Purpose: Reports remain sparse on the outcomes of quadratus femoris muscle pedicle bone grafting (QF-MPBG) for osteonecrosis of the femoral head (ONFH) in the existing literature. This study reports on the clinico-radiological outcomes of this procedure in early-stage non-traumatic ONFH using a quadriceps-coxae sparing (QCS) modified posterior approach. Materials and Methods: This prospective study included 22 symptomatic patients suffering from early-stage, non-traumatic ONFH. These patients underwent QF-MPBG surgery using a QCS modified posterior approach and were followed up for a minimum duration of 24 months. Results: The mean age of patients was 29 years (range, 20-47 years). As per the modified Kerboul’s combined necrotic angle, the distribution of patients was as follows: grade 1 (n=5); grade 2 (n=9); grade 3 (n=4); and grade 4 (n=4). All four patients belonging to grade 4 and two belonging to grade 3 required total hip arthroplasty (THA) within 24 months. As per the modified Ficat’s classification, 18 cases were in stage II and four in stage I. Six cases (out of the preoperative 18 cases classified as stage II) deteriorated to stage IV, and two deteriorated to stage III. The mean Harris hip score improved from 63 (range, 57-67) to 75 (range, 50-93) after surgery (P<0.05). Four out of six patients necessitating THA had steroid-induced ONFH. Conclusion The QCS modified posterior approach provides sufficient exposure required for QF-MPBG. Steroid-induced ONFH and a modified Kerboul’s combined necrotic angle of >250° may be considered as potential risk factors for progression of this disease.

Background: and Purpose Autoimmune encephalitis (AIE) following coronavirus disease 2019 (COVID-19) is an underexplored condition. This study aims to systematically review the clinico-investigational and pathophysiologic aspects of COVID-19 and its vaccines in association with AIE, and identify the factors predicting neurological severity and outcomes. Methods: Relevant data sources were searched using appropriate search terms on January 15, 2022. Studies meeting the criteria for AIE having a temporal association with COVID-19 or its vaccines were included. Results: Out of 1,894 citations, we included 61 articles comprising 88 cases: 71 of COVID-19-associated AIE, 3 of possible Bickerstaff encephalitis, and 14 of vaccine-associated AIE.There were 23 definite and 48 possible seronegative AIE cases. Anti-NMDAR (N-methyl-D-aspartate receptor; n=12, 16.9%) was the most common definite AIE. Males were more commonly affected (sex ratio=1.63) in the AIE subgroup. The neurological symptoms included altered mental state (n=53, 74.6%), movement disorders (n=28, 39.4%), seizures (n=24, 33.8%), behavioural (n=25, 35.2%), and speech disturbances (n=17, 23.9%). The median latency to AIE diagnosis was 14 days (interquartile range=4–22 days). Female sex and ICU admission had higher risks of sequelae, with odds ratio (OR) of 2.925 (95% confidence interval [CI]=1.005–8.516) and 3.515 (95% CI=1.160–10.650), respectively. Good immunotherapy response was seen in 42/48 (87.5%) and 13/13 (100%) of COVID-19-associated and vaccine-associated AIE patients, respectively. Sequelae were reported in 22/60 (36.7%) COVID-19 associated and 10/13 (76.9%) vaccine-associated cases. Conclusions The study has revealed diagnostic, therapeutic, and pathophysiological aspects of AIE associated with COVID-19 and its vaccines, and its differences from postinfectious AIE.Systematic review registration PROSPERO registration number CRD42021299215

As a safety measure, dentures are routinely removed before surgery. Aspiration of a denture could be catastrophic, with medicolegal implications. Foreign body aspiration is uncommon in adults; however, aspirations may remain asymptomatic and undiagnosed for long periods of time. We report an adult male who presented with a cough for more than 6 months. On radiography, a foreign body was found migrating within the tracheobronchial tree from one mainstem bronchus to the other, at different time points. The foreign body was later found to be a portion of his denture. The aspiration may have occurred at the time of a surgical procedure.
Adult ; Airway Management ; Aspirations (Psychology) ; Bronchi ; Bronchoscopy ; Cough ; Dentures ; Foreign Bodies ; Humans ; Male ; Radiography ; Trees