Background: Total Hip Arthroplasty remains the standard treatment protocol for patients with neglected traumatic dislocations of the hip with arthritis. A total hip arthroplasty needs to be frequently combined with a subtrochanteric shortening femoral osteotomy to aid in the reduction of the hip joint in such cases. Still long-term stable implant fixation, rigid construct, and favorable functional outcome remain a challenge. In respect to subtrochanteric shortening osteotomy, various techniques have been described in the literature, including the step-cut, double chevron, transverse, and oblique osteotomies. Out of these types, a subtrochanteric step-cut osteotomy provides a better rotational stability and a larger surface of contact to aid in union. As there is a paucity in the literature regarding the step-cut osteotomy for traumatic dislocations of the hip, we designed this study to evaluate the outcomes of this procedure. Methods: We prospectively evaluated 24 patients with neglected traumatic dislocations of the hip, who underwent total hip arthroplasty with a step-cut subtrochanteric shortening osteotomy using a long modular stem within a span of 4 years. The indications were severe pain and difficulty in walking and performing activities of daily living. Patients fulfilling the inclusion criteria were evaluated in terms of Harris Hip Score, leg length discrepancy, neurological status, union of the osteotomy, and implant stability. Results: The mean Harris Hip Score significantly improved from 33.4 preoperatively to 89.2 postoperatively at the latest follow-up. At the final follow-up, all patients showed union at the osteotomy site and there were no cases of implant loosening or instability. No neurological complications were reported. Conclusions Total hip arthroplasty combined with a step-cut subtrochanteric femoral shortening osteotomy in patients with neglected dislocations of the hip was associated with good functional outcome and higher success rates in terms of stable implant fixation and union at the site of osteotomy.

Background/Aims: Gluten-free diet has an excess of fats and simple sugars and puts patients with celiac disease at risk of metabolic complications including metabolic syndrome and fatty liver. We assessed prevalence of metabolic syndrome and fatty liver in two cohorts of celiac disease. Methods: Study was done in 2 groups. In group 1, 54 treatment naïve patients with celiac disease were recruited. Of them, 44 returned after 1-year of gluten-free diet and were reassessed. In group 2, 130 celiac disease patients on gluten-free diet for ≥1 year were recruited. All patients were assessed for anthropometric and metabolic parameters and fatty liver. Metabolic syndrome was defined as per consensus definition for Asian Indians. Fatty liver was defined as controlled attenuation parameter value >263 decibels by FibroScan. Results: In group 1, of 44 treatment naïve patients with celiac disease, metabolic syndrome was present in 5 patients (11.4%) at baseline and 9 (18.2%) after 1 year of gluten-free diet. Patients having fatty liver increased from 6 patients (14.3%) at baseline to 13 (29.5%) after 1year of gluten-free diet (P=0.002). In group 2, of 130 patients with celiac disease on gluten-free diet for a median duration of 4 years, 30 out of 114 (26.3%) and 30 out of 130 patients (23%) had metabolic syndrome and fatty liver, respectively. Conclusions Patients with celiac disease are at high risk of developing metabolic syndrome and fatty liver, which increases further with gluten-free diet. These patients should be assessed for nutritional and metabolic features and counseled about balanced diet and physical activity regularly.

Varying degrees of necrozoospermia are common findings in cases of male sub-fertility; however, it is rare to find persistent and 100 % necrozoospermia. A case of persistent 100 % necrozoospermia was presented in this paper, where aneuploidy analysis was carried out on sperm. No known associations like thyrotoxicosis, genital infection, spinal injury and diabetes were found. Sperm fluorescent in situ hybridization (FISH) was carried out to evaluate sperm aneuploidy for chromosome 1, 9, 12, 13, 16, 18, 21, X and Y and did not show any excess of aneuploidy over controls. To the best of our knowledge, this is the first attempt on meiotic segregation analysis on 100 % necrozoospermic patients.
Adult ; Aneuploidy ; Chromosome Mapping ; Chromosome Segregation ; genetics ; Humans ; In Situ Hybridization, Fluorescence ; Male ; Meiosis ; Necrosis ; Oligospermia ; genetics ; pathology ; Spermatozoa ; pathology

Purpose: Feeding jejunostomy (FJ) is a critical procedure to establish a source of enteral nutrition for upper gastrointestinal disorders. Minimally invasive surgery has the inherent benefit of better patient outcomes, less postoperative pain, and early discharge. This study aims to describe our total laparoscopic technique of Witzel FJ and to compare its outcome with its open counterpart. Methods: A retrospective database analysis was performed in patients who underwent laparoscopic (n = 20) and open (n = 21) FJ as a stand-alone procedure from July 2018 to July 2022. A readily available nasogastric tube (Ryles tube) and routine laparoscopic instruments were used to perform laparoscopic FJ. Perioperative data and postoperative outcomes were analyzed. Results: Baseline preoperative variables were comparable in both groups. The median operative duration in the laparoscopic FJ group was 180 minutes vs. 60 minutes in the open FJ group (p = 0.01). Postoperative length of hospital stay was 3 days vs. 4 days in the laparoscopic and open FJ groups, respectively (p = 0.08). Four patients in the open FJ group suffered from an immediate postoperative complication (none in the laparoscopic FJ group). After a median follow-up of 10 months, fewer patients in the laparoscopic FJ group had complications such as tube clogging, tube dislodgement, surgical-site infection, and small bowel obstruction. Conclusion Laparoscopic FJ with the Witzel technique is a safe and feasible procedure with a comparable outcome to the open technique. Patient selection is vital to overcome the initial learning curve.

BACKGROUND/AIMS: The data on the risk of tuberculosis (TB) reactivation with infliximab (IFX) in patients with inflammatory bowel disease (IBD) from TB endemic countries, like India, is limited. The risk of TB reactivation on IFX and its predictors in patients with IBD was assessed. METHODS: This retrospective review included consecutive patients with IBD who received IFX, and were on follow-up from January 2005 to November 2017. The data was recorded on age/disease duration, indications for IFX, screening for latent tuberculosis (LTB) before IFX, response to IFX, incidence and duration when TB developed after IFX, and type of TB (pulmonary [PTB]/extra-pulmonary [EPTB]/disseminated). RESULTS: Of 69 patients (22 ulcerative colitis/47 Crohn’s disease; mean age, 35.6±14.5 years; 50.7% males; median follow-up duration after IFX, 19 months [interquartile range, 5.5–48.7 months]), primary non-response at 8 weeks and secondary loss of response at 26 and 52 weeks were seen in 14.5%, 6% and 15% patients respectively. Prior to IFX, all patients were screened for LTB, 8 (11.6%) developed active TB (disseminated, 62.5%; EPTB, 25%; PTB, 12.5%) after a median of 19 weeks (interquartile range, 14.0–84.5 weeks) of IFX. Of these 8 patients’ none had LTB, even when 7 of 8 were additionally screened with contrast-enhanced chest tomography. Though not statistically significant, more patients with Crohn’s disease than ulcerative colitis (14.9% vs. 4.5%, P=0.21), and those with past history of TB (25% vs. 9.8%, P=0.21), developed TB. Age, gender, disease duration, or extraintestinal manifestations could not predict TB reactivation. CONCLUSIONS: There is an extremely high rate of TB with IFX in Indian patients with IBD. Current screening techniques are ineffective and it is difficult to predict TB after IFX.
Colitis, Ulcerative ; Crohn Disease ; Follow-Up Studies ; Humans ; Incidence ; India* ; Inflammatory Bowel Diseases* ; Infliximab* ; Interferon-gamma Release Tests ; Latent Tuberculosis ; Male ; Mass Screening* ; Retrospective Studies ; Thorax ; Tuberculosis* ; Ulcer