Publications by authors named "Sumit Arora"

181 Publications

Spontaneous subcapital femoral neck fracture complicating osteonecrosis of femoral head.

Acta Orthop Belg 2021 Mar;87(1):25-34

Spontaneous subcapital fracture (SSF) of femoral neck in pre-existent osteonecrosis of femoral head (ONFH) is a rare presentation. Only a few cases have been reported so far and majority of them have been reported to have unilateral hip involvement. We retrospectively reviewed clinical-radiological data of 10 patients (12 hips) with SSF complicating ONFH. All of them underwent uncemented total hip arthroplasty. All the available publications in the English language based medical literature were critically reviewed and results were summarized. The median age of presentation was 32 years (range : 24 years to 61 years). They were followed up for a mean duration of 25 months (range : 12 months to 59 months). The most common risk factor was corticosteroid consumption (7 out of 10 patients). All except one (modified Ficat and Arlet stage II) belonged to advanced stage of ONFH {stage III 3 patients (3 hips), stage IV 6 patients (8 hips)}. The mean time lag of ONFH to presentation was 22.3 months (range : 5 months to 60 months), and SSF to presentation was 13.8 days (range : 1 day to 28 days). Mean pre- operative Harris Hip Score was 10.8 (range : 8 to 14), which improved to 93 (range : 91 to 96) after total hip arthroplasty when last followed up (p<0.05). Corticosteroids induced ONFH has a propensity to develop SSF. This entity should find a place in existing classification system.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2021

Compressive Myelopathy in Dengue Infection: A Report of 2 Cases and Literature Review.

JBJS Case Connect 2021 06 10;11(2). Epub 2021 Jun 10.

Department of Internal Medicine, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, India.

Cases: We report 2 cases of compressive myelopathy secondary to spontaneous neuroaxial bleed in dengue infection. One was treated by surgical decompression during the recovery phase of illness, whereas the other was treated nonoperatively.

Conclusion: A conscious decision for surgical decompression should be taken in cases not responding to initial medical management and planned during the recovery phase of dengue infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2106/JBJS.CC.20.00772DOI Listing
June 2021

Electric Shock-Induced Vertebral Fracture: A Case Report and Literature Review with Special Emphasis on Fracture Morphology.

JBJS Case Connect 2020 Oct-Dec;10(4):e2000143

1Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, India 2Department of Radiodiagnosis, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, India.

Case: A 35-year-old man suffered electric injury with 220 V alternating current when he was connecting electric wires at approximately 5 feet height and accidentally touched a live wire. He was diagnosed to have fracture involving superior and inferior endplates of L2 vertebral body without involvement of posterior elements. He, subsequently, underwent spinal stabilization with percutaneous pedicle screws fixation.

Conclusion: Electric shock can cause vertebral fractures even at a low voltage. These fractures tend to have coronal plane involvement and involve both superior and inferior end plates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2106/JBJS.CC.20.00143DOI Listing
June 2021

Epineurotomy for leprous, high ulnar neuropathy: defining a safe corridor based on the epineural vascular anatomy.

Int Orthop 2021 07 24;45(7):1783-1792. Epub 2021 May 24.

Department of Orthopaedic Surgery, The Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, 110002, India.

Background: Leprous neuropathy is treatable but still a source of disability worldwide. Multidrug therapy (MDT) and oral steroids are the main stay of treatment. Ulnar nerve, at the elbow, is commonly involved. Nerve decompression may be required in selected cases by an epineurotomy (internal neurolysis). The preferred surface of ulnar nerve for performing this procedure to minimize iatrogenic vascular compromise is a matter of debate.

Questions/purposes: We describe the epineural vessel arrangement on the medial and lateral surface of ulnar nerve around the medial epicondyle while performing epineurotomy for leprous neuropathy.

Methods: We enrolled patients of symptomatic leprous ulnar neuropathy of less than one year duration on MDT that did not respond to steroids, for surgical decompression. Ten patients underwent epineurotomy of ulnar nerves (N = 11) around medial epicondyle. The epineural vessels were classified as per Sunderland's classification of arteriae nervorum. The number of epineural vessels was assessed on the medial and lateral surface of the ulnar nerve adjoining the medial epicondyle. The epineurotomy incision was placed over the surface of ulnar nerve having relatively less vessels.

Results: The mean number of epineural vessels on the medial surface was 9.72 (range; 7-14) and on the lateral surface were 4.72 (range; 3-6). The average number of vessels per cm of the medial and lateral surface of the nerve was 0.94 and 0.48, respectively. The most common type of epineural vessel was type 3 on both medial and lateral surface of the nerve. Lateral epineurotomy was performed in all 11 cases. All the patients had relief from neuropathic pain. The mean VAS score improved from 3.20 ± 0.89 to 0.50 ± 0.34 at 2 years follow-up (p = 0.02). The mean motor score improved from 9.31 ± 4.12 to 15.42 ± 3.10 and sensory score improved from 40.0 ± 30.70 to 85 ± 9.90 at two years follow-up (p < 0.01).

Conclusion: Lateral surface (facing the medial epicondyle) of ulnar nerve has a lesser density of epineural vessels in comparison to its medial (subcutaneous) surface.

Clinical Relevance: This anatomical understanding may be helpful in minimizing the iatrogenic vascular compromise of ulnar nerve while performing its epineurotomy around the medial epicondyle for leprous neuropathy. The findings may be extrapolated to other clinical indications of epineurotomy of ulnar nerve, for example, in cubital tunnel syndrome, traumatic ulnar neuroma in continuity, and benign ulnar nerve tumors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00264-021-05084-4DOI Listing
July 2021

Denosumab biosimilar in postmenopausal osteoporotic women: A randomized, assessor-blind, active-controlled clinical trial.

Indian J Pharmacol 2021 Jan-Feb;53(1):6-12

Clinical Trial Operations and Medical Services, Lambda Therapeutic Research Ltd., Ahmedabad, Gujarat, India.

Objective: The study assessed the efficacy, safety, pharmacokinetic (PK), and immunogenicity profiles of denosumab-biosimilar and denosumab-reference in postmenopausal osteoporotic women from India.

Materials And Methods: In this randomized, assessor-blind, active-control, multicenter trial, 114 patients were randomly allocated to receive denosumab-biosimilar (n = 58) or denosumab-reference (n = 56) at a subcutaneous dose of 60 mg every 6 months, for a year. Vitamin D and oral calcium were given daily. Lumbar spine bone mineral density (BMD) change was the primary end point.

Results: Of 114 randomized patients, 111 (denosumab-biosimilar, n = 56; denosumab-reference, n = 55) completed the study. All 114 patients were part of safety and immunogenicity analyses, 110 (denosumab-biosimilar, n = 56; denosumab-reference, n = 54) were part of efficacy analysis, and 20 (denosumab-biosimilar, n = 10; denosumab-reference, n = 10) were part of PK analysis. The bone mineral density (BMD) (lumbar spine) percent change at 1 year with denosumab-biosimilar and denosumab-reference (7.22 vs. 7.62; difference:-0.40; 95% confidence interval: -5.92, 5.12) showed no statistically relevant difference. Likewise, alkaline phosphatase (bone-specific) and PK parameters also did not show statistically relevant differences. Adverse events were reported in 44.83% of patients on denosumab-biosimilar versus 33.93% of patients on denosumab-reference; most events were mild or moderate and not related to the study drugs. No patients showed anti-denosumab antibody positivity.

Conclusions: Denosumab-biosimilar and denosumab-reference showed biosimilarity in osteoporotic postmenopausal women. Availability of denosumab-biosimilar provides a treatment alternative for patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ijp.IJP_346_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8216120PMC
May 2021

Tuberculous osteomyelitis of tibial diaphysis following saphenous vein graft harvest for coronary artery bypass: a case report.

Indian J Thorac Cardiovasc Surg 2021 May 14;37(3):307-310. Epub 2020 Sep 14.

Central Institute of Orthopaedics, Vardhman Mahavir Medical College & associated Safdarjung Hospital, New Delhi, 1100029 India.

Tuberculosis in the tibial diaphysis following saphenous vein graft harvest for coronary artery bypass grafting has not been reported, to the best of authors' knowledge. We report the first such clinical case in view of its clinical rarity and as a complication of the simple procedure like saphenous vein graft harvest.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12055-020-01009-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8079564PMC
May 2021

Traumatic posterior fracture-dislocation of the fifth lumbar vertebra: report of two cases with review of literature.

Spinal Cord Ser Cases 2021 Apr 13;7(1):30. Epub 2021 Apr 13.

Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Associated Safdarjung Hospital, New Delhi, India.

Introduction: Posterior fracture-dislocation of fifth lumbar vertebra (L5) is a rare injury pattern. Existing Aihara classification system lacks its mention.

Case Presentation: We report two cases of posterior fracture-dislocation of L5 with comminuted fracture of body that presented with cauda equina syndrome. The smaller anteroinferior vertebral body fragment of L5 had its relationship maintained with sacrum, whereas the larger posterosuperior fragment of the body was retropulsed. Decompression and instrumented fusion through posterior approach yielded good clinical outcome.

Discussion: We also present literature review with special emphasis on fracture characteristics and suggest its possible inclusion as a separate sub-type in existing Aihara classification.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41394-021-00399-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8044229PMC
April 2021

On Absorption Modeling and Food Effect Prediction of Rivaroxaban, a BCS II Drug Orally Administered as an Immediate-Release Tablet.

Pharmaceutics 2021 Feb 20;13(2). Epub 2021 Feb 20.

Research Center Pharmaceutical Engineering (RCPE) GmbH, Inffeldgasse 13, 8010 Graz, Austria.

The present work evaluates the food effect on the absorption of rivaroxaban (Riva), a BCS II drug, from the orally administered commercial immediate-release tablet (Xarelto IR) using physiologically based pharmacokinetic (PBPK) and conventional in vitro-in vivo correlation (IVIVC) models. The bioavailability of Riva upon oral administration of Xarelto IR tablet is reported to exhibit a positive food effect. The PBPK model for Riva was developed and verified using the previously reported in vivo data for oral solution (5 and 10 mg) and Xarelto IR tablet (5 and 10 mg dose strength). Once the PBPK model was established, the in vivo performance of the tablet formulation with the higher dose strength (Xarelto IR tablet 20 mg in fasted and fed state) was predicted using the experimentally obtained data of in vitro permeability, biorelevant solubility and in vitro dynamic dissolution data using United States Pharmacopeia (USP) IV flow-through cell apparatus. In addition, the mathematical IVIVC model was developed using the in vitro dissolution and in vivo profile of 20 mg strength Xarelto IR tablet in fasted condition. Using the developed IVIVC model, the pharmacokinetic (PK) profile of the Xarelto IR tablet in fed condition was predicted and compared with the PK parameters obtained via the PBPK model. A virtual in vivo PK study was designed using a single-dose, 3-treatment cross-over trial in 50 subjects to predict the PK profile of the Xarelto® IR tablet in the fed state. Overall, the results obtained from the IVIVC model were found to be comparable with those from the PBPK model. The outcome from both models pointed to the positive food effect on the in vivo profile of the Riva. The developed models thus can be effectively extended to establish bioequivalence for the marketed and novel complex formulations of Riva such as amorphous solid dispersions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/pharmaceutics13020283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7923293PMC
February 2021

Relationship of triceps aponeurosis with radial nerve in anterior compartment of the arm.

Surg Radiol Anat 2021 May 27;43(5):695-696. Epub 2021 Feb 27.

Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, 110002, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00276-021-02722-9DOI Listing
May 2021

Exploring the active constituents of in intervention of novel coronavirus (COVID-19) based on molecular docking method.

Netw Model Anal Health Inform Bioinform 2021 6;10(1). Epub 2021 Feb 6.

Pharmaceutics Department, Gurunanak College of Pharmacy, Nari, Nagpur, Maharashtra 440026 India.

The severe acute respiratory syndrome COVID-19 declared a global pandemic by WHO has become the present wellbeing worry to the whole world. There is an emergent need to search for possible medications. We report in this study a molecular docking study of eighteen molecules with the main protease (M) responsible for the replication of SARS-CoV-2 virus. The outcome of their molecular simulation and ADMET properties reveal four potential inhibitors of the enzyme (Baicalein-7--diglucoside, Chrysin-7--glucuronide, Oroxindin and Scutellarein) with preference of ligand Chrysin-7--glucuronide that has the second highest binding energy (- 8.6 kcal/mol) and fully obeys the Lipinski's rule of five.

Supplementary Information: The online version contains supplementary material available at 10.1007/s13721-020-00279-y.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13721-020-00279-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7865104PMC
February 2021

Evaluating the impact of acid-reducing agents on drug absorption using biorelevant in vitro tools and PBPK modeling - case example dipyridamole.

Eur J Pharm Sci 2021 May 11;160:105750. Epub 2021 Feb 11.

Institute of Pharmaceutical Technology, J. W. Goethe University, 9 Max von Laue St., 60438, Frankfurt am Main, Germany; Fraunhofer Institute of Translational Medicine and Pharmacology, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany. Electronic address:

Background: In vitro and in silico methods have become an essential tool in assessing metabolic drug-drug interactions (DDI) and avoiding reduced efficacy and increased side-effects. Another important type of DDI is the impact of acid-reducing agent (ARA) co-therapy on drug pharmacokinetics due to changes in gastric pH, especially for poorly soluble weakly basic drugs.

Methods: One-stage, two-stage and transfer dissolution experiments with dipyridamole tablets using novel biorelevant media representing the ARA effect were conducted and the results were coupled with a PBPK model. Clinical pharmacokinetic data were compared with the simulations from the PBPK model and with output from TIM-1 experiments, an evolved in vitro system which aims to simulate the physiology in the upper GI tract.

Results: Two-stage and transfer experiments confirmed that these in vitro set-ups tend to overestimate the extent of dipyridamole precipitation occurring in the intestines in vivo. Consequently, data from one-stage dissolution testing under elevated gastric pH conditions were used as an input for PBPK modeling of the ARA/dipyridamole interaction. Using media representing the ARA effect in conjunction with the PBPK model, the ARA effect observed in vivo was successfully bracketed. As an alternative, the TIM-1 system with gastric pH values adjusted to simulate ARA pre-treatment can be used to forecast the ARA effect on dipyridamole pharmacokinetics.

Conclusion: Drug-drug interactions of dipyridamole with ARA were simulated well with a combination of dissolution experiments using biorelevant media representing the gastric environment after an ARA treatment together with the PBPK model. Adjustment of the TIM-1 model to reflect ARA-related changes in gastric pH was also successful in forecasting the interaction. Further testing of both approaches for predicting ARA-related DDIs using a wider range of drugs should be conducted to verify their utility for this purpose.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejps.2021.105750DOI Listing
May 2021

Prospecting for to treat COVID-19 via molecular docking models of the SARS-CoV-2.

J Biomol Struct Dyn 2021 Jan 15:1-10. Epub 2021 Jan 15.

Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India.

The severe acute respiratory syndrome COVID-19 declared as a global pandemic by the World Health Organization has become the present wellbeing worry to the whole world. There is an emergent need to search for possible medications. is reported to show antitubercular, antibacterial and expectorant property. In this research, we aim to prospect the COVID-19 main protease crystal structure (M; PDB ID: 6LU7) and the active chemical constituents from in order to understand the structural basis of their interactions. We examined the binding potential of active constituents of plant to immensely conserved protein M of SARS-CoV-2 followed by exploration of the vast conformational space of protein-ligand complexes by molecular dynamics (MD) simulations. The results suggest the effectiveness of 3,5-Dicaffeoylquinic acid and Quercetin against standard drug Remdesivir. The active chemical constituents exhibited good docking scores, and interacts with binding site residues of M by forming hydrogen bond and hydrophobic interactions. 3,5-Dicaffeoylquinic acid showed the best affinity towards M receptor which is one of the target enzymes required by SARS CoV-2 virus for replication suggesting it to be a novel research molecule. The potential of the active chemical constituents from against the SARS-CoV-2 virus has best been highlighted through this study. Therefore, these chemical entities can be further scrutinized and provides direction for further consideration for and validations for the treatment of covid-19. Communicated by Ramaswamy H. Sarma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/07391102.2021.1872419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7814567PMC
January 2021

Localization of radial nerve at the spiral groove.

J Orthop Translat 2021 Mar 9;27. Epub 2020 Dec 9.

Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, 110002, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jot.2020.11.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726478PMC
March 2021

Assessment of Bone Quality Using Radiogrammetric Parameters of Proximal Humerus in India: Defining the Osteoporotic Fracture Risk Limit Value and its Reliability.

Indian J Orthop 2020 Dec 9;54(Suppl 2):307-315. Epub 2020 Aug 9.

Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, c/o Mr Raj Kumar Arora, B-253, Second floor, New Delhi, 110002 India.

Background: World health organization (WHO) has defined osteoporosis clinically on the basis of bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry (DXA) scan and the presence of fractures. This facility is expensive and not readily available in majority of the centers in India. The authors have attempted to study defined measurements on radiographs (radiogrammetric parameters) to diagnose osteoporosis in Indian population.

Patients And Methods: We prospectively studied 200 proximal humerus radiographs for measuring radiogrammetric parameters and divided into Group A and B ( = 100 in each group). Group A involved patients with age < 50 years and without any illness affecting bone quality. Group B involved patients with age > 50 years and sustained acute osteoporotic fractures of distal radius/ anterior wedge vertebral fracture/intertrochanteric fracture following trivial trauma. Three parameters (cortical thickness, cortical index and deltoid tuberosity index) were measured by 3 observers at 2 different occasions.

Results: The mean age of patients was 37.87 years and 58.38 years for group A and B, respectively. The 'cortical thickness' of the proximal humerus diaphysis had the mean value for Group A and B to be 0.4 ± 0.07 cm and 0.33 ± 0.06 cm respectively. The mean values for the 'cortical index' of proximal humerus came out to be 0.4 ± 0.07 for group A and 0.32 ± 0.06 for group B. The 'deltoid tuberosity index' measurements showed the mean values for group A and B were 1.81 ± 0.23 and 1.55 ± 0.16, respectively. Inter-observer reliability for single measures was excellent for deltoid tuberosity index (ICC 0.8077) and good for cortical thickness (ICC 0.7032) and cortical index (ICC 0.7357). Observer 1 had excellent intra-observer reliabilities for all the three parameters. Observer 2 and 3 had excellent reliability for deltoid tuberosity index and good intra-observer reliability for cortical thickness and cortical index. The cortical thickness had a cut off of ≤ 0.372 cm with a sensitivity of 86.02 and specificity of 82.12. The cortical index had a cut off of ≤ 0.378 with a sensitivity of 89.16 and specificity of 84.22. The deltoid tuberosity index had a cut off of ≤ 1.684 with a sensitivity of 96.61 and specificity of 84.08.

Conclusion: The outcome of this study is likely to help in early diagnosis of osteoporosis at the community level in the absence of DXA scan as it identifies threshold values for radiogrammetric parameters which can be a predictor of the osteoporosis. The deltoid tuberosity index was found to be the most suitable of these parameters.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s43465-020-00224-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7609647PMC
December 2020

Functional Outcome of Early, Selective Surgical Nerve Decompression in Leprous Neuropathy.

J Hand Surg Asian Pac Vol 2020 Dec;25(4):407-416

Department of Orthopaedic Surgery, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India.

Leprous neuropathy is a significant, yet preventable, cause of disability worldwide. Decompressive surgery and oral steroids have been used along with Multi Drug Therapy (MDT) for treating leprous neuropathy with varied success as reported in literature. We prospectively studied 16 peripheral nerves in 10 patients with leprous neuropathy of less than a year duration and not responding to steroid therapy in 3 weeks. The patients were divided into 2 groups: Group-A (decompressive nerve surgery was done within 12 weeks of onset of neurological deficit), and Group-B (nerve decompression was performed after 12 weeks from onset of neurological deficit). Post-operatively patients were assessed for regression of deformity, sensory, motor, vasomotor recovery and neuropathic pain. Median age of patients was 32 years (range; 18 years to 46 years). Mean motor score and mean grip strength was significantly better for group A patients at 2 years follow-up ( < 0.05). Mean sensory score improved significantly in both the groups ( < 0.05). Similarly, mean VAS score for neuropathic pain improved significantly in both the groups ( < 0.05). Recovery of autonomic function was observed in 3 nerves in group A and 1 in group B. The cases who underwent nerve decompression surgery within 12 weeks had better functional outcomes, especially in terms of motor recovery, than those who were operated after that. Studies involving larger number of patients are required to draw firm conclusions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1142/S2424835520500435DOI Listing
December 2020

Prevalence of fatty liver in metabolic syndrome.

J Family Med Prim Care 2020 Jul 30;9(7):3246-3250. Epub 2020 Jul 30.

Department of Medicine, GGS Medical College and Hospital Faridkot, Affliated to Baba Farid University of Health Sciences, Faridkot, Punjab, India.

Background: In Western world, non-alcohlic fatty liver disease (NAFLD) is considered to be the commonest liver problem, and it is being recognised as a major cause of liver-related morbidity and mortality. As the prevalence of overweight/obesity and metabolic syndrome increases, NASH may become one of the more common causes of end stage liver disease and hepatocellular carcinoma. But much information is not available in this association. So an attempt has been made to correlate both.

Aims: The aims of this study are: 1. to study the prevalence of non-alcoholic fatty liver in metabolic syndrome; and 2. to study the correlation between the non-alcoholic fatty liver and metabolic syndrome along with its individual components.

Materials And Methods: The study was an observational and analytical study of patients attending OPD and indoor patients of the Department of Medicine, G.G.S. Medical College and Hospital Faridkot. In total, 100 patients diagnosed as metabolic syndrome according to the NCEP ATP III criteria were subjected to ultrasonography; age and sex matched 100 controls were also taken; and the relationship between metabolic syndrome and NAFLD was studied.

Results: In total, 73% cases of metabolic syndrome according to NCEP ATPIII were having fatty liver, while in controls 38% persons were having fatty liver which is statistically significant.

Conclusions: Fatty liver was found to be highly prevalent in metabolic syndrome, and the early detection of fatty liver can help in modifying the disease course and delaying more serious complications like cirrhosis of liver and hepatocellular carcinoma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jfmpc.jfmpc_1108_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7567270PMC
July 2020

Shortening Dome Osteotomy for Correction of Complex Multiplanar Elbow Deformities: A New Surgical Technique.

Tech Hand Up Extrem Surg 2020 Oct 2;25(2):123-126. Epub 2020 Oct 2.

Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital.

Despite surgical advances in fracture management, it is not uncommon to find pediatric or adolescent patients with elbow deformities. Correction of severe deformities, often leaves the ingenuity of the treating surgeon asking for more. Various osteotomy techniques have been described in the literature for the correction of elbow deformities. Although, the concept of dome osteotomy did address certain inadequacies of the existing osteotomy techniques for distal humerus, but correction of complex deformities associated with deformation of trochlea and olecranon fossa still remain a surgical challenge which has not been adequately addressed in the literature so far. Our experience with the existing osteotomies for distal humerus led to the development of a new surgical technique of shortening dome osteotomy for correction of such complex multiplanar elbow deformities. Surgical steps, indications, and expected outcome is described.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/BTH.0000000000000314DOI Listing
October 2020

Physiologically Based Pharmacokinetic Modeling of Transdermal Selegiline and Its Metabolites for the Evaluation of Disposition Differences between Healthy and Special Populations.

Pharmaceutics 2020 Sep 30;12(10). Epub 2020 Sep 30.

Certara UK Limited, Simcyp Division, Level 2-Acero, 1 Concourse Way, Sheffield S1 2BJ, UK.

A physiologically based pharmacokinetic (PBPK) model of selegiline (SEL), and its metabolites, was developed in silico to evaluate the disposition differences between healthy and special populations. SEL is metabolized to methamphetamine (MAP) and desmethyl selegiline (DMS) by several CYP enzymes. CYP2D6 metabolizes the conversion of MAP to amphetamine (AMP), while CYP2B6 and CYP3A4 predominantly mediate the conversion of DMS to AMP. The overall prediction error in simulated PK, using the developed PBPK model, was within 0.5-1.5-fold after intravenous and transdermal dosing in healthy and elderly populations. Simulation results generated in the special populations demonstrated that a decrease in cardiac output is a potential covariate that affects the SEL exposure in renally impaired (RI) and hepatic impaired (HI) subjects. A decrease in CYP2D6 levels increased the systemic exposure of MAP. DMS exposure increased due to a reduction in the abundance of CYP2B6 and CYP3A4 in RI and HI subjects. In addition, an increase in the exposure of the primary metabolites decreased the exposure of AMP. No significant difference between the adult and adolescent populations, in terms of PK, were observed. The current PBPK model predictions indicate that subjects with HI or RI may require closer clinical monitoring to identify any untoward effects associated with the administration of transdermal SEL patch.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/pharmaceutics12100942DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600566PMC
September 2020

Electrocuted Hip: Late Consequences of Electrical Shock Injuries of Orthopaedic Relevance: A Case Report and Review of Literature.

JBJS Case Connect 2020 Jul-Sep;10(3):e1900632

1Department of Orthopaedic Surgery, Maulana Azad Medical College & associated Lok Nayak Hospital, New Delhi, India 2Department of Radiodiagnosis, Maulana Azad Medical College & associated Lok Nayak Hospital, New Delhi, India 3Department of Pathology, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India 4Department of Orthopaedics, ESIC Medical College & Hospital, Faridabad, Haryana, India.

Case: A 43-year-old man suffered household electric shock from 220 V alternating current when he accidently touched a live wire with his left hand. Subsequently, he was diagnosed to have osteonecrosis of the left femoral head and underwent total hip arthroplasty.

Conclusion: We suggest that the electric current could have thrombosed the terminal subsynovial vessels of the femoral head, leading to osteonecrosis. To the best of authors' knowledge, only 2 cases of osteonecrosis of the hip after electric shock have been reported in the literature. A literature review of the delayed consequences of electric shock injuries pertaining to orthopaedics is also presented.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2106/JBJS.CC.19.00632DOI Listing
April 2021

Symptomatic CSF HIV Escape in Patients on Anti Retroviral Therapy - A Case Series from India.

J Assoc Physicians India 2020 Aug;68(8):47-51

Department of Pathology, Army College of Medical Sciences and Base Hospital, Delhi Cantt., New Delhi.

The central nervous system is believed to be a safe sanctuary site which is established very early in the course of HIV infection where the virus can escape antiretroviral therapy. HIV associated neurocognitive disorder (HAND) is seen to occur even in patients on successful systemic ART. HIV RNA can be at higher levels in CSF than plasma termed as CSF / plasma discordance or CSF escape. We aimed to study the prevalence, risk factors and outcomes in HIV patients who develop neurocognitive dysfunction on otherwise successful (suppressive) ART. We reported 6 cases of HAND in patients on regular successful ART over a 3 year period. Neurological examination , CSF analysis , plasma CD4 T cell count and neuroimaging were done.. Plasma HIV RNA and CSF HIV RNA was also estimated. Most of the patients' (5/6) were male, median age was 38.5 years and median time since HIV diagnosis was 3 years. All patients' were on Tenofovir plus Boosted Protease inhibitors when neurocognitive symptoms were manifest. 4/6 patients had an acute onset of clinical presentation. CSF showed elevated protein and mild pleocytosis in all patients. Median nadir CD4 T cell count was 222 cells / μl and at presentation of HAND with CSF escape was 374 cells / μl. CSF / Plasma HIV RNA discordance was present in all patients' at time of diagnosis. Outcome is good if diagnosed and treated early.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2020

Functional evaluation of early tendon transfer for thumb opposition in median nerve palsy.

J Clin Orthop Trauma 2020 Jul-Aug;11(4):650-656. Epub 2020 Jun 3.

Department of Orthopaedics, ESIC Medical College & Hospital, Faridabad, India.

Background: There is paucity of literature on early tendon transfer in surgical rehabilitation of hands with median nerve injuries. Since the single most important functional deficit in median nerve palsy is the loss of thumb opposition, we evaluated the results of early tendon transfer in restoration of thumb opposition.

Methods: This prospective study involved 10 cases of isolated median nerve paralysis (axonotmesis or neurotmesis) that underwent early tendon transfer for restoration of thumb opposition. A pre- and post-operative evaluation in terms of power and precision grip strength and range of opposition of thumb was done. Median nerve exploration was performed in 4 cases and was supplemented by a tendon transfer for thumb opposition. The extensor indicis proprius (EIP) opponensplasty was performed in nine out of ten cases. In one case where the patient had scarring over the EIP tendon, palmaris longus (PL) opponensplasty was performed.

Results: The median age at injury was 29 years (range; 8 years-57 years). Minimum period of follow-up was 6 months. Six patients who underwent EIP transfer had excellent opposition while 3 had good opposition. The patient, in whom PL opponensplasty was done, had an excellent opposition. The median time for return to work was 2.75 months.There was significant improvement in the power grip and all three types of precision grip at 6 months follow-up. The percentage deficit in the affected hand compared to the normal hand was significantly reduced. There was no case of tendon pull out in our study, nor did any of our patients have an extensor lag following EIP transfer.

Conclusion: Early tendon transfer has a unique role in the management of median nerve palsy hand and we suggest this procedure should be considered in both high and low lesions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcot.2020.05.036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355086PMC
June 2020

Biopharmaceutic Extrapolation (IVIV_E) Informed Physiologically-Based Pharmacokinetic Model of Ritonavir Norvir Tablet Absorption in Humans Under Fasted and Fed State Conditions.

Mol Pharm 2020 07 1;17(7):2329-2344. Epub 2020 Jun 1.

Certara UK Limited, Simcyp Division, Level 2-Acero, Sheffield, S1 2BJ, U.K.

Ritonavir is a well-known CYP3A4 and CYP2D6 enzyme inhibitor, frequently used to assess the drug-drug interaction (DDI) liability of susceptible drugs. It is also used as a pharmacokinetic booster to increase exposure to CYP3A4 substrates. This study aimed to develop a mechanistic absorption and disposition model to describe exposure to ritonavir following oral dosing of the commercial amorphous solid dispersion tablet, Norvir, under fasted and fed conditions. A mechanistic description of ritonavir absorption from Norvir tablets may help to improve the design of DDI studies. Key parameters of amorphous ritonavir including free base solubility (solubility of the unbound, un-ionized species), bile micelle partition coefficients, formulation wetting/disintegration, and precipitation parameters were either obtained from the literature or estimated by modeling biopharmaceutic experiments. Based on variety of evidence, a main assumption of the model is that ritonavir does not form a crystalline precipitate while resident in the gastrointestinal tract. In the model, if simulated luminal concentration exceeds the amorphous solubility limit, then precipitation to an amorphous form is immediate. Simulated and observed and AUC parameters were well captured (within 1.5-fold) for both fasted and fed states in healthy volunteers. By accounting for luminal fluid viscosity differences in the different prandial states (affecting drug diffusivity) as well as the effect of drug free fraction on gut wall permeation rates, it was possible to explain the negative food effect observed for Norvir tablets in humans. In summary, a biopharmaceutic extrapolation approach provides confidence in (verification of) key input parameters of the physiologically-based pharmacokinetic ritonavir model which resulted in successful simulation of observed plasma profiles.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1021/acs.molpharmaceut.0c00043DOI Listing
July 2020

Biorelevant Two-Stage In Vitro Testing for rDCS Classification and in PBPK Modeling-Case Example Ritonavir.

J Pharm Sci 2020 08 7;109(8):2512-2526. Epub 2020 May 7.

Department of Pharmaceutical Technology, Goethe University, Frankfurt/Main, Germany; Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine and Pharmacology TMP, Frankfurt/Main, Germany. Electronic address:

Biorelevant two-stage in vitro testing is increasingly used as a tool for various applications in drug development. Three important applications of two-stage in vitro testing are the classification of weakly basic drug compounds as part of the refined Developability Classification System, the prediction of intraluminal drug concentrations in the gastrointestinal tract and the prediction of plasma concentration profiles using physiologically based pharmacokinetic modeling. For the weakly basic, antiretroviral drug ritonavir, two-stage testing is triggered as a customized investigation in the refined Developability Classification System classification process to assess whether the drug could supersaturate and precipitate when exposed to the steep change in pH that occurs during drug transfer from the stomach into the small intestine. It was shown that for 2 Norvir® formulations, a tablet and an oral powder formulation, the two-stage test yielded similar results to the more complex "transfer" model with regard to the supersaturation and precipitation behavior of these amorphous solid dispersion formulations. Furthermore, solubility and two-stage data were mechanistically modeled in the in vitro data Analysis Toolkit and the results used as input parameters for a physiologically based pharmacokinetic model built in the Simcyp Simulator.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.xphs.2020.04.023DOI Listing
August 2020

Co-targeting of CXCR4 and hedgehog pathways disrupts tumor-stromal crosstalk and improves chemotherapeutic efficacy in pancreatic cancer.

J Biol Chem 2020 06 1;295(25):8413-8424. Epub 2020 May 1.

Department of Pathology, College of Medicine, University of South Alabama, Mobile, Alabama

Pancreatic cancer (PC) remains a therapeutic challenge because of its intrinsic and extrinsic chemoresistance mechanisms. Here, we report that C--C motif chemokine receptor 4 (CXCR4) and hedgehog pathways cooperate in PC chemoresistance via bidirectional tumor-stromal crosstalk. We show that when PC cells are co-cultured with pancreatic stellate cells (PSCs) they are significantly more resistant to gemcitabine toxicity than those grown in monoculture. We also demonstrate that this co-culture-induced chemoresistance is abrogated by inhibition of the CXCR4 and hedgehog pathways. Similarly, the co-culture-induced altered expression of genes in PC cells associated with gemcitabine metabolism, antioxidant defense, and cancer stemness is also reversed upon CXCR4 and hedgehog inhibition. We have confirmed the functional impact of these genetic alterations by measuring gemcitabine metabolites, reactive oxygen species production, and sphere formation in vehicle- or gemcitabine-treated monocultures and co-cultured PC cells. Treatment of orthotopic pancreatic tumor-bearing mice with gemcitabine alone or in combination with a CXCR4 antagonist (AMD3100) or hedgehog inhibitor (GDC-0449) displays reduced tumor growth. Notably, we show that the triple combination treatment is the most effective, resulting in nearly complete suppression of tumor growth. Immunohistochemical analysis of Ki67 and cleaved caspase-3 confirm these findings from imaging and tumor measurements. Our findings provide preclinical and mechanistic evidence that a combination of gemcitabine treatment with targeted inhibition of both the CXCR4 and hedgehog pathways improves outcomes in a PC mouse model.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1074/jbc.RA119.011748DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7307206PMC
June 2020

Common Peroneal Nerve: The "CHHUI-MUI" Nerve".

Turk J Phys Med Rehabil 2020 Mar 3;66(1):96. Epub 2020 Mar 3.

Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5606/tftrd.2020.5357DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171889PMC
March 2020

A novel approach to detect highly manipulated fat adulterant as Reichert-Meissl value-adjuster in ghee (clarified butter) through signature peaks by gas chromatography of triglycerides.

J Food Sci Technol 2020 Jan 24;57(1):191-199. Epub 2019 Aug 24.

Dairy Chemistry Division, National Dairy Research Institute (ICAR-NDRI), Karnal, Haryana 132001 India.

Ghee, the clarified butter fat being the costliest fat among other edible oils and fats in India, prone to adulteration with highly manipulated cheaper oils/fats, especially during lean season. The present investigation carried on triglycerides profile of one of the latest components of the adulterant fat i.e. RM (Reichert-Meissl)-adjuster, has been exploited to check the adulteration of ghee with a newly emerged highly manipulated fat. Using standardized (S)-limits specified by the ISO/IDF for cow milk fat, the minimum level of detection of the adulterant fat was observed as 7.5%. However, in case of buffalo ghee, due to non-availability of the ISO/IDF limits, the detection of this adulterant fat in buffalo ghee was not possible. Gas chromatograms showed specific signature peaks of large size in the retention time region of 4.5 to 6.5 min for RM-adjuster and adulterant fat, whereas no such peaks were observed in pure cow and buffalo ghee samples. The new approach of zooming in and superimposing of selected peaks in the chromatograms of triglycerides of suspected ghee has been used as a strategy to find adulterant fat's presence. Through this approach, the addition of RM-adjusted highly manipulated foreign fat (adulterant fat) to the tune of even 0.5% could be achieved in both cow as well as buffalo ghee.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13197-019-04047-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6952487PMC
January 2020

Bioavailability assessment of zinc enriched lactobacillus biomass in a human colon carcinoma cell line (Caco-2).

Food Chem 2020 Mar 16;309:125583. Epub 2019 Oct 16.

National Dairy Research Institute, Karnal, Haryana 132001, India.

The present study utilizes lactobacilli strains having the potential to accumulate a significant amount of Zinc (Zn) in their biomass and ability to deliver the same mineral in a highly bioavailable form. A human origin Lactobacillus fermentum SR4 and Lactobacillus rhamnosus GG (LGG) were studied for their ability to accumulate Zn by growing them in the medium containing Zn salt. Further, Zn enriched cell lysates were prepared by Ultrasonication, as an organic Zn source. Various functional groups involved in bacterial Zn binding were identified by FT-IR spectroscopy and elemental Zn in bio-chelated cell lysate complex was confirmed by SEM and Energy Dispersive X-ray Spectrometry (EDX). Experimental data demonstrated a significantly higher (P < 0.05) bioavailability of Zn chelated by SR4 followed by LGG i.e., 57% and 48%, as compared to the commercially available inorganic (ZnSo) and even organic (Zinc gluconate) forms tested which has 15.6% and 21.7% respectively.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.foodchem.2019.125583DOI Listing
March 2020

Effect of processing conditions on the stability of native vitamin A and fortified retinol acetate in milk.

Int J Vitam Nutr Res 2021 Jan 8;91(1-2):133-142. Epub 2019 Nov 8.

Shoolini University, Solan, Himachal Pradesh, India.

The objective of this investigation was to evaluate the stability of vitamin A in fortified milk which was exposed to different processing conditions . heat treatments (pasteurization, boiling and sterilization), light exposure treatments (1485, 2970 and 4455 lux for 2, 4, 8, 16 and 32 h) and different packaging materials (polyethylene pouches and glass bottles) and also to evaluate the effect of fortified iron (ferric pyrophosphate soluble (FPP) and ferrous gluconate hydrate (FG) on vitamin A stability during processing and storage. Toned milk was fortified with 25 ppm iron and vitamin A acetate 2500 IU/L, singly and also in combination. The vitamin A analysis method was optimized and accuracy and precision were below ± 5%. The results indicated that vitamin A was heat-labile and its degradation increased with the increase in the intensity of heat treatments. Pasteurized milk (318.11 IU/L) showed non-significant (p > 0.05) decrease, however, boiling (250.21 IU/L) and sterilization (205.65 IU/L) showed a significant difference (p < 0.05) in vitamin A content in comparison to control (324.71 IU/L). Similarly, vitamin A was light sensitive and its degradation significantly increased (p < 0.05) with an increase in the intensity of light exposure (34.82 to 92.53%). Loss of vitamin A (%) was significantly greater (p < 0.05) in iron-fortified milk suggesting that iron might have played a role in accelerating the degradation of vitamin A. Extent of losses were significantly higher (p < 0.05) in FG compared to FPP fortified milk. Vitamin A (microencapsulated form) which was added externally was more stable than the inherent vitamin A present in milk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1024/0300-9831/a000617DOI Listing
January 2021

Organic solvent-free extraction of carotenoids from carrot bio-waste and its physico-chemical properties.

J Food Sci Technol 2019 Oct 8;56(10):4678-4687. Epub 2019 Jul 8.

2Dairy Chemistry Division, ICAR-National Dairy Research Institute, Karnal, Haryana 132001 India.

The bio-wastes (like peels, seeds, etc.) from food industry are rich source of bio-active components, but are poorly managed. In present study, carotenoids were extracted from carrot pomace using ultrasonication and high shear dispersion techniques and flaxseed oil as green solvent (green biorefinery approach). Various combinations of time and temperature were used and final selection was made on the basis of maximum recovery of carotenoids. High shear disperser yielded maximum carotenoids (recovery 94.8 ± 0.08%). The total carotenoid content, antioxidant activity as ABTS, DDPH and FRAP and β-carotene of carotenoid rich extract from carrot pomace (CREP) were 82.66 ± 0.06 μg/g, 1596.04 ± 69.45 μg Trolox eq./ml, 380.21 ± 39.62 μg Trolox eq./ml, 941.20 ± 19.91 μM Trolox eq./ml, 78.37 μg/g, respectively were significantly higher (< 0.05) when compared with the extracting medium. The L*, a* and b* values of CRE were 18.65 ± 0.037, 19.42 ± 0.21, 27.947 ± 0.65 and were significantly higher than extracting medium. The CRE could be used as a natural source of β-carotene and natural colorant for food applications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13197-019-03920-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6801288PMC
October 2019

An Unusual Presentation of Hemophilia A: Pseudotumor of Distal End Radius-Masquerading as Giant Cell Tumor.

J Hand Microsurg 2019 Oct 28;11(Suppl 1):S11-S15. Epub 2018 May 28.

Department of Orthopedics, Maulana Azad Medical College, Lok Nayak Hospital, New Delhi, India.

Hemophilia is a coagulation defect caused by a functional or absolute deficiency of coagulation factors. Deficiency of factor VIII leads to hemophilia A; deficiency of factor IX causes hemophilia B. Pseudotumor may arise from hemorrhage into the muscle and within the subperiosteal space and can lead to destruction of the adjacent muscle, bone, nerves, and vessels. A 60-year-old man presented with the complaint of pain and swelling in right wrist. The patient consulted the general practitioner who misdiagnosed it as a case of giant cell tumor due to typical X-ray changes. Biopsy was done following which there was prolonged bleeding leading to worsening of clinical condition and the patient presented in our hospital with ulcerated swelling. Routine blood investigations were within normal limit. Prothrombin time was 12.1 seconds and activated partial thromboplastin time (aPTT) was 54.3 seconds. Raised aPTT led to suspicion of hemophilia, and factor VIII and IX levels were investigated. Factor IX level was within normal limit. Factor VIII level was 6.3%. The patient was managed conservatively. Factor VIII level was replaced according to standard protocol (40 IU/kg per dose thrice a week for 10 days). Daily dressing was done using tranexamic acid locally. Lesion healed completely in 6 months.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0038-1646774DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791804PMC
October 2019
-->