Bhabha Hospital

Carica papaya leaf extract (CPLE) is known to increase platelet counts (PCs) in certain infections. Patients were randomly assigned in a 2:1 ratio to the CPLE or placebo arm and continued treatment until the PC improved to 75,000 × 109/L or above, a platelet transfusion was required, or upto D+10. The primary outcome was to evaluate whether CPLE improves PC faster compared with placebo in a significant proportion of patients with a modified intention-to-treat protocol. Between March 2020 and October 2024, 219 patients were randomly assigned, of whom 198 patients (CPLE arm: 129; placebo arm: 69) were analyzed for outcomes. The primary end point with modified intention-to-treat analysis showed a statistically significant increase in PC to ≥75,000 × 109/L in a greater proportion of patients by D+4 compared with placebo (59% v 44%; P = .042). The primary outcome of increasing PC >75,000 × 109/L at D+4 was significantly improved by CPLE (83/129, 64% v 33/69, 48%; P = .034) compared with placebo as per protocol analysis. There was no grade 3 or grade 4 treatment-related adverse events associated with CPLE. About 43% of patients in the placebo arm versus 25% of patients in the CPLE arm needed dose reductions or delays in their subsequent chemotherapy treatment for patients with grade 2 chemotherapy-induced thrombocytopenia (CIT) at the baseline (P 0.033) and not significant in grade 3 CIT. CPLE is a potential therapeutic intervention to improve CIT faster and to a greater extent than placebo in this phase III randomized trial without any safety concerns. It could be potentially used as a secondary prophylaxis to maintain the chemotherapy intensity.

Background: Plasma cell neoplasms encompass a spectrum of disorders ranging from monoclonal gammopathy of undetermined significance (MGUS) to multiple myeloma (MM), characterized by clonal plasma cell proliferation and M-protein production. Accurate diagnosis and risk stratification are critical for clinical management, aided by immunophenotyping and cytogenetic profiling. Methods: This retrospective study analysed 57 plasma cell neoplasm cases diagnosed via flow cytometry at a North Indian tertiary care center from January to November 2024. Flow cytometric expression of CD27, CD28, CD56, CD117, and CD319 was evaluated alongside cytogenetic abnormalities using FISH. Cases were risk-stratified according to ISS, R-ISS, and IMWG systems. Statistical associations were assessed using appropriate tests, with significance defined as p

To assess the efficacy and safety of oral melatonin in treating sleep problems in children with cerebral palsy (CP). A randomized, double-blind, placebo-controlled trial was conducted at a tertiary care government hospital in 120 children with CP (3 to 12 y) suffering from sleep problems and who failed to respond to non-pharmacological therapy (4 wk). Participants were randomized to receive oral melatonin (3mg escalated to 10mg)/ placebo for 12 wk. Sleep measures included the Sleep Disturbance Scale for Children (SDSC), and caregivers reported sleep and nap diaries (SND). Outcome measures included decreased sleep onset latency (SOL) and increased total sleep time (TST) calculated using sleep diaries at 4 and 12 wk. The mean (SD) total sleep time in the melatonin and placebo groups was 5.09 (0.76) vs. 4.90 (0.77) h [Mean difference (MD) 0.19; P = 0.17] at baseline; 5.66 (0.84) vs. 4.89 (0.83) h (MD 0.77; P < 0.001) at 4 wk; 6.29 (0.78) vs. 4.98 (0.85) h (MD 1.31; P < 0.001) at 12 wk, respectively. The mean (SD) sleep onset time in melatonin and placebo groups was 79.18 ± 17.89 vs. 76.78 ± 13.60min (MD 2.4; P = 0.41) at baseline; 63.70 ± 16.63 vs. 72.89 ± 15.38min (MD 9.19; P < 0.003) at 4 wk; 43.20 ± 15.57 vs. 70.92 ± 14.95min (MD 27.72; P < 0.001) at 12 wk, respectively. Melatonin was well tolerated with minimal side effects (n = 10). Melatonin, at a dose range of 3-10mg once daily can significantly reduce SOL and improve TST in children with CP who have sleep problems with minimal adverse effects.

Background:Routine Papanicolaou (PAP) stain is a commonly adopted cytological method of diagnosing lesions of the oral piece, but it suffers drawbacks on the issue of time, cost, and reagents consumed. Faster and cheaper alternatives have been suggested, which are modified ultrafast PAP (MUFP) and rapid economic acetic Papanicolaou (REAP).Purpose:The aim of the study was to evaluate the quality of staining, staining efficiency, and cost-effects of PAP, MUFP, and REAP staining techniques in the oral cytology and to know which one offers the best overall diagnostic advantage.Materials and Methods:The experiments were carried out on 30 volunteers; none had any oral pathology or a history of smoking. Each volunteer gave three smears. There was PAP-stained, MUFP-stained, and REAP-stained one. Cell morphology and staining in general were assessed by three independent observers. It was measured in time and cost. Statistical tests (Chi-square) were carried out to identify statistical differences.Results:Most observers found the quality of cell morphology stains to be unchanged among three approaches, showing no statistically significant difference. Nonetheless, MUFP was much better in overall quality of staining and proved to be the most time- and cost-effective one.Conclusion:MUFP and REAP stain with similar or even higher quality than PAP conventional and will be better suited in cases where there is an urgency of staining and where economy staining is necessary in a clinical environment.

AimsFollowing resection of a primary bone tumour, reconstruction is commonly performed using either a megaprosthesis or biological reconstruction. Periprosthetic joint infection (PJI) remains one of the most frequent complications. Various treatment strategies exist for PJI, including debridement, antibiotics, and implant retention (DAIR), and single- and two-stage revision, although consensus on optimal management remains elusive. This study aimed to investigate the global practices regarding DAIR in tumour cases through an electronic survey among orthopaedic oncology surgeons.MethodsA global cross-sectional observational survey study was distributed to 272 orthopaedic oncology surgeons who attended the BOOM Consensus Meeting in January 2024. The survey contained 19 multiple choice questions focusing on DAIR practices. Responses were collected anonymously and analyzed using descriptive statistics.ResultsThe survey was completed by 173/272 surgeons (64%) from 44 countries. While 62% (169/272) routinely performed radical soft-tissue debridement in DAIR, only 39% exchanged all modular components, indicating variability in surgical approaches. DAIR was more commonly performed in acute rather than chronic infections, with 55% finding it very useful in acute cases. The use of local antibiotic delivery was supported by 56%, although only 49% found antibiotic cement coatings beneficial. Systemic antibiotic duration post-DAIR varied, with 39% favouring six weeks and 35% preferring three months.ConclusionThe study highlights global inconsistencies in DAIR practices for PJI in orthopaedic oncology, with financial disparities impacting modular component exchange. Standardized definitions are lacking, and we propose that if only polyethylene is changed, then the procedure is referred to as ‘poly exchange’; we recommend defining the procedure as DAIR when extensive debridement, lavage, and removal, wash, and reimplanting of all modular components is done while retaining stable stems, followed by suppressive antibiotic therapy; and finally, we recommend that if all the modular components are changed for new ones, the procedure is referred to as ‘DAIR plus’.Cite this article: Bone Jt Open 2025;6(11):1495–1503.

High-energy proximal tibial fractures, particularly Schatzker Type VI, pose significant treatment challenges due to their complexity and associated soft-tissue compromise. Early surgical intervention in the presence of severe swelling and blistering increases the risk of complications. Staged or delayed management remains the preferred approach in such scenarios. We report the case of an elderly male patient who sustained a comminuted right proximal tibial fracture following a crush injury caused by the toppling of a sugarcane-laden truck. On presentation, he had gross swelling, multiple skin blisters, and extensive soft-tissue trauma. In view of the critical soft-tissue condition, initial management was conservative and included limb elevation, anti-inflammatory medications, analgesia, sterile dressings, and active toe mobilization. Once the soft-tissue status improved – indicated by subsidence of swelling and appearance of skin wrinkles – definitive internal fixation was performed. An anterolateral locking plate was used for the lateral tibial plateau, and the medial condylar fragment was stabilized with partially threaded cancellous screws. Postoperative recovery was uneventful, and physiotherapy was initiated early. The patient achieved full weight-bearing mobility with excellent joint function at follow-up. This case highlights the efficacy of a soft-tissue-guided, staged approach in the management of complex tibial plateau fractures. Conservative initial management, followed by timely fixation using limited surgical exposure, can minimize complications and ensure excellent functional outcomes.

The establishment of a dedicated Musculoskeletal Oncology Unit within a healthcare system requires meticulous planning, coordination, and collaboration among diverse medical professionals. A multidisciplinary team approach is essential for delivering comprehensive, patient-centered care to individuals diagnosed with musculoskeletal malignancies. Integrating orthopaedic oncology into existing oncology services enhances clinical care, addressing the needs of patients with musculoskeletal tumours and providing supportive/palliative care for skeletal lesions from other primary tumours. Core members of a successful unit typically include orthopaedic surgeons, medical and radiation oncologists, radiologists, pathologists, physical therapists, and specialized nursing staff. Additionally, integrating supportive disciplines such as nutritionists, social workers, and palliative care specialists is crucial for addressing the multifaceted needs of patients. Reconstruction and rehabilitation are vital for restoring patient function. Establishing an MSK Oncology Unit within an existing oncology framework optimizes the use of shared diagnostic services like radiology, onco-pathology, nuclear imaging, and therapeutic services, providing a cost-effective model. The Department of Orthopaedic Oncology requires team members who can provide care in the operating theatre, surgical ward, and emergency departments. Given the complexity of bone and soft tissue tumour surgeries, access to surgical intensive care and blood bank support is essential. Coordinating diverse professionals presents challenges due to differing expertise and priorities, but a cohesive multidisciplinary team can yield transformative benefits. Moreover, advancements in medical technology-such as modular operating theatres, navigation equipment, 3D imaging techniques, and custom implant manufacturing-are shaping the future of personalized care in Musculoskeletal Oncology. This article summarizes our experience in establishing a MSK Oncology Unit at a tertiary cancer care level, asserting that the concept of a free-standing orthopaedic oncologist is a myth, as the foundation of this department is rooted in teamwork.

A retrospective study of 18 pediatric patients with high-risk relapsed/refractory classical Hodgkin lymphoma demonstrated that a fixed low-dose combination of nivolumab and bendamustine achieved an 88% complete response rate, with 1-year progression-free survival (PFS) of 88.2% and overall survival (OS) of 94.4%.