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Jaiswal NK, Kumar V, Puvanesarajah V, Dagar A, Prakash M, Dhillon M, Dhatt SS. Necessity of Direct Decompression for Thoracolumbar Junction Burst Fractures with Neurological Compromise. World Neurosurg 2020; 142:e413-e419. [PMID: 32688041 DOI: 10.1016/j.wneu.2020.07.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgical management of burst fractures is controversial, with many different operative options. From a posterior approach, decompression of the spinal cord can be performed through both indirect and direct methods, the former relying on ligamentotaxis. It is unclear whether indirect decompression with ligamentotaxis is as effective as direct decompression. METHODS Prospective, randomized controlled data were retrospectively analyzed to include only burst fractures of the thoracolumbar junction. Patients were treated with either direct decompression, involving wide posterior decompression in addition to operative stabilization, or indirect decompression, where decompression was performed solely through ligamentotaxis. Patients were followed up at 6 months with clinical assessment and imaging. Additional clinical assessment was performed at 1 year. For all analyses, P < 0.05 was significant. RESULTS The study included 46 patients, with 18 patients in the direct decompression subgroup and 28 patients in the indirect decompression subgroup. The average age of the full cohort was 35.1 ± 13.1 years (range, 16-60 years). Most patients had L1 fractures (21/46; 46%), with an AOSpine classification type A4 fracture morphology (17/46; 37%), and were American Spinal Injury Association grade B (18/46; 39%). Both treatments resulted in similar increases in canal diameter and decreases in dural sac compromise (P > 0.5) at 6-month follow-up. Both treatments resulted in similar grades of neurological improvement (P = 0.575) at 1 year. CONCLUSIONS There were no significant differences in clinical and imaging outcomes when comparing direct decompression with ligamentotaxis. Ligamentotaxis alone may be effective in carefully selected cases.
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Prakash M, Pabitha P. A hybrid node classification mechanism for influential node prediction in Social Networks. INTELL DATA ANAL 2020. [DOI: 10.3233/ida-194724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Thakur M, Gainder S, Saha SC, Prakash M. To study the changes in maternal hemodynamics with intravenous labetalol or nifedipine in acute severe hypertension. Pregnancy Hypertens 2020; 21:180-183. [PMID: 32570152 DOI: 10.1016/j.preghy.2020.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study the maternal hemodynamic changes in acute severe hypertension after treatment with intravenous labetalol or oral nifedipine using color doppler ultrasound. STUDY DESIGN We evaluated thirty pregnant women with gestational age between 28 and 40 weeks in acute severe hypertension (more than or equal to 160/105 mmHg) which were randomly allocated to receive either intravenous labetalol or oral nifedipine until blood pressure was lowered to less than or equal to 140/90 mmHg. Doppler vascular indices namely pulsatility index, resistance index, S/D ratio of bilateral uterine arteries and maternal renal artery were measured baseline at the time of acute severe hypertension and repeated after control of blood pressure, to assess the changes in maternal hemodynamics if any with labetalol or nifedipine. RESULTS When evaluating right uterine artery Doppler parameters, a trend to increase in PI and RI was observed in those who received labetalol and nifedipine however the difference was not statistically significant. Whereas, while evaluating left uterine artery indices a trend to decrease PI was seen in nifedipine group but the difference was not statistically significant. On intergroup comparison there was no any significant change in any of uterine artery as well as renal artery indices in either group. CONCLUSION The use of labetalol and nifedipine were not related to any significant changes in maternal Doppler, which is reassuring about the safety of these drugs when treating acute severe hypertension in pregnancy.
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Thangamani R, Baskaran L, Prakash M, Karmegam N. Effect of pre-composting on seed viability and subsequent vermicomposting of an invasive alien weed,Alternanthera ficoidea (L.) P. Beauv. ACTA ACUST UNITED AC 2020. [DOI: 10.20546/ijcrbp.2020.704.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lemiale V, Prakash M, Cruz AM. Data-Driven Approaches to Integrated Disaster Risk Management. INTERNATIONAL JOURNAL OF DISASTER RISK SCIENCE 2020; 11:693-695. [PMCID: PMC7720785 DOI: 10.1007/s13753-020-00324-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/17/2020] [Indexed: 11/17/2023]
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Sethi J, Divyaveer S, Gupta N, Prakash M, Kohli H. Knee swelling in a renal transplant recipient. INDIAN JOURNAL OF TRANSPLANTATION 2020. [DOI: 10.4103/ijot.ijot_19_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sendhil Kumaran M, Thapa M, Narang T, Prakash M, Dogra S. Ultrasonography versus clinical examination in detecting leprosy neuropathy. LEPROSY REV 2019. [DOI: 10.47276/lr.90.4.364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Das L, Bhansali A, Prakash M, Jude EB, Rastogi A. Effect of Methylprednisolone or Zoledronic Acid on Resolution of Active Charcot Neuroarthropathy in Diabetes: A Randomized, Double-Blind, Placebo-Controlled Study. Diabetes Care 2019; 42:e185-e186. [PMID: 31597669 DOI: 10.2337/dc19-1659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 09/08/2019] [Indexed: 02/03/2023]
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Chouhan DK, Chand Saini U, Kumar Rajnish R, Prakash M. Complex bicondylar tibial plateau fractures with reversed tibial slope - Our experience with a fracture-specific correction strategy. Trauma Case Rep 2019; 25:100256. [PMID: 31872030 PMCID: PMC6909138 DOI: 10.1016/j.tcr.2019.100256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/08/2019] [Accepted: 10/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background Tibial plateau fractures are complex and may result in sub-optimal results despite a timely and excellent reduction. An important cause for this may be the inability to detect and correct sagittal malalignment consequent to a reversal of the posterior tibial slope. We describe here the surgical steps to restore posterior tibial slope in a series of our patients with tibial condyle fractures involving the posterior column fragment using a fixed-angle locking plate. Methods This was a prospective cohort study of 4 cases who had sustained closed, bicondylar tibial plateau fractures (AO/OTA 41-C3) involving the posterior column fragment and reversed sagittal slope. All patients were operated in a prone position through a posterior approach. The fixation was done with a fixed angle locking plate. Results The average time taken for fracture union was 12 (range 10-15) weeks. The posterior tibial slope was restored in all the four patients (mean posterior proximal tibial angle = 8.5°, mean medial proximal tibial angle = 88°). There were no procedure-related complications. All patients attained excellent Knee Society Score at one year follow up (mean score = 93). Conclusion A posterior approach in the prone position gives direct access to the fracture apex which eases the fracture reduction and fixation to correct the sagittal malalignment in tibial condyle fractures involving the posterior column fragment. We propose this approach as an critical surgical technique which helps in improved outcomes of tibial condylar fractures.
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Satpathy S, Prakash M, Debbarma S, Sengupta AS, Bhattacaryya BK. Design a FPGA, fuzzy based, insolent method for prediction of multi-diseases in rural area. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2019. [DOI: 10.3233/jifs-181577] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Rajeswari D, Prakash M, Suresh J. Computational grid scheduling architecture using MapReduce model-based non-dominated sorting genetic algorithm. Soft comput 2019. [DOI: 10.1007/s00500-019-03946-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rastogi A, Hajela A, Prakash M, Khandelwal N, Kumar R, Bhattacharya A, Mittal BR, Bhansali A, Armstrong DG. Teriparatide (recombinant human parathyroid hormone [1-34]) increases foot bone remodeling in diabetic chronic Charcot neuroarthropathy: a randomized double-blind placebo-controlled study. J Diabetes 2019; 11:703-710. [PMID: 30632290 DOI: 10.1111/1753-0407.12902] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/22/2018] [Accepted: 01/08/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Currently, there is no consensus regarding the medical treatment of chronic Charcot neuroarthropathy (CN) of foot, except for effective off-loading. Because tarsal bones are predominantly trabecular, teriparatide may improve the macroarchitecture of foot bones in chronic CN. METHODS People with diabetes and chronic CN were randomized to receive either 20 μg teriparatide or placebo subcutaneous daily for 12 months. Thirty-eight patients were screened and data were analyzed for 20. The maximum standardized uptake (SUVmax ) value of 18 F-FDG PET/CT the region of interest, bone turnover markers and foot bone mineral density BMD were determined. The primary outcome measure was change in SUVmax g/ml. RESULTS Mid-foot was the most common region involved. After 12 months, SUVmax increased from 30.6 ± 14.7 to 37.7 ± 18.0 (P = 0.044) in the teriparatide group, but decreased from 27.6 ± 12.2 to 22.9 ± 10.4 with placebo (P = 0.148). The estimated treatment difference (ETD) was 11.9 ± 4.3 (95% CI 2.9, 20.8; P = 0.012). Similarly, P1NP increased with teriparatide (19.8 ± 5.5; P = 0.006) but decreased with placebo (-5.1 ± 3.8 ng/mL; P = 0.219); ETD was 24.8 ± 6.6 (95% CI 10.8, 38.8; P < 0.001) and CTX increased in both the teriparatide and placebo groups. Foot BMD increased by 0.06 ± 0.04 g/cm2 (P = 0.192) with teriparatide, but decreased by -0.06 ± 0.08 g/cm2 with placebo (P = 0.488; intergroup comparison, P = 0.096). CONCLUSION Teriparatide increases foot bone remodeling by an osteoanabolic action in people with CN.
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Prakash M, Joukainen A, Torniainen J, Honkanen MKM, Rieppo L, Afara IO, Kröger H, Töyräs J, Sarin JK. Near-infrared spectroscopy enables quantitative evaluation of human cartilage biomechanical properties during arthroscopy. Osteoarthritis Cartilage 2019; 27:1235-1243. [PMID: 31026649 DOI: 10.1016/j.joca.2019.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/11/2019] [Accepted: 04/09/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the feasibility of near-infrared (NIR) spectroscopy (NIRS) for evaluation of human articular cartilage biomechanical properties during arthroscopy. DESIGN A novel arthroscopic NIRS probe designed in our research group was utilized by an experienced orthopedic surgeon to measure NIR spectra from articular cartilage of human cadaver knee joints (ex vivo, n = 18) at several measurement locations during an arthroscopic surgery. Osteochondral samples (n = 265) were extracted from the measurement sites for reference analysis. NIR spectra were remeasured in a controlled laboratory environment (in vitro), after which the corresponding cartilage thickness and biomechanical properties were determined. Hybrid multivariate regression models based on principal component analysis and linear mixed effects modeling (PCA-LME) were utilized to relate cartilage in vitro spectra and biomechanical properties, as well as to account for the spatial dependency. Additionally, a k-nearest neighbors (kNN) classifier was employed to reject outlying ex vivo NIR spectra resulting from a non-optimal probe-cartilage contact. Model performance was evaluated for both in vitro and ex vivo NIR spectra via Spearman's rank correlation (ρ) and the ratio of performance to interquartile range (RPIQ). RESULTS Regression models accurately predicted cartilage thickness and biomechanical properties from in vitro NIR spectra (Model: 0.77 ≤ ρ ≤ 0.87, 2.03 ≤ RPIQ ≤ 3.0; Validation: 0.74 ≤ ρ ≤ 0.84, 1.87 ≤ RPIQ ≤ 2.90). When predicting cartilage properties from ex vivo NIR spectra (0.33 ≤ ρ ≤ 0.57 and 1.02 ≤ RPIQ ≤ 2.14), a kNN classifier enhanced the accuracy of predictions (0.52 ≤ ρ ≤ 0.87 and 1.06 ≤ RPIQ ≤ 1.88). CONCLUSION Arthroscopic NIRS could substantially enhance identification of damaged cartilage by enabling quantitative evaluation of cartilage biomechanical properties. The results demonstrate the capacity of NIRS in clinical applications.
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Arya AK, Bhadada SK, Mukherjee S, Singh P, Rana SS, Dahiya D, Sood A, Saikia UN, Prakash M, Bhasin DK, Behera A, Walia R, Bhansali A. Frequency & predictors of pancreatitis in symptomatic primary hyperparathyroidism. Indian J Med Res 2019; 148:721-727. [PMID: 30778006 PMCID: PMC6396558 DOI: 10.4103/ijmr.ijmr_353_16] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background & objectives: The frequency and predictors of pancreatitis in primary hyperparathyroidism (PHPT) are not well understood. The objective of the present study was to evaluate the frequency of pancreatitis in patients with PHPT and its association with clinical and biochemical parameters of the disease. Methods: In this retrospective study all consecutive patients with PHPT registered in the PHPT registry (www.indianphptregistry.com) from the year 2004 to 2013 were included. The clinical, biochemical and radiological parameters related to pancreatitis were evaluated in histologically proven PHPT patients. Results: A total of 218 patients (63 men; mean age: 40.6±14.4 yr) underwent surgery for PHPT during the study. Pancreatitis occurred in 35 [16%, 18 acute and 17 chronic pancreatitis (CP)] patients and male:female ratio was 1:0.94. Skeletal manifestations were seen less frequently in PHPT with pancreatitis as compared to that of PHPT without pancreatitis. PHPT with pancreatitis had significantly higher serum calcium (12.4±2.0 vs. 11.7±1.5 mg/dl, P<0.05) in comparison to PHPT without pancreatitis. PHPT with acute pancreatitis (AP) had higher serum calcium (P<0.05) and parathyroid hormone (PTH) (P<0.05) levels than PHPT with CP. Curative parathyroidectomy improved the symptoms associated with pancreatitis as there was no recurrence in AP group, whereas recurrence was observed only in about 10 per cent patients of the CP group. Interpretation & conclusions: Pancreatitis was observed in 16 per cent of PHPT patients with male predominance in the study population. No recurrence of AP was observed after curative surgery. It may be proposed that serum amylase with calcium and PTH should be measured in all patients of PHPT with pain abdomen to rule out pancreatitis.
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Prakash M, Abhinaya S, Kumar A, Khandelwal N. Bilateral retropharyngeal internal carotid artery: A rare and potentially fatal anatomic variation. Neurol India 2019; 65:431-432. [PMID: 28290430 DOI: 10.4103/neuroindia.ni_1210_15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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kumar S , SK, Maharani B, Babu RV, Prakash M. Adherence to prescribed medication and its association with quality of life among COPD patients treated at a tertiary care hospital in Puducherry – a cross sectional study. SOUTHWEST JOURNAL OF PULMONARY AND CRITICAL CARE 2019. [DOI: 10.13175/swjpcc021-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Sandhu G, Prakash M, Narang T. 'Dot in circle sign' in thigh: an unusual site of mycetoma. BMJ Case Rep 2019; 12:12/5/e229499. [PMID: 31076497 DOI: 10.1136/bcr-2019-229499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Jain TK, Sood A, Sood A, Basher RK, Prakash G, Prakash M, Mittal BR. Utility of F-18 Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in a Patient Presenting with Acute Paraparesis in Detecting Isolated Relapse of Non-Hodgkin's Lymphoma Infiltrating the Spinal Cord. Indian J Nucl Med 2019; 34:178-179. [PMID: 31040541 PMCID: PMC6481211 DOI: 10.4103/ijnm.ijnm_23_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rastogi A, Gupta K, Prakash M, Bhansali A. Innocuous "foot lump" in patient with diabetes mellitus: A manifestation of phaeohyphomycosis. Foot (Edinb) 2019; 38:4-7. [PMID: 30530011 DOI: 10.1016/j.foot.2018.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/08/2018] [Accepted: 11/25/2018] [Indexed: 02/04/2023]
Abstract
Invasive mycotic infection presenting as "foot lump" in an immunocompetent patient is extremely rare. The case highlights the difficulty in diagnosis of fungal infections of foot including attempts to isolate the fungus and non-response to anti-fungal agents. A 64-year-old lady with T2DM for four years presented with painless, gradually progressive swelling over plantar aspect of left mid-foot for six months. Foot examination revealed soft-to-firm lump over the plantar aspect of left mid-foot obscuring the lateral longitudinal arch. No signs of inflammation or bony deformities were noticed. X-ray foot revealed radio-dense shadow in soft tissue without bone changes, corroborated by MRI. A diagnosis of lipoma, ganglion cyst, tubercular abscess and a fungal infection were considered. Aspirate cytology suggested the presence of Aspergillus hyphae although repeated cultures were unsuccessful. Medical management in form of itraconazole initially, followed by voriconazole was tried. However, there was no response to anti fungal agents and the lesion was surgically excised. Histopathological examination confirmed the presence of pigmented fungus (phaehyphomycosis).
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Sharma M, Behera P, Sen RK, Aggarwal S, Tripathy SK, Prakash M, Saini G, Saibaba B. Total hip arthroplasty for arthritis following acetabular fractures-evaluation of radiological, functional and quality of life parameters. J Clin Orthop Trauma 2019; 10:131-137. [PMID: 30705548 PMCID: PMC6349613 DOI: 10.1016/j.jcot.2017.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Total hip arthroplasty (THA) has been termed as 'operation of the century' as it provides a stable and mobile hip to patients who are debilitated by pathologies affecting the hip. Acetabular fractures pose a challenge for their initial management as well for the management of secondary osteoarthritis which is often the outcome of these fractures. The study attempts to evaluate the short term radiological, functional and quality of life outcomes of THA done in patients with prior acetabular fractures and to find a correlation between various factors. MATERIALS AND METHODS 47 patients who provided consent for this retrospective study were clinically and radiologically evaluated at their latest follow up. Ratios of horizontal offset, vertical offset, body lever arm and cup inclination were calculated with respect to the opposite normal hip on a radiograph. Questionnaires were filled up for Harris Hip Score (HHS), Short form -12, Short Musculoskeletal functional assessment (SMFA) and WHO-quality of life (WHO-QoL). RESULTS HHS and quality of life scores had a tendency to improve over time. A statistically significant difference (p < 0.05) was noted between scores of patients having less than 2 years follow up and more than 4 years follow-up. The HHS, radiological and quality of life parameters were not statistically significantly different when analysed based on acetabular fracture pattern, their primary management and aetiology necessitating the THA. CONCLUSION The short term radiological, functional and quality of life parameters are dependent on the accuracy of the THA performed and are not significantly affected by the fracture type, initial management and outcomes of that management. However, longer follow up is necessary to evaluate these parameters even more accurately.
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Hooda A, Dhillon M, Prabhakar S, Prakash M, John R, Kanwat H. MRI evaluation of anterolateral ligament tears in knee injury with anterior cruciate ligament rupture. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.01.2018.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kaushik A, Vinay K, Narang T, Saikia UN, Modi M, Prakash M, Dogra S. Ichthyosiform sarcoidosis: a mimic of leprosy? Clin Exp Dermatol 2018; 44:677-680. [DOI: 10.1111/ced.13863] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2018] [Indexed: 01/07/2023]
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Subbulakshmi P, Prakash M. Mitigating eavesdropping by using fuzzy based MDPOP-Q learning approach and multilevel Stackelberg game theoretic approach in wireless CRN. COGN SYST RES 2018. [DOI: 10.1016/j.cogsys.2018.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rastogi A, Prakash M, Bhansali A. Varied presentations and outcomes of Charcot neuroarthropathy in patients with diabetes mellitus. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-018-0700-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Gunashekar S, Prakash M, Minz RW, Sharma A, Sharma S, Dhir V. Comparison of articular manifestations of mixed connective tissue disease and systemic lupus erythematosus on clinical examination and musculoskeletal ultrasound. Lupus 2018; 27:2086-2092. [PMID: 30304980 DOI: 10.1177/0961203318804891] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Polyarthritis is common to both mixed connective tissue disease (MCTD) and systemic lupus erythematosus (SLE). Apart from being erosive and deforming in the former, we speculated that it was more common and the extent of joints involved would be higher in MCTD. METHODS This was a cross-sectional study that included patients with MCTD aged 18-75 years fulfilling the Kasukawa criteria. An equal number of patients with SLE matched for disease duration and gender were included. Clinical manifestations were compared between patients with MCTD and with SLE. Examination of joints was done for the presence of tenderness or swelling and deformity. Musculoskeletal ultrasound was done on the non-dominant hand for detection of synovitis and tenosynovitis and radiographs of the hands were obtained. The use of methotrexate and non-steroidal anti-inflammatory drugs (NSAIDs) for arthritis was noted. Statistical tests used were non-parametric. RESULTS Forty patients with MCTD and forty patients with SLE were included in this study, with patients being slightly older in MCTD than SLE (36 ± 10.2, 31.8 ± 13.3 years, p = 0.01). There were no significant differences in disease duration (4.7 ± 3.1, 3.7 ± 2.3, p = 0.1) or gender (females = 38, 38). Nearly one-half of patients with MCTD had at least one swollen joint compared with only 15% of patients with SLE. Median (95% confidence interval) tender joint count (5 (4.8-10.4), 0 (1.3-7.2), p = 0.01) and swollen joint count (0 (0.9-2.6), 0 (0-1.2), p = 0.002) was significantly higher in patients with MCTD compared with SLE. More patients with MCTD than SLE had tender or swollen proximal interphalangeal joints (12, 4, p = 0.025). More patients with MCTD than SLE had received methotrexate (8,2, p = 0.04) and NSAIDs (39, 32, p = 0.03) for arthritis. There was no difference in the number of patients with MCTD or SLE who had evidence of synovitis or tenosynovitis on ultrasound. There was no difference in erosive disease on hand radiographs, but acro-osteolysis was higher among MCTD patients. CONCLUSIONS A higher proportion of patients with MCTD had at least one swollen and tender joint as compared with patients with SLE, as well as higher use of methotrexate and NSAIDs. However, there was no difference in ultrasound detected synovitis or tenosynovitis.
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