Saifee Hospital

BACKGROUNDThe optimal surgical approach for patients with primary glenohumeral osteoarthritis (GHOA) and an intact rotator cuff remains debated. While anatomic total shoulder arthroplasty (TSA) has traditionally been favoured, reverse TSA (RTSA) is increasingly utilized.AIMTo systematically compare the outcomes of RTSA and TSA in this specific patient population.METHODSA systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Retrospective comparative studies evaluating RTSA and TSA in patients with GHOA and intact rotator cuff were included. Key outcomes assessed included complication and reoperation rates, patient-reported outcome measures (PROMs), and range of motion. Risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool.RESULTSTwelve studies encompassing 1608 patients (580 RTSA, 1028 TSA) met inclusion criteria. RTSA was associated with a lower reoperation rate compared to TSA [odds ratio = 0.37; 95% confidence interval (CI): 0.14-0.94; P value = 0.04], while no significant difference in overall complication rates was observed (odds ratio = 0.47; 95%CI: 0.19-1.16; P value = 0.10). RTSA patients showed superior outcomes in University of California Los Angeles, Simple Shoulder Test, and Shoulder Pain and Disability Index scores; however, the differences did not exceed the minimal clinically important difference. TSA patients had significantly better external rotation (mean difference= -9.0°; 95%CI: -13.21 to -5.02; P value < 0.0001). No significant differences were found in other range of motion measures or satisfaction scores. The overall methodological quality of included studies was moderate to serious.CONCLUSIONIn patients with GHOA and an intact rotator cuff, RTSA may offer comparable or improved outcomes to TSA with lower reoperation rates and similar complication profiles. Functional outcomes favour RTSA in certain patient-reported outcome measures, while TSA retains an advantage in external rotation. Surgical decision-making should remain individualized based on patient characteristics and functional demands.

Ovarian cancer (OC) is a complex disease with challenges such as delayed diagnosis and development of chemoresistance. Exosomes play a crucial role in intercellular communication within the tumor microenvironment and have been reported to transmit drug-resistant traits and promote proliferation and metastasis. We aimed to investigate the role of exosomal miRNAs in OC, focusing on their involvement in chemoresistance, immune evasion, and metastasis. We investigated the expression levels of miR-182, miR-9, miR-130a, miR-20a, and miR-23b, which are implicated in chemoresistance, immune evasion, and metastasis in OC. We used real-time PCR to assess the expression of these miRNAs in different exosomal and non-exosomal fractions isolated from the serum of 20 chemo naive, 20 chemotreated, and 20 healthy women. Our results revealed that ovarian tumors release higher levels of EpCAM-positive exosomes, which carry specific miRNAs that reflect the tumor's influence on the exosomal cargo. Elevated levels of miR-182, and miR-9 were found in EpCAM-positive exosomes from OC patients, with miR-182 being associated with disease relapse and the FIGO stage. In addition, miR-20a was found to be elevated in exosomes from chemotherapy-treated OC patients, indicating chemotherapy's impact on the exosomal miRNA profile. Notably, the miRNA expression in EpCAM-negative exosomes remained unchanged, highlighting the selective loading of miRNAs in EpCAM-positive exosomes. Overall, the study highlights a probable mechanism for miRNA packaging and release in OC through EpCAM-positive exosomes, offering potential biomarkers for monitoring disease progression and relapse.

Locally advanced squamous cell carcinomas of the head and neck (LA-SCCHN) are one of the most common cancers globally and in India. Though many treatment options are available for LA-SCHHN, chemotherapy administered concurrently with radiotherapy (CCRT) is the most common treatment modality. Cisplatin-based CCRT is the guideline-recommended standard of care (SoC) in definitive and adjuvant settings. However, cisplatin-based CCRT often fails or cannot be administered due to toxicity. Hence, 60% of LA-SCCHN patients experience locoregional recurrence, and 20% experience distant metastasis. Many of these patients are cisplatin-ineligible/unfit due to absolute or relative contraindications; thus, continued cisplatin-based CCRT is unsuitable for them. Hence, alternative treatment strategies have been suggested for cisplatin-unfit LA-SCCHN patients and include docetaxel, carboplatin, and cetuximab-based regimens. Of these, docetaxel and carboplatin-based regimens have an unfavorable toxicity profile when compared with cetuximab-based regimens. Additionally, cetuximab-based regimens have demonstrated good locoregional control (LRC), improved disease-free survival (DFS), and OS (including 5-year OS) in LA-SCCHN patients. Therefore, Indian and international guidelines recommend cetuximab-based regimens for cisplatin-ineligible/unfit LA-SCCHN patients, Cetuximab is a costly drug for Indian patients. However, with the availability of cetuximab biosimilars, it has become possible to extend the drug's benefits to cisplatin-ineligible/unfit LA-SCCHN patients in India. Hence, this Expert opinion from India was organized, and nine consensus statements were drafted to highlight the various clinical settings where cetuximab-based regimens can benefit cisplatin-ineligible/unfit LA-SCCHN patients. An attempt was also made to understand the burden and causes of cisplatin ineligibility and toxicity in Indian patients.

Introduction:Posterolateral corner (PLC) injuries are often associated with cruciate ligament tears. Historically known as the “dark side” of the knee, advancements have greatly improved our understanding of the PLC, offering various management options today.Case Report:We present the case of a 44-year-old male with a combined PLC and posterior cruciate ligament (PCL) Grade 2 injury. He was managed with an isolated PLC reconstruction using an open anatomical Arciero-based technique with a tibialis anterior allograft. At subsequent follow-ups, the patient was shown to have excellent knee functional outcomes, no instability, and ease of performing regular activities, including low to moderate-demand sporting activities.Conclusion:Effective management of combined PLC and PCL injuries necessitates early identification of the PLC injury and a case-specific management approach, considering factors such as the patient’s condition, surgeon expertise, and graft availability. Allografts are a viable alternative to autografts for PLC reconstruction, offering several advantages over the latter.

We study the distributed function computation problem with <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$k$</tex> users of which at most <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$s$</tex> may be controlled by an adversary and characterize the set of functions of the sources the decoder can reconstruct robustly in the following sense if the users behave honestly, the function is recovered with high probability (w.h.p.); if they behave adversarially, w.h.p, either one of the adversarial users is identified or the function is recovered with vanishingly small distortion.

In India, the increasing prevalence of diabetes and obesity poses a significant threat towards a surge in the incidence of metabolic dysfunction‐associated steatotic liver disease (MASLD), formerly known as non‐alcoholic fatty liver disease (NAFLD). Concomitant with the evolving guidelines, there is a need to direct and spread awareness among practicing diabetologists to identify and screen high‐risk individuals for MASLD for timely management. Its asymptomatic nature and the evolving guidelines on diagnosis have hindered the precise estimates of MASLD in the high‐risk group of individuals in a clinical setting. Therefore, an expert panel of diabetologists from India convened to review, discuss and document the approach towards screening, diagnosis and management of MASLD. Serum biomarkers, simple non‐invasive tools and imaging techniques could direct the risk stratification of the patients. Early lifestyle interventions including weight loss and exercise are beneficial. The pharmacological landscape of drugs directed to insulin resistance, lipid metabolism, oxidative stress, inflammation, apoptosis and fibrogenesis pathways for the management of MASLD is expanding. In summary, the consensus statements are expected to serve as a useful guide in the screening and management of MASLD in the region and to direct a well‐planned study design that could enhance the scientific value of these statements.

Oral and intravenous iron therapy for the treatment of iron deficiency anemia during antenatal and postnatal period: An expert consensus - IJOGR- Print ISSN No: - 2394-2746 Online ISSN No:- 2394-2754 Article DOI No:- 10.18231/j.ijogr.2025.051, Indian Journal of Obstetrics and Gynecology Research-Indian J Obstet Gynecol

Background Hip fractures, particularly among the aging population, present a significant burden due to their association with morbidity, mortality, and long-term disability. Total hip arthroplasty (THA) is increasingly being adopted for fracture management in active patients, but implant performance data in real-world Indian settings remain sparse. This study assesses the early clinical efficacy, functional outcomes, and implant survivorship of the Latitud™ total hip replacement system (HRS) (Meril Healthcare Pvt. Ltd., Vapi, India), a novel prosthesis designed and manufactured in India, in patients undergoing THA for hip fractures. Methods This post hoc analysis derives from a prospective, multi-center, post-marketing surveillance study conducted across 11 tertiary care centers in India. A total of 44 adult patients presenting with various fracture patterns, including femoral neck, femoral head, intertrochanteric, sub-capital, and head-neck fractures, were evaluated following THA using the Latitud™ HRS. The primary objectives of the study were implant survivorship and adverse events over a two-year follow-up period, whereas the secondary objective of the study was to assess functional outcomes using the Harris hip score (HHS) and Oxford hip score (OHS) at six weeks, six months, one year, and two years postoperatively. Paired t-tests or Wilcoxon signed-rank tests were used for statistical comparisons, with p < 0.05 considered significant. Results A total of 44 patients were identified with the following fracture types: femoral neck (n = 18), femoral head (n = 8), head-neck (n = 2), and hip fractures (n = 12), with one case each of intertrochanteric, subcapital, intracapsular neck of femur (ICNF), and neck of femur fractures due to fall at home. Functional outcomes significantly improved, with the mean HHS increasing from 9.19 ± 9.52 preoperatively to 89.61 ± 3.57 (p < 0.0001), and the OHS from 4.89 ± 4.41 to 44.89 ± 3.77 (p < 0.0001). No serious adverse events were observed apart from the isolated revision case. At two years, implant survivorship was 97.7%, with a single revision due to polyethylene liner fracture. No other major complications, including infections, dislocations, or periprosthetic fractures, were reported. Conclusion The Latitud™ HRS demonstrated excellent short-term survivorship and marked functional improvement in patients with hip fractures, with minimal complications. These findings support its safety and effectiveness in the Indian clinical context and suggest its potential as a reliable implant for fracture-related THA. Further large-scale, long-term comparative studies are warranted to confirm these outcomes.

Mupirocin (MUP), a potent antibacterial agent, has been a cornerstone of topical antimicrobial therapy for several decades. As an older, yet widely used antibiotic, MUP has exhibited efficacy against various bacterial strains, making it a versatile tool in the management of a range of infections. The review synthesizes available literature to highlight the evolution of MUP, from its initial discovery to its current status as a go-to topical antibiotic. In the era of rising antibiotic resistance, MUP is positioned as a valuable therapeutic option due to its broad-spectrum activity against gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). Emphasis is placed on its distinctive role in different infections, enhanced efficacy with different additives, and newer drug delivery strategies.In addition to its classical applications in impetigo and other superficial skin infections, this review delves into emerging indications and novel uses of MUP, potentially expanding its clinical utility. The exploration of combination therapies, alternative formulations, and ongoing research endeavors will contribute to a forward-looking perspective on the role of MUP in future antimicrobial strategies.