Background: Present study was done to evaluate the Socio-clinical variables of elderly patient having fracture neck femur and undergone bipolar hip arthroplasty at Indira Gandhi Medical College, Shimla. Material and Methods: The present study was conducted in Department of Orthopaedic Surgery Indira Gandhi Medical College, Shimla. It included both prospective and retrospective cases who were operated by posterolateral approach of hip joint for unstable fracture neck of femur and treated with modular bipolar hip arthroplasty. A prospective cases included 35 patients from May 2016 onwards and retrospective cases included 25 traceable operated patients in last 5 years. Results: The mean average age of the patients was 78.5±6.87 years with female predominance of 67% and involving left side in 57% of patients. The mode of injury was fall while walking in 63.3% of patients. Only one patient had road side accident as mode of injury. Only one patient had associated undisplaced fracture of proximal fibula which was managed conservatively. Transcervical fracture pattern was seen in 67% of patients as compared to subcapital in 20% and basal type in 13% of patients. Pulmonary disease (COPD) and Hypertension shared major medical preoperative morbidity in our series. Anaemia was quite prevalent in our patients (82%) and therefore warranted postoperative blood transfusion in majority (98%) of patients. We had short injury to admission interval in majority (63%) and patients were operated after optimal medical stabilization only. Majority (72%) of patients were operated within 7 days of hospitalization. Average duration of surgery was less than 120 min in 95% cases and blood loss was less than 300 mL in all patients. Mean hospital stay was about 22 days in our series, as patients were discharged only after removal of stitches and after being comfortable to effort tolerance on walking. Only minor complications were observed in our series, DVT in only one patient, superficial infection in one and Grade 1 bedsore in 6 patients. Conclusion: Present study concluded that despite advanced age bipolar hip arthroplasty can be recommended as procedure of choice in displaced fracture neck femur. 

Background: Cutibacterium acnes (formerly Propionibacterium acnes) is a Gram-positive, rod-shaped bacterium that is aerotolerant and grows slowly under anaerobic conditions. Aim: The aim of this study to isolate and identify Cutibacterium acnes in Acne Vulgaris Patients through polymerase chain reaction and its antibiotic sensitivity. Materials and Methods: The study was conducted at the laboratory of the college of Veterinary Medicine for the period from first of October, 2021 to May 2022. The sample of this study consisted of collecting skin swabs from 90 patients who had acne vulgaris and attending dermatology private clinics in the Kirkuk city/ Iraq, for isolating and identifying Cutibacterium acnes. In order to collect the samples from a skin lesion, cotton swabs made of sterile cotton were used. In the clinic, the lesion was opened under aseptic conditions and then placed under the same conditions in a Thioglycolate medium tube. The growing bacteria were diagnosed based on their color, shape and size, edge, height, and whether or not they catalase production. In addition, secondary cultures were done for antibiotic sensitivity tests as well as molecular detection of C.acnes using PA primer and various virulence factors including hemolysis and lipase activity by polymerase chain reaction. Results: In the present study, five antibiotics were chosen to perform the susceptibility tests by disc diffusion assay. The study showed that 91.67% of C. acnes isolates were resistance to erythromycin, resistance to clindamycin (75%) and levofloxacin (33.3%) respectively However, they showed low resistance to tetracycline (8.3%) and (25%) doxycycline was performed. The current results showed that six out the 12 tested isolates that tested were positive for PA form severe acnes . While one strain from mild and moderate groups respectively was positive. The study showed that all C. acnes isolates that positive to PA primer had hemolysis gene as detected by PCR using tly primer. The study showed that 62.5% of C. acnes isolates were succeed with this type of lipase gene as detected by PCR, using lipase primer.

Background: The study was conducted to evaluate the socio-demographic and clinical characteristics of Patients with Type 2 Diabetes Mellitus present at Ophthalmology OPD of Tertiary Care center. Material & methods: This was a cross-sectional study on type 2 diabetes patients conducted in the department of ophthalmology, Indira Gandhi Medical College Shimla (H.P) for a period of one year. Patients who fulfilled the inclusion criteria were interviewed regarding the duration of diabetes mellitus and treatment history. A complete ophthalmologic examination was performed to all patients. Early Treatment of Diabetic Retinopathy Study criteria were used to define stages of diabetic retinopathy. They also underwent investigations like FBS, HbA1c etc. Results:  A total of 260 eyes from 130 patients (87 males,43 females; mean age 56.88±8.26 years) were included in this study. The mean duration of DM was 8.87±2.34 years (range, 1-25 years). Among 130 diabetic patients there were 32 (24.6%) patients with no diabetic retinopathy, 27 (20.8%) with very mild NPDR, 26 (20%) with mild NPDR, 25 (19.2%) with moderate NPDR and 20 (15.4%) with severe NPDR. Conclusion: Present study concluded that most of the diabetic patients were aged between 56-65 years of age, having diabetes for less than 10 years of duration, had poor glycemic control and had mild form of retinopathy.

Background: The study was conducted to evaluate the Correlation between Central Macular Thickness (CMT) & Fasting Blood Sugar (FBS) in Patients of Type 2 Diabetes Mellitus present at Ophthalmology OPD of Tertiary Care center. Material & methods: This was a cross-sectional study on type 2 diabetes patients conducted in the department of ophthalmology, Indira Gandhi Medical College Shimla (H.P) for a period of one year. Patients who fulfilled the inclusion criteria were interviewed regarding the duration of diabetes mellitus and treatment history. A complete ophthalmologic examination including Central Macular Thickness (CMT) was performed to all patients. They also underwent investigations like FBS, HbA1c etc. Results:  A total of 260 eyes from 130 patients (87 males, 43 females; mean age 56.88±8.26 years) were included in this study. The mean duration of DM was 8.87±2.34 years (range, 1-25 years). In the present study, CMT in right eye ranged from 189–751 μm with mean value of 260.41±101.66. CMT in left eye ranged from 180–561 μm with mean value of 255.69±88.89. Fasting blood sugar value ranged from 75–408 mg/dl with mean value of 151.62±59.57.No statistically significant correlation was found between FBS and CMT in right eye (r=0.098; p=0.267) and left eye (r=0.058; p=0.513). Conclusion: Present study concluded that there was no statistically significant correlation between FBS and CMT in both eyes among Patients of Type 2 Diabetes Mellitus present at Ophthalmology OPD.

We read with interest the article by Pichardo-Rodriguez et al. on a 48 years-old male who developed spontaneous multifocal bleeding 25 days after a moderate infection with SARS-CoV-2, treated with glucocorticoids, anticoagulation, and oxygen for 6 days [1]. Thereafter, the patient developed paresthesias and “burning sensations” in the lower limbs followed by lower limb weakness and weakness of the left upper limb [1]. Guillain-Barre syndrome (GBS) was diagnosed in the absence of a dissociation cyto-albuminiqe and therapy with gluco-corticosteroids was started three months after the first symptoms [1]. Thrombocytopenia was treated with platelet transfusions and steroids. Under this regimen the patient achieved an incomplete recovery at the last follow-up [1]. The study is promising but raises concerns that should be discussed.

The results of “electromyography” (most likely the authors meant nerve conduction studies (NCSs)) are unclear having been described as “subacute, axonal motor-sensory demyelinating polyneuropathy” [1]. The two main subtypes of GBS are acute, inflammatory demyelinating polyneuropathy (AIDP) and acute, motor axonal neuropathy (AMAN). We should know which subtype of GBS was diagnosed by NCSs in the index patient. 

We also should know which type of anticoagulation the patient received for the treatment of COVID-19. In case the patient received low-molecular weight heparin it is conceivable that he produced heparin-induced thrombocytopenia (HIT) antibodies, which could be responsible for thrombocytopenia and spontaneous bleeding. We therefore should know if HIT antibodies were elevated or not. 

Unfortunately, the patient did not receive any treatment immediately after diagnosing GBS [1]. Treatment started with a prolonged delay of >3 months after the initial diagnosis. We should know why the patient was exposed towards a high risk of further deterioration and involvement of the respiratory muscles.

We disagree with the statement that GBS is rarely associated with other autoimmune disease [1]. Several reports have shown that GBS can be associated with transverse myelitis [2], encephalitis [3], thyroiditis [4], or myocarditis [5].

There is no general agreement on how to delineate an acute and chronic SARS-CoV-2 infection, and how to define post-COVID respectively long-COVID. Such definitions may be irrelevant as long as complications of a SARS-CoV-2 infection are recognised as such and managed appropriately.

There is a discrepancy between the description “complete response” and “motor improvement” [1]. We should know if there was complete or incomplete recovery of GBS and of thrombocytopenia. Given the delayed onset of GBS treatment, it can be speculated that clinical manifestations of GBS had resolved only partially at the 2 months follow-up. 

Overall, the interesting study has limitations that call the results and their interpretation into question. Clarifying these weaknesses would strengthen the conclusions and could improve the study. A delay of >3months between the onset of GBS and the start of GBS treatment with corticosteroids is unacceptable, as the outcome improves the earlier a treatment for GBS is initiated.

Acknowledgements

Funding: No funding was received               

Author contribution

JF: design, literature search, discussion, first draft, critical comments, final approval. 

Disclosures

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

High maternal mortality and negative perinatal outcomes are related to the patient's low socioeconomic status and restricted usage of labor nursing care. The purpose of this study was to evaluate the perinatal and natal outcomes of singleton pregnancies during the research period. During the study period, a descriptive cross-sectional study of singleton pregnant women was carried out at 5 hospitals. Utilizing the study instrument, an interviewing technique for each laboring woman, and a check of their medical records, data from pregnant women were collected. The data results were analyzed using tables and graphs. Out of 50 pregnant women, 66% were under 30 years old, 88% were unemployed, 70% had only completed their primary education, and 90% lived in urban areas; 26% had CS due to malpresentation. The prematurity was the key factor in the 10% of newborns who required resuscitation. Majority of them had normal weight. Most babies had an Apgar score of 7 to 10. When pregnant women attend the primary healthcare facility, it is important to give them with ongoing health education, keep them informed about their pregnancies and how the embryo develops over time, listen to their problems, and address them.

We read with interest the review article by Paliwal et al. about the neuromuscular manifestations of neuro-COVID [1]. It has been concluded that peripheral nervous system (PNS) disease in COVID-19 includes myalgia, myositis/rhabdomyolysis, myasthenia gravis, Guillain-Barre syndrome (GBS), neuropathy, olfactory/gustatory dysfunction, and neuropathy of cranial nerves [1]. The study is attractive but raises concerns that should be discussed.

We disagree with the number of PNS abnormalities triggered by SARS-CoV-2 infections. Not only the abnormalities reported in the results belong to neuro-COVID of the PNS, but also disorders such as plexopathy (Parsonage-Turner syndrome), myasthenic syndrome, small fiber neuropathy, dermatomyositis, and vasculitis of the PNS.

We also disagree with the classification of the PNS anormalies. Myalgia is a symptom and not a neurological condition. Myalgia is non-specific and can occur without a specific neurological condition being diagnosed. However, myalgia can also be a manifestation of myositis, vasculitis, or rhabdomyolysis. 

We disagree cranial nerve (CN) involvement in SARS-CoV-2 infections includes only CN-I, CN-II, CN-III, CN-IV, CN-V, and CN-VI [1]. With the exception of the accessory nerve, all other CNs can be involved in SARS-CoV-2 infections. Vestibulo-cochlear nerve neuritis was reported in a pregnant Moroccan female six weeks after the onset of SARS-CoV-2 [2]. Vestibular neuronitis has been reported as a complication of a SARS-CoV-2 infection in a 60yo male [3]. Involvement of CN-IX and CN-X has been particularly reported in GBS patients but also without involvement of the peripheral nerves. Involvement of the hypoglossal nerve has been observed in connection with SARS-CoV-2 associated polyneuritis cranialis [4]. 

With regard to the olfactory or gustatory dysfunction in SARS-CoV-2 infections, it is still unclear whether it is due to involvement of the central nervous system (CNS) or the peripheral nervous system (PNS). There are even indications that it could only be due to direct affection of the taste buds or olfactory cells. 

What is missing from the review is the involvement of the autonomic nervous system. Autonomic dysfunction is a common finding in SARS-CoV-2 infected patents and can be due to interference with the peripheral or central part of the sympathetic or parasympathetic pathways.

It lacks the neuromuscular complications caused by anti-SARS-CoV-2 drugs or drugs used to treat COVID-19 patients in the intensive care unit. These drugs can cause toxic neuropathy, critical ill neuropathy,/myopathy, (e.g. chloroquine), or rhabdomyolysis (e.g. azithromycin, hydroxy-chloroquine, placitaxel, propofol, imastinib, piperacillin, meropenem, hydrochlorothiazide, and acetaminophen). It has been also reported that chloroquine causes myasthenic syndrome in individual patients [5].

Secondary neuropathies due to involvement of organs other than the lungs, such as the kidneys (e.g. renal neuropathy) or pancreas (e.g. diabetic neuropathy) were not discussed.

Overall, the interesting study has some shortcomings that call the results and their interpretation into question. Clarifying these weaknesses would strengthen the conclusions and could add value to the study. PNS involvement in neuro-COVID is more widespread than expected.

This study sought to determine the reasons for the reluctance of doctors to work in the popular medicals clinic and its relationship and its impact on the quality of health service provided.  The origin of the seven hypotheses show the correlation between the variables of the study, (12) of the popular medical clinics in the karkh district in the city of Baghdad were selected to conduct this study. Doctors working in clinics surveyed the adoption of the questionnaire form for this purpose, as well as personal interviews to support the accuracy of the data and used a range of statistical methods in data and extracting results analysis depending on software (spss19). 50 doctors comprising of 35 males and 15 females were recruited for the study. The higher percentage of them was in the age more than 50 years. 40% of them had Bachelor degree.  To determine the reasons for the reluctance of doctors to work in the popular clinics through the analysis of the quality of work life sheds light on a lot of aspects that overlooked by managers in how to maintain the mission of the various scientific disciplines and qualifications of medical staffs, causing reluctance to work and therefore a decline in the level of medical services provided.  The need to work to amend the health sector laws, the most important the separation of the public sector for the private because of its great significance in promoting the career of belonging by identifying affiliation, as well as modifying the medical gradient law allowing doctors to specialists working for a certain period in the popular medical clinics.

This paper deals with the subject of choosing hospital managers according to the basis of efficiency and effectiveness, as one of the important topics, as the choice of hospital managers process according to the criteria of efficiency and effectiveness of a direct effect on the success of the hospitals in achieving the goals that they found for it and its success in providing medical and health services at the required level. The research sample represented by a number of government hospitals in Baghdad province, five hospitals distributed among the Departments of Health Baghdad's Karkh and Rusafa , either research sample identified five managers of hospitals sample individuals in addition to (50) of subordinates distributed on the five hospitals of (10) subordinates for each hospital and researcher prepared measurement resolution tool to be the main source for the collection of data and information on the subject of research, which included five criteria, the standard qualifications and experience, the standard personal characteristics, standard capacity, standard skills, standard values, and used statistical methods of loops and the mean weight percentile. Most hospital administrators do not have the tendencies and the desire for full - time to the practice of administrative work as managers of hospitals, and prefer their availability to work in the medical attributions and director of the hospital has a key role in the leadership of his hospital towards success and development, and the fact that the science of management is based in itself, so he needs to be guided by the curriculum Scientific management, and knowledge and specialization to the principles of management of the exercise of his functions different, roles, and hospital managers currently are doctors who hold medical specialties often and lacked competence in administrative areas as the hospital management is an art.

Background: Arthritis describes a set of symptoms that includes pain, stiffness, and joint deformities subsequent to an inflammatory process. The destructive process can occur through multiple pathways. These include: degenerative disease (osteoarthritis), auto-immune or auto-inflammatory processes (rheumatoid arthritis and ankylosing spondylitis), crystal deposition (gout and pseudo-gout), and infection (septic arthritis). Many systemic diseases can have arthritis as a major manifestation such as systemic lupus erythematosus (SLE), psoriasis, Lyme disease, reactive arthritis, and celiac disease among numerous others. Other diseases like hypothyroidism, diabetes and certain malignancies can sometimes have arthritis as one of the manifestations and one must be aware of arthritic presentation of such disorders. The present study was carried out to study the Lab Profile of Patients investigated for Arthritis in the Department of Orthopaedics at a tertiary care center in Himachal Pradesh. Methodology:This was an observational hospital-based study conducted in the Department of Orthopaedics, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, from 1^st June 2020 to 31^st May 2021. 161 patients presenting to Orthopaedics OPD with symptoms of arthritis were included in this study after diagnosis. Results: A total of 161 patients were included in the study over a period of 1 year. There were 100 (62.1%) females and 61 (37.9%) males in the study with a female to male ratio of 1.64:1. The most common age group observed was 61-80 years with 84 (52.2%) patients followed by 31-60 years age group with 40 (24.8%) patients. The most common type of arthritis observed in our study was OA which was observed in 91 (56.5%) patients followed by RA in 42 (26.1%) patients. There were 9 (5.6%) cases of septic arthritis and 7 (4.3%) cases of AS. AVN, gouty arthritis, osteoarticular TB, RA along with septic arthritis and charcot arthropathy was observed in 2 (1.2%) cases each. In OA cases there was female predominance with 74.7% females. In septic arthritis, males predominated with 88.8%. AS, AVN, gouty arthritis, psoriatic arthritis and RA along with AVN was present in only males. There was a statistically significant difference between the different types of arthritis in terms of gender distribution (p value <0.001). Conclusion: The recent onset arthritis is an important issue which could have a good prognosis if diagnosed and treated early. A large proportion of these patients have a self-limited course which may go into remission without aggressive treatment. The estimated burden of arthritis demands a public health approach, availability and accessibility of health care services.

Background: Pain from the lateral aspect of the elbow was first described in 1873, and has since then been given different names such as tennis elbow (TE), lateral epicondylitis, epicondylosis, epicondylalgia and lateral elbow pain. The most frequently used term is probably TE, implying a relationship with repetitive mechanical load while using a forceful grip, as in playing tennis. Lateral epicondylitis is an inflammatory condition that occurs at the origin of the common extensor tendon of forearm over the lateral epicondyle. It is the commonest chronic disabling painful condition of the elbow. It causes symptoms in 1% to 3% of the general population. It is common in people whose occupation requires frequent rotatory motion of the forearm like carpenter, gardener, computer workers and knitting workers. The age of onset of lateral epicondylitis is between 35 and 50 years with an equal male to female sex ratio. The dominant upper limb is most commonly affected. Objective: To study the outcome analysis of percutaneous tenotomy in patients with chronic tennis elbow- a prospective and retrospective hospital-based study. Methodology: A hospital-based prospective study conducted at department of Orthopaedics, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, HP, India for a duration of 1 year (2019-20). All patients of tennis elbow (>6 months duration) consenting to be part of the study during the study duration were enrolled in the study. Results: In our study, there were a total of 47 patients, with history of chronic tennis elbow for more than 6 months duration, enrolled for the study with lost to follow up of 2 patients at 6^th month onwards. There were 24 males and 23 females. Patients' age ranged from 29-65 years with mean age of 47±9.8 years. 33 patients had tennis elbow of right side while 10 had problem on left side. 4 patients presented with difficulty on both sides. As per NRS score, at 9^th month, there were 15 patients with excellent score, 24 with good and 4 with fair score. 2 patients had poor outcome after 9^th month. As per DASH score after 9 months, 15 patients had excellent outcome and 24 had good outcome. Fair outcome was observed in 4 patients and poor in 2 patients. Conclusion: Patients with ChronicTennis Elbow (>6 months) is a unique group which require special consideration. Many treatment modalities are available to address this subgroup patients with tennis elbow, Percutaneous Tenotomy has proven to be a reliable treatment method which has given sustained and improved outcomes without requirement of any additional modality of treatment /medication option.