, with potential for further dissemination. It also highlights the need for environmental surveillance of antibiotic resistance in low prevalence settings like Norway.
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http://dx.doi.org/10.1186/s12866-020-01821-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249450PMC
May 2020

A Rare Case Report of Tuberculous Infection in a Previously Neglected Dysplastic Hip of a Young Woman.

J Am Acad Orthop Surg Glob Res Rev 2020 02 5;4(2). Epub 2020 Feb 5.

Department Of Orthopedics, Seth G.S Medical College & King Edward Memorial Hospital, Parel (Dr. Aiyer, Dr. Raj, Dr. Shah, and Dr. Marathe); and the Department Of Orthopedics, T.N. Medical College (Dr. Sujith), Mumbai, India.

A 14-year-old girl presented with an insidious onset of left hip pain, limp, and intermittent fever for a 3-month duration. Patient had a history of toe walking since childhood which continued into adolescence. On radiographic investigations, she was found to have a dysplastic hip with fluid collection around the hip which was surgically drained. The microbiological investigations proved the presence of Mycobacterium tuberculosis (TB). Accordingly, she was started on anti-TB chemotherapy as per drug sensitivity. TB infection in a previously neglected dysplastic hip is not reported as per our knowledge and poses unique diagnostic and management difficulties.
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http://dx.doi.org/10.5435/JAAOSGlobal-D-19-00144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7209812PMC
February 2020

Sympathetic Outflow Disturbance After Posterior Deformity Correction: A Rare Complication.

World Neurosurg 2020 08 11;140:89-95. Epub 2020 May 11.

Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India.

Introduction: Sympathetic system injury is a known but rare complication in scoliosis deformity correction. It is not common following posterior correction. We report a case of diastematomyelia with neuromuscular scoliosis with unusual complication of sympathetic outflow disturbance, after posterior instrumented correction.

Case Description: A 13-year-old girl presented with complaints of deformity in the back first noticed 4 years ago. Roentgenogram revealed a right thoracolumbar kyphoscoliotic deformity of 105° with apex at T8 with non-structural lumbar and cervicothoracic curves with positive sagittal alignment. Magnetic resonance imaging showed split-cord malformation with bony crest near the apex of the curve. Detethering followed by removal of the bony crest and restoration of the dual dural sleeves of the split cord into single neural tube was done in the first stage. In the second stage, pedicle screw fixation with was done from D3 to L3. Deformity correction was achieved using multilevel Smith Peterson osteotomy and concave rib osteotomy. On the second postoperative day, intensive care unit staff noticed persistent sinus tachycardia and profuse sweating in both upper limbs, chest, and upper-back. Twenty-four-hour Holter monitoring did not reveal any abnormality. Patient improved gradually and was discharged on postoperative day 9 when both sinus tachycardia and hyperhidrosis resolved.

Conclusions: Sympathetic chain disturbances after surgery recover with time. The exact time duration needed for recovery is not yet defined, however. Spine surgeons should be aware of this postsurgical complication and identify it so that management can be initiated. The symptoms may be long and drawn out, thus the roles of communication with and counseling of the patient as cannot be underemphasized.
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http://dx.doi.org/10.1016/j.wneu.2020.05.039DOI Listing
August 2020

Discovery of a novel integron-borne aminoglycoside resistance gene present in clinical pathogens by screening environmental bacterial communities.

Microbiome 2020 03 20;8(1):41. Epub 2020 Mar 20.

Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.

Background: New antibiotic resistance determinants are generally discovered too late, long after they have irreversibly emerged in pathogens and spread widely. Early discovery of resistance genes, before or soon after their transfer to pathogens could allow more effective measures to monitor and reduce spread, and facilitate genetics-based diagnostics.

Results: We modified a functional metagenomics approach followed by in silico filtering of known resistance genes to discover novel, mobilised resistance genes in class 1 integrons in wastewater-impacted environments. We identified an integron-borne gene cassette encoding a protein that conveys high-level resistance against aminoglycosides with a garosamine moiety when expressed in E. coli. The gene is named gar (garosamine-specific aminoglycoside resistance) after its specificity. It contains none of the functional domains of known aminoglycoside modifying enzymes, but bears characteristics of a kinase. By searching public databases, we found that the gene occurs in three sequenced, multi-resistant clinical isolates (two Pseudomonas aeruginosa and one Luteimonas sp.) from Italy and China, respectively, as well as in two food-borne Salmonella enterica isolates from the USA. In all cases, gar has escaped discovery until now.

Conclusion: To the best of our knowledge, this is the first time a novel resistance gene, present in clinical isolates, has been discovered by exploring the environmental microbiome. The gar gene has spread horizontally to different species on at least three continents, further limiting treatment options for bacterial infections. Its specificity to garosamine-containing aminoglycosides may reduce the usefulness of the newest semisynthetic aminoglycoside plazomicin, which is designed to avoid common aminoglycoside resistance mechanisms. Since the gene appears to be not yet common in the clinics, the data presented here enables early surveillance and maybe even mitigation of its spread.
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http://dx.doi.org/10.1186/s40168-020-00814-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7085159PMC
March 2020
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