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Fulltext Anticipating Urinary Retention Following Total Hip and Total Knee Replacements

Hamed Y, Ramesh A, Taylor R, Michaud R

Malays Orthop J, 2020 Nov;14(3):110-113.
PMID: 33403070 DOI: 10.5704/MOJ.2011.017

Introduction: Urinary retention is a widely recognised postoperative complication. Although anecdotally lower limb arthroplasty is linked with high rates of urinary retention, there are no current accepted standards for determining which patients are at higher risk and should therefore be offered intra operative catheterisation.
Materials and Methods: One hundred patients, 55 females and 45 males, who underwent uncomplicated total hip or total knee replacements at Furness General Hospital were recruited between January and April 2017.
Results: Post-operative urinary retention was seen frequently, with 38 patients (38%) requiring post-operative catheterisation. Twenty-one males (46%) developed postoperative retention compared to 17 (30%) of females, representing a statistically significant increase in risk seen in male patients. (p 0.009). Post-operative urinary retention requiring catheterisation was associated with increasing age, with those over 75 years having a significantly higher risk than those less than 75 years irrespective of gender (p 0.04). There was no significant difference in urinary retention rates between patients who had general (n=21) or spinal anaesthetic (n=79) with 33% of GA patients and 39% of spinal anaesthetic patients requiring catheterisation (p 0.17).
Conclusion: There are increased rates of urinary retention seen in lower limb arthroplasty patients than those described in the general surgical population, with male patients and all those over 75 years of age having a significantly higher risk. Clinically, it may therefore be sensible to consider offering routine intra operative catheterisation to this cohort of patients.
Fulltext Accuracy of Femoral Tunnel Placement between Anteromedial and Anterolateral Visualisation Portals in Anterior Cruciate Ligament Reconstruction - Outcomes of a CT based Cross-Sectional Study

Balaji G, Yadav G, Patel SA, Ramesh A, Nema S, Ramalingam T

Malays Orthop J, 2023 Jul;17(2):7-12.
PMID: 37583529 DOI: 10.5704/MOJ.2307.002

INTRODUCTION: Anatomical femoral tunnel placement is critical for anterior cruciate ligament reconstruction (ACLR). Tunnel placement may vary with different surgical techniques. The aim of this study was to compare the accuracy of femoral tunnel placement between the Anteromedial (AM) and Anterolateral (AL) visualisation portals on post-operative CT scans among a cohort of ACLR patients.
MATERIALS AND METHODS: This cross-sectional study was conducted from January 2018 to March 2020 after obtaining ethics clearance. Patients who went for arthroscopic ACLR in our institute were divided into an AM (group 1) and an AL (group 2) based on the visualisation portal for creating the femoral tunnel and a 3D CT scan was done. The femoral tunnel position was calculated in deep to shallow and high to low direction using the Bernard Hertel grid. Femoral tunnel angle was measured in the 2D coronal image. Statistical analysis was done with the data collected.
RESULTS: Fifty patients with an average age of 26.36 (18-55) years ±7.216 SD were enrolled in the study. In this study, the AM technique was significantly more accurate (p<0.01) than the AL technique in terms of femoral tunnel angle. Furthermore, the deep to the shallow position was significantly (p= 0.018) closer to normative values, as determined by the chi-square test. The chances of error in tunnel angle in femoral condyle are 2.6 times greater in the AL technique (minimal clinical difference).
CONCLUSION: To conclude, in ACLR the anteromedial visualisation portal can facilitate accurate femoral tunnel placement compared to the anterolateral visualisation portal.
Fulltext A challenge in soft tissue reconstruction: The use of pedicled anterolateral thigh fasciocutaneous flap and gluteal fasciocutaneous rotational flap in reconstructing a huge full thickness lateral trunk defect

Yi L, Jimeno ZKL, Sasidaran RA, Feng PA, Nik Lah NAS

Ann Med Surg (Lond), 2021 Nov;71:102933.
PMID: 34745600 DOI: 10.1016/j.amsu.2021.102933

Introduction and importance: Lateral abdominal wall (LAW) defect presents as a rare and unique challenge to the reconstructive surgeons.
Case presentation: We report a huge recurrent right lateral abdominal DFSP with local invasion in a 35-year-old lady. After wide local excision, the reconstruction was done by using pedicled anterolateral thigh fasciocutaneous flap and gluteal fasciocutaneous rotational flap.
Clinical discussion: The goal of reconstruction of the lateral abdominal wall is similar to that of the anterior abdominal wall, namely to provide a static repair that will not attenuate and form a bulge or hernia over time. Anchoring a mesh to stable fixation points is expected to ensure structural integrity in the LAW defect. However, we selected fascial inset from our flaps which did not lead to hernia formation or a bulge following a 7-month postoperative review. In terms of soft tissue coverage, the pedicled anterolateral thigh fasciocutaneous flap and gluteal fasciocutaneous rotational flap were used. The standard free flap will require more complexity of works, especially if the recipient vessels for microsurgical reconstruction are remotely situated or sometimes not even available.
Conclusion: Huge full-thickness LAW defect following an oncological resection can be reconstructed with combination of simpler locoregional flaps which yield good functional and aesthetic outcome.
Fulltext Host-dependent molecular factors mediating SARS-CoV-2 infection to gain clinical insights for developing effective targeted therapy

Shafi G, Desai S, Srinivasan K, Ramesh A, Chaturvedi R, Uttarwar M

Mol Genet Genomics, 2021 May;296(3):501-511.
PMID: 33743061 DOI: 10.1007/s00438-021-01774-1

Coronavirus disease 2019 (COVID-19), a recent viral pandemic that first began in December 2019, in Hunan wildlife market, Wuhan, China. The infection is caused by a coronavirus, SARS-CoV-2 and clinically characterized by common symptoms including fever, dry cough, loss of taste/smell, myalgia and pneumonia in severe cases. With overwhelming spikes in infection and death, its pathogenesis yet remains elusive. Since the infection spread rapidly, its healthcare demands are overwhelming with uncontrollable emergencies. Although laboratory testing and analysis are developing at an enormous pace, the high momentum of severe cases demand more rapid strategies for initial screening and patient stratification. Several molecular biomarkers like C-reactive protein, interleukin-6 (IL6), eosinophils and cytokines, and artificial intelligence (AI) based screening approaches have been developed by various studies to assist this vast medical demand. This review is an attempt to collate the outcomes of such studies, thus highlighting the utility of AI in rapid screening of molecular markers along with chest X-rays and other COVID-19 symptoms to enable faster diagnosis and patient stratification. By doing so, we also found that molecular markers such as C-reactive protein, IL-6 eosinophils, etc. showed significant differences between severe and non-severe cases of COVID-19 patients. CT findings in the lungs also showed different patterns like lung consolidation significantly higher in patients with poor recovery and lung lesions and fibrosis being higher in patients with good recovery. Thus, from these evidences we perceive that an initial rapid screening using integrated AI approach could be a way forward in efficient patient stratification.