59 Robotic-Assisted Knee Replacement Surgery & Infection: A Systematic Review and Meta-Analysis

Aim

An increasing proportion of knee arthroplasties are performed using robotic-assisted surgical techniques. While these techniques are associated with shorter lengths of stay, better patient outcomes and lower revision rates, the increase in intra-operative time and requirement for extra instrumentation, such as array pins, may lead to an increased risk of infection. Therefore, this review reports summary rates of surgical site infection (SSIs) in robotic-assisted knee arthroplasties.

Method

The protocol for this review was prospectively registered on PROSPERO. Embase, PubMed/MEDLINE, Cochrane and CINAHL databases were searched from 2004 to November 2020 to reflect modern robotic surgical practice. The primary outcome was overall number of SSIs that occurred within one year of the primary operative procedure, which was sub-classified into either deep or superficial and pin-site infections. Risk of bias was assessed via the Cochrane RoB2 tool. Conventional Q and I2 tests for heterogeneity were performed with subsequent meta-analysis using a DerSimonian-Laird random-effects model.

Results

From 1052 studies identified, 17 were included, of which 13 were deemed to have an overall ‘low’ risk of bias. This review included 4400 unicompartmental and 1883 total knee arthroplasties. The summary rate of overall SSIs within one year of primary robotic knee arthroplasty was 0.568% (SE=0.183, 95% CI=0.209–0.927). This rate fell to 0.154% (SE=0.069, 95% CI=0.018–0.290) for deep infections and 0.347% (SE=0.109, 95% CI=0.133–0.561) for superficial and pin-site infections.

Conclusions

The rates of surgical site infection were found to be low in robotic knee arthroplasty, however, further research is required to compare outcomes with conventional knee arthroplasty.

Air Quality during the COVID–19 Lockdown and Unlock Periods in India Analyzed Using Satellite and Ground-based Measurements

Abstract

A nationwide lockdown was imposed in India from 24 March 2020 to 31 May 2020 to contain the spread of COVID-19. The lockdown has changed the atmospheric pollution across the continents. Here, we analyze the changes in two most important air quality related trace gases, nitrogen dioxide (NO₂) and tropospheric ozone (O₃) from satellite and surface observations, during the lockdown (April–May 2020) and unlock periods (June–September 2020) in India, to examine the baseline emissions when anthropogenic sources were significantly reduced. We use the Bayesian statistics to find the changes in these trace gas concentrations in different time periods. There is a strong reduction in NO₂ during the lockdown as public transport and industries were shut during that period. The largest changes are found in IGP (Indo-Gangetic Plain), and industrial and mining areas in Eastern India. The changes are small in the hilly regions, where the concentrations of these trace gases are also very small (0–1 × 10¹⁵ molec./cm²). In addition, a corresponding increase in the concentrations of tropospheric O₃ is observed during the period. The analyses over cities show that there is a large decrease in NO₂ in Delhi (36%), Bangalore (21%) and Ahmedabad (21%). As the lockdown restrictions were eased during the unlock period, the concentrations of NO₂ gradually increased and ozone deceased in most regions. Therefore, this study suggests that pollution control measures should be prioritized, ensuring strict regulations to control the source of anthropogenic pollutants, particularly from the transport and industrial sectors.

Highlights

• Most cities show a reduction up to 15% of NO₂ during the lockdown

• The unlock periods show again an increase of about 40–50% in NO₂

• An increase in tropospheric O₃ is observed together with the decrease in NO₂

Supplementary Information

The online version contains supplementary material available at 10.1007/s40710-022-00585-9.

1537 Squamous Cell Carcinoma Arising in A Maxillary Odontogenic Keratocyst in Gorlin Goltz Syndrome - A Rare Case Report

Introduction

Gorlin Goltz syndrome (GGS) is a rare, hereditary, AD condition with multiple BCCs, odontogenic keratocysts (Jaw cysts), calcification of falx cerebri, skeletal anomalies & a predisposition to neoplasms like medulloblastomas, fibromas and rhabdomyosarcomas.

Aim

We present a rare case of a Squamous cell carcinoma (SCC) developing in a Maxillary odontogenic keratocyst in a 32-year male with GGS.

Discussion

This patient was referred to the OMFS unit with a non-healing UL3 extraction socket and exophytic growth. Initial biopsies suggested an atypical squamo-proliferative lesion, however a repeat biopsy demonstrated an invasive SCC arising from a background odontogenic keratocyst of the maxilla. He was initially reluctant to undergo a staging CT scan to avoid risks of developing further BCCs due to IR exposure. This was eventually performed as per H&N MDT recommendation & showed a T4aN0M0 SCC of the left maxilla and bilateral multiple mandibular odontogenic keratocysts. He underwent a left maxillectomy, left neck dissection & reconstruction with a DCIA free flap, but did not want his mandibular keratocysts treated at the same time. Complete tumour clearance was achieved with no involved neck nodes & he remains disease-free at 4 months postoperatively. Although for a T4 tumour he would have needed postoperative radiotherapy, in view of the GGS, no adjuvant treatment was indicated.

Conclusions

SCC developing in a maxillary OKC is exceedingly rare with only two previous cases reported in GG syndrome. This is the first reported case of a GGS patient with oral SCC undergoing a complex free flap reconstruction.

728 A Systematic Review of The Efficacy and Safety of Outpatient Bladder Tumour Ablation

Introduction

The management of recurrent non-muscle-invasive bladder cancer (NMIBC) typically requires repeated transurethral resections under general anaesthesia. This is costly and results in poor health-related quality-of-life for patients. Outpatient-based laser ablation and diathermy to recurrent tumours could reduce morbidity and cost of managing NMIBC. This systematic review evaluates the safety and efficacy of outpatient-based diathermy or laser ablation for recurrent NMIBC.

Method

The EMBASE, MEDLINE and Cochrane Library were searched until June 2020. All studies evaluating the use of outpatient diathermy or laser ablation for NMIBC were included. The quality of evidence and risk of bias were assessed using the GRADE and ROBINS-I tools, respectively.

Results

From 1328 studies identified, 17 studies (1584 patients) were included. Overall, the majority of tumours (80%) were low-grade (G1 and G2). Laser ablation and diathermy resulted in a mean recurrence rate of 47% and 40% at 20-31 months follow-up, respectively, with a mean progression rate of 3-11%. Both procedures were well-tolerated with low pain scores (mean score of 1) and low periprocedural complication rates. However, the overall quality of evidence of low.

Conclusions

This review demonstrates that both procedures have good short-term efficacy in patients with low-grade NMIBC. The procedures are well-tolerated with low complication rates and importantly, reduce the need for intervention under general anaesthesia. These findings can aid patient counselling regarding less invasive treatment options, avoiding the morbidity of transurethral resection. Future randomised studies with standardised risk stratification and outcome measures are required to add to the quality of evidence.

733 Long-Term Outcomes of Outpatient Laser Ablation for Recurrent Non-Muscle Invasive Bladder Cancer: A Retrospective Cohort Study

Aim

Non-muscle-invasive bladder cancer (NMIBC) is the most prevalent form of bladder cancer, predominantly affecting the elderly population. The most common treatment for recurrent NMIBC is transurethral resection of the bladder tumour (TURBT), which carries a risk of perioperative morbidity and mortality in this often-co-morbid population. Outpatient laser ablation of low-grade NMIBC recurrences is a minimally invasive treatment option, but long-term efficacy is poorly reported.

Method

We retrospectively reviewed the case notes of all patients treated with Holmium:YAG laser ablation from 2008-2016. Data regarding patient demographics, original histology, dates of procedures, follow-up time, recurrence, progression, and complications were recorded.

Results

A total of 199 procedures were performed on 97 patients (mean age of 83.56), 73 (75.3%) of which originally had low-grade (G1 or G2) tumours. Overall, 55 (56.7%) patients developed tumour recurrence at long-term follow-up (mean 5.36 years), and only 9 (9.3%) patients had tumour progression to a higher stage or grade, but there was no progression to muscle-invasive disease. The median recurrence-free, progression-free and overall survival times were 1.69 years (95% CI 1.20-2.25), 5.70 years (95% CI 4.10-7.60) and 7.60 years (95% CI 4.90-8.70), respectively. No patients required emergency inpatient admission after laser ablation for any associated complications.

Conclusions

Office-based Holmium: YAG laser ablation is an oncologically-safe method of managing recurrent low-grade non-muscle-invasive bladder cancer in the long-term, with no patients progressing to muscle-invasive disease. Furthermore, the procedure is safe, and no significant complications were seen in this elderly and co-morbid population.

660 Trapeziectomy Versus Joint Replacement for First Carpometacarpal (CMC-1) Joint Osteoarthritis: A Systematic Review and Meta-Analysis

Aim

The challenge of managing first carpometacarpal (CMC-1) joint osteoarthritis is the lack of guidance on which surgical intervention is superior. This systematic review and meta-analysis compares joint replacement (JR) and trapeziectomy techniques to provide an update.

Method

In August 2020, MEDLINE, Embase and Web of Science were searched for eligible studies that compared these two techniques for the treatment of CMC-1 joint osteoarthritis (PROSPERO registration ID: CRD42020189728). Primary outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH and pain visual analogue scale (VAS) scores. Secondary outcomes, such as total complication, dislocation, and revision surgery rates, were also measured.

Results

From 1909 studies identified, 14 studies (1005 patients) were eligible. Our meta-analysis found that post-operative QuickDASH score was lower for patients in the JR group, indicating decreased disability following this technique (5 studies, p = 0.0002). However, pain VAS scores were similar between the two groups (5 studies, p = 0.22). Interestingly, JR techniques had significantly greater odds of overall complications (12 studies; OR 2.27; 95% CI 1.17-4.40, p = 0.02) and significantly greater odds of revision surgery (9 studies; OR 5.14; 95% CI 2.06-12.81, p = 0.0004).

Conclusions

Overall, based on low to moderate quality evidence, we found that JR treatments may result in better function with less disability with comparable pain (VAS) scores; however, JR has greater odds of complications and greater odds of requiring revision surgery. More robust RCTs that compare JR and TRAP with standardised outcome measures and long-term follow-up would add to the overall quality of evidence.

Biogenic link to the recent increase in atmospheric methane over India

Methane (CH₄) is a prominent Greenhouse Gas (GHG) and its global atmospheric concentration has increased significantly since the year 2007. Anthropogenic CH₄ emissions are projected to be 9390 million metric tonnes by 2020. Here, we present the long-term changes in atmospheric methane over India and suggest possible alternatives to reduce soil emissions from paddy fields. The increase in atmospheric CH₄ concentrations from 2009 to 2020 in India is significant, about 0.0765 ppm/decade. The Indo-Gangetic Plains, Peninsular India and Central India show about 0.075, 0.076 and 0.074 ppm/decade, respectively, in 2009-2020. Seasonal variations in CH₄ emissions depend mostly on agricultural activities and meteorology, and contribution during the agricultural intensive period of Kharif-Rabi (i.e., June-December) is substantial in this regard. The primary reason for agricultural soil emissions is the application of chemical fertilizers to improve crop yield. However, for rice farming, soil amendments involving stable forms of carbon can reduce GHG emissions and improve soil carbon status. High crop production in pot culture experiment resulted in lower potential yield-scaled GHG emissions in rice with biochar supplement. The human impact of global warming induced by agricultural activities could be reduced by using biochar as a natural solution.

Antifungal activity of Syzygium samarangense leaf extracts against Candida

Candida species are opportunistic human fungal pathogens that cause acute and chronic infections against which only few antifungal agents are available. Here we have elucidated the antifungal effect of Syzygium samarangense leaf extracts (SSLE). Antifungal activity of SSLE was studied against Candida albicans, C. krusei, C. parapsilosis, C. glabrata, C. auris and C. tropicalis. Following experiments were performed: minimum fungicidal concentration (MFC) determination, agar well disc diffusion assays, fungal morphology analysis using scanning electron microscope (SEM), ex vivo fungal survival assays on porcine tongue and skin and in vivo fungal survival assays using Drosophila melanogaster fly model. Results demonstrated MFC of SSLE ranges between 100 and 125 mg ml^-1 . SEM images showed cell wall degradation of C. albicans when treated with SSLE. Around 75% decrease in C. albicans viability was observed when infected porcine tongue and skin were treated using SSLE. The C. albicans infected D. melanogaster when fed with SSLE showed significant decrease (around 80%) of fungal count than the infected control. Furthermore, agar plate disc diffusion assays demonstrated that the antifungal activity of SSLE could be due to chalcone, which is one of the active constituents in SSLE. Our study demonstrated that SSLE could be used for the topical treatment of Candida infections.

Record high levels of atmospheric ammonia over India: Spatial and temporal analyses

Atmospheric ammonia (NH₃) is an alkaline gas and a prominent constituent of the nitrogen cycle that adversely affects ecosystems at higher concentrations. It is a pollutant, which influences all three spheres such as haze formation in the atmosphere, soil acidification in the lithosphere, and eutrophication in water bodies. Atmospheric NH₃ reacts with sulfur (SO_x) and nitrogen (NO_x) oxides to form aerosols, which eventually affect human health and climate. Here, we present the seasonal and inter-annual variability of atmospheric NH₃ over India in 2008-2016 using the IASI (Infrared Atmospheric Sounding Interferometer) satellite observations. We find that Indo-Gangetic Plains (IGP) is one of the largest and rapidly growing NH₃ hotspots of the world, with a growth rate of +1.2% yr^-1 in summer (June-August: Kharif season), due to intense agricultural activities and presence of many fertilizer industries there. However, our analyses show insignificant decreasing trends in annual NH₃ of about -0.8% yr^-1 in all India, about -0.4% yr^-1 in IGP, and -1.0% yr^-1 in the rest of India. Ammonia is positively correlated with total fertilizer consumption (r = 0.75) and temperature (r = 0.5) since high temperature favors volatilization, and is anti-correlated with total precipitation (r = from -0.2, but -0.8 in the Rabi season: October-February) as wet deposition helps removal of atmospheric NH₃. This study, henceforth, suggests the need for better fertilization practices and viable strategies to curb emissions, to alleviate the adverse health effects and negative impacts on the ecosystem in the region. On the other hand, the overall decreasing trend in atmospheric NH₃ over India shows the positive actions, and commitment to the national missions and action plans to reduce atmospheric pollution and changes in climate.

Association between multiple respiratory viral infections and pediatric intensive care unit admission among infants with bronchiolitis

Background

It is unclear whether multiple respiratory viral infections are associated with more severe bronchiolitis requiring pediatric intensive care unit (PICU) admission. We aimed to identify the association between multiple respiratory viral infections and PICU admission among infants with bronchiolitis.

Methods

We performed a 1:1 case-control study enrolling previously healthy full-term infants (≤12 months) with bronchiolitis admitted to the PICU as cases and those to the general pediatric ward as controls from 2015 to 2017. Multiplex polymerase chain reaction (PCR) was used for detection of the respiratory viruses. We summarized the characteristics of infants admitted to the PICU and the general pediatric unit. Multivariable logistic regression analysis was used to fit the association between multiple respiratory viral infections (≥2 strains) and PICU admission.

Results

A total of 135 infants admitted to the PICU were compared with 135 randomly selected control infants admitted to the general pediatric unit. The PICU patients were younger (median: 2.2 months, interquartile range: 1.3–4.2) than the general ward patients (median: 3.2 months, interquartile range: 1.6–6.4). Respiratory syncytial virus (74.1%), rhinovirus (28.9%), and coronavirus (5.9%) were the most common viruses for bronchiolitis requiring PICU admission. Patients with bronchiolitis admitted to the PICU tended to have multiple viral infections compared with patients on the general ward (23.0% vs. 10.4%, P < 0.001). In the multivariable logistic regression analysis, bronchiolitis with multiple viral infections was associated with higher odds of PICU admission (adjusted odds ratio: 2.56, 95% confidence interval: 1.17–5.57, P = 0.02).

Conclusion

Infants with multiviral bronchiolitis have higher odds of PICU admission compared with those with a single or nondetectable viral infection.

Second primary malignancy: A retrospective analysis report from a tertiary cancer center of North India

AIM OF STUDY

We analyzed the data of second primary malignancy (SPM) from one of the tertiary cancer centers of North India, and the basic aim was to retrieve incidence, prognosis, and outcomes.

MATERIALS AND METHODS

A retrospective study was conducted in the Department of Radiation Oncology in a tertiary cancer center between January 1, 2011, and December 31, 2015. A total of 6000 cases of cancer were analyzed, out of which cases who presented with histological proven synchronous SPM were included in this study.

RESULTS

The present study showed three cases (8.1%) of SPM who are attributed to field carcinogenesis. There were five cases in which metachronous malignancy develops in the previous radiation therapy field. There is 26% of synchronous malignancy as compared to 74% of metachronous malignancy. In the present study, most diagnosed synchronous malignancies were carcinoma breast, while in metachronous malignancies, carcinoma breast and gynecological cancers were most common.

CONCLUSIONS

SPMs are not very rare. Hence, pretreatment and follow-up evaluation should be meticulous to rule out SPMs.

A study of changes in the oral fungal flora of patients on radiotherapy for head and neck malignancies and their correlation with funguria and fungemia

BACKGROUND

Patients of head and neck malignancies often develop oral mucositis and invite various pathogens to colonize over it.

OBJECTIVES

The objective of this study is to identify the fungi isolated from patients undergoing radiotherapy (RT) for head and neck cancer, to determine the antifungal susceptibility of these isolates and to determine the time and week of fungal colonization.

PATIENTS AND METHODS

Three specimens (throat, urine, and blood) were collected from each of the head and neck cancer patients, who were advised RT. These specimens, which were collected before the start of RT, during RT (2nd and 6th week), and post-RT (8th week) were inoculated into fungal culture media. Candida species were identified by standard methods and antifungal susceptibility of the candidal isolates was done.

RESULTS

Candida infection was found in 24/42 patients (57.14%) out of which Candida albicans was isolated in 14.28%, Candida tropicalis (28.57%) and Candida parapsilosis (14.28%). Maximum isolation of yeast was in the 6th week of RT. Fungemia was found in 3/42 patients. All the yeast isolates were sensitive to fluconazole except two.

CONCLUSION

Prophylactic antifungal therapy in patients undergoing RT for head and neck malignancy is particularly important to prevent intraoral colonization and infection by Candida. Screening of such patients on RT for fungal infections can prevent fatal mold infections.

A Retrospective Comparative Study of Concomitant Chemoradiotherapy followed by Adjuvant Temozolomide Versus Radiotherapy Alone In Newly Diagnosed Glioblastoma Multiforme - An Experience at Radium Institute, Patna Medical College and Hospital, India

INTRODUCTION

Glioblastoma Multiforme (WHO grade IV glioma) still remains a dreadful diagnosis in oncology with the median survival ranging between 12 to 17 months, despite the recent advances in its management. It is the most common malignant primary tumour in adults(13). The standard of care is Maximal Safe Resection followed by Concomitant ChemoRadiotherapy.

METHODS

During the period 2006 to 2010 at Radium Institute, Patna Medical College and Hospital (PMCH) in India, a study was conducted on 37 newly diagnosed GBM cases in which the control-arm (c-arm) received Conventional Radiotherapy (60Gy/30#) only whereas the study arm (s-arm) received Concomitant Chemoradiotherapy followed by Adjuvant Temozolomide.

RESULTS

The median survival was 15.4 months in the s-arm as compared to 12.4 months in the c-arm. The OS showed a significant improvement with p-value of 0.05 and PFS also showed a benefit with a p-value of 0.005.

CONCLUSION

The results were encouraging with improvement in OS as well as PFS in the s-arm and were at par with the other similar studies conducted in different parts of the world.

Middle East respiratory syndrome coronavirus (MERS-CoV) infections in two returning travellers in the Netherlands, May 2014

Two patients, returning to the Netherlands from pilgrimage in Medina and Mecca, Kingdom of Saudi Arabia, were diagnosed with Middle East respiratory syndrome coronavirus (MERS-CoV) infection in May 2014. The source and mode of transmission have not yet been determined. Hospital-acquired infection and community-acquired infection are both possible.

Clinical evaluation of a new art material: Nanoparticulated resin-modified glass ionomer cement

Context:

The success of atraumatic restorative treatment (ART) technique depends on the restorative material; hence, clinical studies with various materials are necessary.

Aim:

The aim of the present study was to clinically evaluate and compare the nanoionomer and high-viscosity glass ionomer using United States Public Health Services (USPHS) Modified Cvar/Ryge Criteria with ART approach.

Materials and Methods:

Two primary molars in 50 healthy children aged between 5 and 8 years were selected for the study. The teeth were treated with ART and divided into two groups. The group 1 teeth were restored with nanoionomer (Ketac Nano 100 3M ESPE) and group 2 with high-viscosity glass ionomer cement (HVGIC), (Fuji IX GC). Each restoration was evaluated using the USPHS Modified Cvar/Ryge Criteria at baseline and 6 months’ and 12 months’ time interval.

Statistical analysis used:

Chi-squared (χ²) test.

Results:

Nanoionomer was significantly better than HVGIC with respect to color match at baseline, 6 months, and 12 months (P<0.001). Nanoionomers were also significantly better than HVGIC in case of cavosurface marginal discoloration and marginal adaptation (P<0.001) at 6 months and 12 months. There was no significant difference between the two materials with respect to secondary caries at 6 months (P>0.05), but at 12 months, nanoionomer was statistically better than HVGIC (P<0.05). There was no statistical significant difference with respect to anatomical form and postoperative sensitivity (P>0.05).

Conclusion:

The results indicate that nanoionomer can be a successful alternative restorative material for use with ART technique.