Objective: A high rate of implant failure is frequently observed in osteoporotic spines. The majority of patients with osteoporosis are relatively old and are often unfit for general anesthesia due to various systemic comorbidities. Cement-augmented pedicle screw fixation is designed to improve stability and fixation strength in patients with compromised bone quality. Methods: A total of 45 patients (23 women and 22 men), with a mean age of 71.37 years (range, 53–94 years), diagnosed with osteoporosis (T score > -2.5) and deemed unfit for general anesthesia, underwent instrumentation with polymethylmethacrylate augmentation of cannulated pedicle screws. In total, 214 pedicle screws were inserted: 28 patients received 4 screws and 17 patients received 6 screws, all with cement augmentation. Preoperative and postoperative visual analogue scale (VAS) scores for pain, as well as Oswestry Disability Index (ODI) questionnaire data, were analyzed. Screw migration, defined as the distance from the screw tip to the anterior cortex and the upper endplate of the vertebra, was also evaluated immediately after surgery. The mean follow-up period was 15.3 months. Results: The mean preoperative VAS was 8.76 (range, 7–10). As intractable pain was the most common complaint, significant improvement was observed postoperatively: the mean postoperative VAS decreased to 2.24 (range, 0–5) (p<0.001). ODI scores also showed significant improvement in quality of life as measured by the ODI (p<0.001). Conclusion Our results support the use of cement-augmented pedicle screw fixation in medically unfit patients with osteoporosis. This technique appears effective in increasing stabilization of fixation and preventing screw loosening in this patient population. The main complication observed was cement leakage.

Methods: This RCT included 60 patients (30 in control and 30 in intervention) between 18 and 80 years old, scheduled for elective single or double-level lumbar spine surgeries through the posterior approach. Intervention group (MBP) received PEGLEC, tablet Metronidazole 400 mg twice daily (BD), tablet Cefuroxime 500 mg BD, and probiotic (Bacillus clausii ) on pre-operation day, whereas the control (non-MBP) had no specific bowel preparation but received only a placebo. Outcome parameters included time to first flatus, bowel sound, and first defecation, which were compared between the two groups. Results: Demographic data such as age, sex, body mass index, level of surgery, and intraoperative data such as duration of surgery and blood loss were similar without significant differences. The time to first flatus, bowel sounds, and first defecation was not statistically significant, but POI was seen in 6.67% of patients, all belonging to the MBP group. No correlation observed between the duration of the ileus and the intraoperative blood loss and duration of surgery. Conclusions Bowel preparation may not be necessary for patients undergoing posterior lumbar spine surgery involving a maximum of two levels.

We describe a simple technique in which traction sutures placed at the palatal flap margin are passed through interdental embrasures and stabilized against adjacent teeth in the contra-lateral arch. This technique was used for 10 patients with impacted maxillary canines.In our clinical use, the technique eliminated the continuous demand of manual retraction, slippage of retractors during the procedure, palatal flap tear due to uneven distribution of retraction forces. Self-stabilizing interdental traction sutures are a practical, reproducible, and minimally invasive adjunct for palatal flap retraction during surgical exposure of impacted canines in selected clinical situations. The technique is particularly advantageous in single-surgeon procedures, resource-limited settings, and cases requiring prolonged palatal exposure for adjunctive orthodontic procedures, including button or attachment placement.

Objective: A cluster of leptospirosis and brucellosis cases in a semi-nomadic, pastoral community was reported in October 2023 from Village A, Uttarakhand State, India. This cluster was investigated to describe the epidemiology and potential exposures. Methods: Suspected cases were residents with sudden-onset fever or myalgia occurring from 1 August 2023 to 7 January 2024; confirmed cases were suspected cases with laboratory confirmation. Suspected cases were identified through a house-to-house case search and were interviewed regarding sociodemographic variables, symptoms and exposures. Those who consented were tested. Data were cleaned and analysed in Microsoft Excel. Results: Fifty suspected cases were identified among a total of 300 residents across 85 households. Among these, 27 agreed to be tested, and 25 were confirmed (13 with leptospirosis, 7 with brucellosis and 5 with both leptospirosis and brucellosis). The cases began in September 2023 following flooding and continued until January 2024, with no deaths. The median age (range) of cases was 30 (17–82) years for leptospirosis, 39 (25–56) years for brucellosis and 39 (22–50) years for coinfection. Altogether, females accounted for 92% (12/13) of leptospirosis cases, 57% (4/7) of brucellosis cases and 80% (4/5) of coinfections. Symptoms included fever, myalgia and arthralgia. All cases reported contact with floodwater and animal abortus. Discussion: This was a laboratory-confirmed co-occurring cluster of leptospirosis and brucellosis, including five cases of coinfection, following flooding, predominantly affecting female Van Gujjar dairy farmers. Education was provided to the community about the hygienic disposal of animal waste.

Owing to recent advancements in various postoperative treatment modalities, such as radiation, chemotherapy, antiangiogenic treatment, and immunotherapy, the radiological and clinical assessment of patients with isocitrate dehydrogenase-wildtype glioblastoma using post-treatment imaging has become increasingly challenging. This review highlights the challenges in differentiating treatment-related changes such as pseudoprogression, radiation necrosis, and pseudoresponse from true tumor progression and aims to serve as a guideline for efficient communication with clinicians for optimal management of patients with post-treatment imaging.

The paradigm of isocitrate dehydrogenase (IDH)-wildtype glioblastoma is rapidly evolving, reflecting clinical, pathological, and imaging advancements. Thus, it remains challenging for radiologists, even those who are dedicated to neuro-oncology imaging, to keep pace with this rapidly progressing field and provide useful and updated information to clinicians. Based on current knowledge, radiologists can play a significant role in managing patients with IDH-wildtype glioblastoma by providing accurate preoperative diagnosis as well as preoperative and postoperative treatment planning including accurate delineation of the residual tumor. Through active communication with clinicians, extending far beyond the confines of the radiology reading room, radiologists can impact clinical decision making. This Part 1 review provides an overview about the neuropathological diagnosis of glioblastoma to understand the past, present, and upcoming revisions of the World Health Organization classification.The imaging findings that are noteworthy for radiologists while communicating with clinicians on preoperative and immediate postoperative imaging of IDH-wildtype glioblastomas will be summarized.

The complex architecture of the papillary muscles (PMs) of the ventricles plays a crucial role in cardiac function and pathology. This comparative study aimed to examine the differences in PMs morphology between the right and left ventricles, focusing on their number, location, and shape. A total of 38 grossly normal hearts from donated bodies were dissected, and the number, location, and shape of PMs in both ventricles were observed. In this study, the left ventricle predominantly exhibited a single PM with 71.05% on the sternocostal surface and 57.89% on the diaphragmatic surface.The right ventricle showed a higher prevalence of single PM, at 89.47% on the sternocostal surface and 63.16% on the diaphragmatic surface. Broad-based shape of the PM emerged as the predominant variant, constituting 55.26% and 44.73% on the sternocostal and diaphragmatic surfaces of the left ventricle, respectively. In contrast, conical-shaped PM predominated in the right ventricle. Unique findings included “H” and “b” shaped muscles, conjoint PMs were observed exclusively in the left ventricle, and small papillary projections with direct tendinous cord attachment in the right ventricle. A distinct webbed shaped configuration of PM was exclusively observed in the right ventricle in only one specimen. No significant difference (P=0.84) was noted in muscle bellies between ventricular surfaces. This study emphasizes the complexity and variability in PM morphology, highlighting the importance of a thorough understanding of these structures for cardiothoracic surgeons, radiologists, and cardiologists to enhance interventional techniques.