Patients Got Research Articles

Clinical-grade natural killer cells expanded from donor peripheral blood and anti-leukemia effect against myeloid leukemia.

e19018 Background: Natural killer (NK) cells play a crucial role in immune surveillance and tumor clearance. It has been reported that allogeneic NK cell therapy has good safety and curative effect in patients with refractory and relapsed acute myeloid leukemia (AML). However, the clinical application of adoptive NK infusion is limited due to the lower number of human NK cells. We established a feeder-free NK cell expansion system from peripheral blood (PB) and explore the anti-leukemia potential in preclinical and clinical studies. Methods: The killing capacity of ex vivo-expanded NK cells were detected by Flow cytometry. The in vivo expansion, survival and anti-leukemia activity of the expanded NK cells were detected in K562-bearing NSG mice. Six AML patients with hematological/extra medullary relapsed (n = 3) or persistent positive minimal residual disease (n = 3) after consolidation and maintenance therapy were enrolled in Peking University Institute of Hematology from 2021 to 2022. The patients were treated with high-dose cyclophosphamide and fludarabine, then combined with adoptive infusion of donor-derived expanded NK cells. The chimerism, the number and function of NK cells were analyzed, and the safety and clinical efficacy were evaluated. Results: The ex vivo-expanded NK cells exhibit highly anti-leukemia activity. NK cells proliferate in mice and the CD56+ cells to reach the peak time in each organ is 3-7 days and drop to the level before infusion after 14 days. NK cell infusion significantly improve the survival of leukemia mice, and the anti-leukemia effect is NK cell dose-dependent. In the clinical trial, six patients received a total of 7 cases of NK cell infusion, including 3 cases in low-dose group and 4 cases in middle-dose group, among which 1 patient received 2 dose (1 low-dose and 1 middle-dose). In the low-dose group, 1 patient got response (1/3), with the minimal residual disease turned negative. In the middle-dose group, 3 patients responded (3/4), of which 1 patient had the fusion gene CBFB /ABL decreased from 0.99% to 0.13%, 1 case of extramedullary recurrence of AML turned negative, and NK cells could be detected in cerebrospinal fluid, 1 case of hematological recurrence got hematological remission after treatment. The survival time of NK cells in vivo was 7d-30d, with longer time in middle dose group than those in low dose group. The proportion and number of NK cells in responding cases were significantly higher than those in non-responsive group. Conclusions: Clinical grade expanded NK cells has strong anti-leukemia activity in patients with relapse or minimal residual positive AML patients. NK cells can survive for 2 weeks and can enter the central nervous system without obvious adverse reactions. The response rate in middle-dose group is higher than that in low-dose group. However, the efficacy of NK cells still needs to be further confirmed in a large sample size. Clinical trial information: NCT04221971 .

17th International Conference on Malignant Lymphoma, Palazzo dei Congressi, Lugano, Switzerland, 13 - 17 June, 2023.

Background: ENKTL is a highly aggressive NHL with a higher incidence in Asia. In 2020 ASH meeting, we reported Sintilimab(anti-PD-1 antibody) plus Chidamide(an oral subtype-selective HDACi) yielded effective antitumor activity, durable response with mild toxicity in patients with relapsed or refractory ENKTL. We then initiated this exploratory study to investigate the efficacy and safety of Sintilimab plus Chidamide(SC) for patients with newly diagnosed ENKTL. Methods: This trial enrolled eligible patients with newly diagnosed ENKTL(ND-ENKTL); ECOG score ≤2; at least one measurable or evaluable lesion. All patients received 2–3 cycles of Sintilimab (200 mg) plus Chidamide (30 mg, twice a week). For patients with early stage, 2 cycles of SC were given, subsequent 2–4 cycles of P-GemOx regimen administered and followed by involved field radiotherapy (IFRT). For advanced stage, patients were treated with 3 cycles of SC and 3–6 cycles of P-GemOx. The primary study endpoints are the ORR of SC and end of treatment assessed according to the lymphoma response to immunomodulatory therapy criteria (LYRIC). Key secondary endpoints included DOR, PFS, OS and safety. Results: From July 2019 to Nov 2021, 42 eligible patients were enrolled from Sun Yat-sen University Cancer Center. The median age was 47.5 (range, 20–81) years, 16(38%) patients with stage III-IV, 15(31%) patients with PINK-E score≥3. All patients were evaluated for efficacy. For stage I-II, 21(81%) patients achieved response, including 18(69%) CR patients with SC. After 2 cycles of SC, 17(94%) of 18 CR patients chosen to continue SC treatment. Only 1 (6%) PR patients accepted 2 cycles of P-GemOx and got CR after chemotherapy. Twenty-five (96%) patients obtained CR after IFRT. For stage III–IV, 9(56%) patients achieved response with 13%(2/16) CR, 3(33.3%) patients experienced rapid progression disease (RPD) in SC portion. Ten (63%) patients entered P-GemOx portion including 1 RPD patient. Thirteen (81%) patient got ORR with 69% (11/16) CR after whole treatment. The median follow-up time was 24.1(5.4–44.3) months. The 2-year PFS and OS rate were 76% and 78%, the prognosis of early stage is better than advanced stage (Fig. 1). Two RPD patients died within one month. Circulating EBV-DNA clearance after SC significantly correlated with superior outcome. Forty(95.2%) patients reported treatment-related adverse effects (TRAEs). The most common TRAEs (≥10%) were neutropenia (43%), thrombocytopenia (38%), elevated transaminase (29%), and anemia (24%). The most common grade 3 TRAEs (≥10%) was elevated transaminase (10%), no grade 4 TRAEs. Keywords: aggressive T-cell non-Hodgkin lymphoma, extranodal non-Hodgkin lymphoma, immunotherapy No conflicts of interests pertinent to the abstract.

Response of Daclatasvir and Sofosbuvir in Treatment-Naïve, HCV Genotype 3, Non-Cirrhotic Pakistani Population: 1 Year Follow-Up Experience

using daclatasvir and sofosbuvir in treatment-naive, non-cirrhotic HCV genotype 3 Pakistani population. Methodology: From January 2017 to February 2019, HCV patients who met the inclusion criteria were included in this open-label, non-randomized, uncontrolled observational trial at HBS General Hospital in Islamabad. A 12-week course of oral daclatasvir and sofosbuvir therapy was administered to each participant. Each patient got 400mg of sofosbuvir and 60mg of daclatasvir. Treatment outcomes included sustained virological response (SVR12 and SVR24), rapid virological response (RVR), and end-of-treatment response (ETR) as primary and secondary respectively. Results: There were 105 participants in the study, of which 72.3% were male and 27.6% were female. RVR for male was 92% (p=0.002), while it was 89.65% for female (p=0.004). 96.05% of the male and 93.1% of the female achieved ETR (p=0.002). Both 93.1% of female and 93.4% of male had SVR12 (p=0.001). A single male patient experienced relapse after achieving SVR12 (p=060). SVR24 rates for male and female were 92.1% (p=0.003) and 93.1%, (p=0.003) respectively. The combination therapy was well-tolerated, with the primary side effect being fatigue (36% in males, 44% in females). Conclusion: The combination therapy of daclatasvir and sofosbuvir demonstrated both safety and efficacy in treating treatment-naïve, non-cirrhotic individuals with HCV genotype 3 in Pakistan. The study underscores the potential of direct-acting antiviral agents in addressing the challenge of HCV infections.

Effect of previous episode of symptomatic dengue infection on recent dengue infection in children

Background: Approximately 390 million people worldwide are affected by dengue fever each year, >70% of them are from Asia. It is thought that antibody enhancement during the subsequent infections with dengue virus can cause more severe form of disease called dengue haemorrhagic fever (DHF). This study aims to observe the effect of prior dengue infection on recent infection. Methods: This retrospective record based descriptive-analytical study was conducted from July 2021 to December 2021 in paediatrics department of Bangabandhu Sheikh Mujib Medical University, Dhaka. Medical records of all admitted confirmed cases of dengue fever during the study period were reviewed retrospectively to find out past symptomatic dengue infection ,which further verified by parents over phone. Finally 98 patients were analyzed after exclusion. Results: Among 98 studied patients, 45 (45%) experienced DHF and 15 (15.3%) diagnosed with DSS. There was no significant (p>0.05) difference of age and sex between patients of DF, DHF and DSS. Majority of the patients 79 (80.6%) did not have a past history of documented symptomatic dengue infection. Here, 9 (23.6%) out of 38 DF patient, 8 (17.7%) out of 45 DHF patient and only 2 (13.3%) out of 15 patient with DSS had past symptomatic dengue infection. Maximum patients (92, 93.8%) were treated with isotonic fluid, 39 patients got colloid (39, 36.79%). This study found no significant (p>0.05) difference between DF, DHF and DSS with or without past symptomatic dengue infection. Conclusions: In our study we noticed that there was no increase in dengue morbidity with documented previous symptomatic dengue infection.

Modified Foam Stability Test (Fs-50) as Predictor of Fetal Lung Maturity in Preterm Premature Rupture of Membrane Patients Given Dexamethasone Therapy

This study aims to determine the ability of the Modified Foam Stability (FS-50) test to predict fetal lung maturity in preterm premature rupture of membranes treated with Dexamethasone. The study sample included pregnant women with PROM at a gestational age of 24 to less than 34 weeks in the ER and Obstetrics Ward of Sanglah Central General Hospital, Denpasar. The patient underwent a vaginal speculum examination to collect fluid pooled in the vagina or from the outer cervical opening. Fluids are checked with the Modified Foam Stability (FS-50) test and graded from 0 to +4 to estimate fetal lung maturity. The first test was performed before Dexamethasone, followed by serial examinations at 12-hour intervals for 48 hours. Before dexamethasone injection, all patients got 0 scores as a baseline. There were statistically significant differences in FS-50 values before and after injection of the first, second, third, and fourth doses of Dexamethasone in PPROM patients. Fetal lung maturity was reached after the third dose of dexamethasone injection (36 hours after the first injection), characterized by an FS-50 value of > +3 and no asphyxia in the newborn. Spearman's rank analysis showed a significant correlation (p=0.005) between infants' maximum FS-50 value and asphyxia status. The FS-50 value > +3 is associated with the absence of asphyxia in infants born to PPROM patients who were given Dexamethasone for lung maturation. FS-50 can predict fetal lung maturity in preterm premature rupture of membranes given dexamethasone therapy.

Injuries related to sauna bathing

PurposeAwareness of well-being and health issues have contributed to increased popularity of sauna bathing. However, little is known about potential risks and injuries. The aim of this study was to identify the causes for injuries, the affected body regions and to define recommendations for prevention. MethodsA retrospective chart data analysis was conducted among patients treated for an injury related to sauna bathing at the local trauma centre of the Medical University of Innsbruck between January 1, 2005 and December 31, 2021. Patients’ demographics, the cause for the injury, the diagnosis, the body region of the trauma and the treatment methods were collected. ResultsTwo hundred and nine patients with injuries related to sauna bathing (83 female [39.7%] and 126 male [60.3%]) were identified. Fifty-one patients showed more than one injuries leading to a total of 274 diagnosis: contusions/distorsions (113; 41.2%), wounds (79; 28.8%), fractures (42; 15.3%), ligament injuries (17; 6.2%), concussions (15; 5.5%), burns (4; 1.5%) and brain bleeding (3; 1.1%). The most common cause for an injury was a slip/fall (157; 57.5%) followed by dizziness/syncope (82; 30.0%). Interestingly, head and face injuries were mostly caused by dizziness/syncope, whereas slip/fall was the leading cause for injuries of foot, hand, forearm and wrist. Nine patients(4.3%) needed surgical treatment mainly due to fractures. Eight patients got injured by wood splinters. One patient sustained grade IIB-III burns lying unconscious with an alcohol intoxication of 3.6‰ in the sauna. ConclusionThe main causes for injuries during sauna bathing were slip/falls and dizziness/syncopes. The latter one might be prevented by improved of the personal behaviour (e.g. drink enough water before and after each sauna bathing), whereas slip/falls might be prevented by the revision of safety regulations, particularly the obligation to wear slip resistant slippers. Thus, everyone himself as well as the operators can contribute to reduce injuries related sauna bathing.

Ayurvedic Management of Kaphaja Yonivyapada (Trichomonas Vaginitis) - A Case Report

Yoni Srava is an annoying symptom that usually reflects infective conditions of genital tract in females. One of the Yonivyapada having Yonisrava as its prominent symptom is Kaphaja Yonivyapada which can be co-related to Trichomoniasis or Candidiasis infections. In Kaphaja Yonivyapada, symptoms of itching along with sticky and unctuous discharges per vaginum have been illustrated. The patient may experience either mild and dull pain or no pain at all. In severe Trichomonas infection, there is mild to moderate pain at the genital organs due to inflammatory changes, though in most cases, it may be painless. Considering all the symptoms, mentioned by Acharya Charaka and others, the Kaphaja Yonivyapada can be closely compared with Trichomonas Vaginitis. A 46 years old female patient was presented with the complaints of itching in vulvar region and white discharge per vaginum since 3 months. On clinical evaluation, ulceration was present on bilateral labia minora along with strawberry spots on vaginal walls, yellowish-white discharge and cervical congestion. Aim and Objective: To study the efficacy of Sthanik Chikitsa along with oral Ayurvedic formulations in Kaphaja Yonivyapada (Trichomoniasis). Nimbadi Kshaya Yoni Dhavan followed by Mahanimba Taila Pichu twice a day for seven days along with oral herbal formulation is prescribed to the patient. Results: After completion of the treatment protocol patient got relief in her symptoms like itching in vulvar region and white discharge per vaginum. Conclusion: In Kaphaja Yonivyapada, especially Trichomonas Vaginitis Ayurvedic management by the use of Mahanimba (Melia azedarach) containing formulations for Sthanik Chikitsa are quite effective as Mahanimba is having Krimighna and Kandughna properties.

Post-Operative Macular Oedema Management Through Ayurveda- A Case Study

Macular oedema is gush of fluid from surrounding vessels of foveal region into tissues which makes pocket or vesicle like spaces and increases thickness of macula which can be checked by Fluorescein angiography and autofluorescence. Blurry or wavy vision near or in the centre of field of vision is its primary symptom. Chronic inflammation, direct macular traction, and decrease in oxygen amount’s common role is assessed in every study till now. Main Clinical Findings: A female patient of age 66 years had been complaining of blurred vision and discomfort in left eye for 3months after her cataract surgery. Diagnosis: She was diagnosed for macular oedema and treated for it. Interventions: The principles of Vataja Timira, Shotha were followed and internal medicine was given. Outcome: Patient got Significant results by improving quality of vision and repair the detached area. Conclusion: The present case anticipates the fruitful approach of Ayurveda science in dealing with Macular oedema. This also confirms relation between macular oedema and treatment principles followed.

Abstract #1405095: PCOS Diagnosis Leading to a Delayed Diagnosis of Cushing's Disease

Polycystic ovarian syndrome (PCOS) is a common disorder affecting pre-menopausal women. Diagnostic criteria for PCOS include menstrual irregularities, biochemical or clinical hyperandrogenism and/or evidence of polycystic ovaries on ultrasound. Any 2 of the above is sufficient for a diagnosis of PCOS. However, PCOS is a diagnosis of exclusion so other pathologies should be investigated including hypercortisolemia. We present a case of Cushing's Disease in which the patient’s clinical features were previously attributed to a diagnosis of PCOS delaying appropriate intervention. A 22-year-old nulligravida woman with no significant past medical history presented to the Ob/Gyn clinic with complaints of amenorrhea and infertility. Patient noted irregular menstrual cycles since attaining menarche, she denies any headaches, galactorrhea but reported facial hirsutism and weight gain. She was initially diagnosed with PCOS but had continued amenorrhea despite treatment with medroxyprogesterone acetate. Additional work up was ordered by Gyn which noted mildly elevated Prolactin at 30.84 ng/ml. MRI head/brain subsequently ordered noted a large T2 weighted hyperintense lesion measuring 2.2 x 1.65 x 2.0 cm involving the sella with extension suggesting a pituitary macro-adenoma. Patient was referred to endocrinology for additional work up. Further evaluation showed normal repeat prolactin level with dilution study normal at 11.9 ng/ml. She was found to have secondary hypogonadism with FSH - 5.32 mIU/ml, LH- 2.1IU/L and estradiol level at < 20 pg/ml. She also had secondary hypothyroidism with TSH 0.88 mIU/ml and free T4 at 0.64 ng/dl. Morning Cortisol was at 19.13 ug/uL with baseline ACTH elevated at 127 pg/ml. This showed adequate adrenal function but concern for ACTH dependent hypercortisolemia. She had 2 failed 1 mg dexamethasone suppression test with cortisol level at 10.92 ug/uL and 20.91 ug/uL with adequate dexamethasone levels. She had 2 elevated 24-hour urine cortisol at 72ug/24hr and 81ug/24hr. She also had 2 elevated midnight salivary cortisol level at 0.338ug/dl and 0.349ug/dl. Other labs showed normal IGF-1 and normal DHEA-S. Patient was diagnosed with Cushing Disease and underwent successful transsphenoidal resection of the pituitary macroadenoma. Post operative cortisol was <2 ug/ul, she was initiated on hydrocortisone 20mg am and 10mg pm. Patient had continued monitoring for recovery of hypothalamic-pituitary-axis. A month after the surgery, patient got pregnant and was continued on her hydrocortisone and levothyroxine replacement. In our case the diagnosis and treatment of Cushing's disease was delayed due to clinical features mimicking PCOS. PCOS is a diagnosis of exclusion, and our case illustrates the importance of excluding the other endocrine pathologies, such as Cushing's disease, to prevent delaying the appropriate treatment and to mitigate the risk of increased morbidity and mortality that may be associated with them.

Management of Sandhigata Vata with Janudhara and Lepa - A Case Study

SandhigataVata is a disorder where Vata dosha is dominant. In particular, SandhigataVatais the changes the inflammation and degeneration in joints. The condition gets tedious when joints like Janusandhi (knee joint) which is a mobile joint, the body gets involved in SandhigataVata. There is more prevalence in overweight patients because, among all the joints, it is the weightbearing joint. The dominance of Vata Dosha is central to the pathogenesis of Sandhigatavata. It can be considered a musculoskeletal abnormality according to modern science. To evaluate the efficacy of dashmool tailjanudharaand Lepa(Shunthi and Haridra) in Sandhigatvatavata. To study the effectiveness of Ayurvedic management with Panchakarma and ShamanaChikitsa (palliative therapy) in Sandhigatavata. A55 years old female individual was diagnosed as SandhigataVata with symptoms of pain, swelling in the right knee joint, and difficulty while walking for one year. There were osteophyte changes in the X-ray of the right knee common. The management plan includes panchakarma in which local abhyanga(massage), Local Swedana with Nadisveda(hot fomentation), Janudhara(oil pouring),andlepa was advised ShamanchikitsaincludedHingwashtakchurna, YogarajGuggulu, and Avipattikarachurna. Pain, Swelling, and difficulty in walking were reduced markedly.:The patient got adequate relief in clinical features; she could walk correctly.

PITUITARY ABSCESS – A RARE CASE REPORT

Study Design: Case Report To report a rare case of Pituitary Abscess, its management and Objective: outcome. A 15-year-old boy Background: presented with history of headache on and off for the past 9 months. MRI revealed a peripheral rim enhancing lesion in the sellar region. Patient underwent Right Frontal Craniotomy, Subfrontal Approach wherein there was pus in the sellar region which was aspirated. Patient was started on antibiotic therapy and on follow up patient got relieved of his symptoms. Pituita Conclusion: ry Abscess is a very rare disease of the sellar region that is difcult to correctly diagnose on the basis of clinical manifestations and MRI. Despite its rareness, a Pituitary Abscess must be considered in the case of a pituitary mass associated with signs of raised Intracranial Pressure with/without pituitary hormone dysregulation and signs of infection. The treatment is a combination of surgery, antibiotics, and hormone substitution whenever needed

CAUDAL BLOCK AS A TREATMENT MODALITY TO AVOID LUMBAR SPINE SURGERY IN PATIENTS WITH CHRONIC BACK PAIN

Introduction: Chronic Lower back pain is the most common cause of functional disability in an adult due to prolonged sitting, ageing society, obesity &amp; sedentary lifestyle, the number of Chronic Lower back pain patients can be expected to increase in the coming decades. Caudal Pain Block is one of the procedures to avoid lumbar spine surgery in patients with chronic low back pain. Main aim of this study is to analyse weather the effect of caudal pain block can avoid lumbar spinal surgery in patients with chronic low back pain. Aims And Objectives: To find out that weather the effect of caudal pain block can avoid lumbar spinal surgery in patients with chronic low back pain.To review the literature. Material and Methods: A prospective study was done on 55 patients with chronic low back pain who were given caudal pain block and followed up at 1,2, 3, and 6 months and outcomes measured using visual analogue scale and The Roland–Morris Disability Questionnaire. Observations: Caudal pain block was given in 55 patients, 51 patients got relieved of their pain and were able to avoid spine surgery and 4 out of 55 patients went for the spine surgery despite given caudal pain block. Results:According to VAS score 12 patients had excellent results, 21 had good results, 18 had fair and 4 had poor results. According to Roland–Morris Disability Questionnaire - 10 patients had excellent results, 20 patients had good results, 21 had fair results and 4 had poor results. Conclusion:Chronic low back pain managed with Caudal pain block is a good treatment modality with excellent results and good alternative to avoid operative procedures.

Investigating the effectiveness of anterolateral distal tibia plate in treating distal tibial fractures in adults: a prospective study

Background: “Pilon” fractures of the distal tibia are a term used usually by orthopaedic surgeons. High-energy trauma and related soft tissue injuries are the main causes. It might be challenging to treat distal one-third of tibial fractures that affect the articular process or not. The objective of this work is to analyze the result of the Anterolateral Distal Tibia Plate in distal tibial fracture treatment in adults. Methods: After receiving permission from the ethical committee, this prospective interventional analysis was conducted among 25 patients who satisfied the inclusion standards and were given anterolateral distal tibia plates. The scoring system created by “Ovadia and Beals” was used to evaluate patients at the conclusion of the follow-up period. Results: The participants in this research varied in age from 18 to 64, with a mean age of 36. 13 patients had a left tibia fracture and 12 patients had a right tibia distal end fracture. There were 4 open GA-I fractures and 21 closed GA-I fractures. 18 patients got fractures as a result of road traffic accidents (“high energy trauma”), and 7 patients sustained a fracture due to a fall (low energy trauma). The union of fracture occurred in 24(96%) patients and 1(4%) case showed delayed union. The average period of union was 18 weeks with the radiological signs of callus formation. 2 patients developed superficial and 1 patient developed deep infection. Conclusions: Distal end tibial fractures especially with intra-articular involvement may be effectively treated by anterolateral plating within a single stage, offers advantages such as adequate fracture exposure, soft tissue preservation, and reliable fracture healing.

Double-column Die-punch fractures of distal radius treated with butterfly plate fixation via Henry approach

To explore clinical effect of open reduction and internal fixation with Henry's approach butterfly plate in treating double-column Die-punch fractures of distal radius. From January 2018 to June 2021, 26 patients with double-column Die-column distal radius were treated with open reduction and internal fixation through Henry's surgical approach and using distal radius volar column plate(butterfly plate), including 14 males and 12 females, aged from 20 to 75 years old with an average age of (44.2±3.4) years old. Postopertaive complications were observed, Gartland-Werley score at 12 months after opertaion was used to evaluate wrist joint function. All 26 patients were followed up from 10 to 18 months with an average of(13.4±0.8) months. All fractures were obtained fracture union, the time ranged from 8.5 to 15.8 weeks with an average of (11.4±0.5) weeks. All incisions healed at stageⅠwithout infection, nerve injury and internal fixation failure occurred. Postoperative Gartland-Werley score at 12 months was (3.65±0.36), and 16 patients got excellent result, 8 good and 2 moderate. Open reduction and internal fixation with butterfly plate for the treatment of double-column Die-punch fractures of the distal radius through volar Henry approach could obtain satisfactory clinical outcomes.

Comparison of clinical effect and postopertaive incisions between No-touch technique and traditional retractor in treating calcaneal fracture

To compare clinical efficacy of No-touch technique and traditional retractor in treating calcaneal fracture. Clinical data of 74 calcaneal fracture patients with closed Sanders typeⅡ to Ⅳ were retrospectively analyzed from July 2019 to June 2021. According to different treatment methods, the patients were divided into No-touch group and conventional group, 37 patinets in each group. In No-touch group, there were 25 males and 12 females, aged from 19 to 70 years old with an average of (42.64±14.16) years old;17 patients were typeⅡ, 14 patinets with type Ⅲ, 6 patients with type Ⅳ according to Sanders fracture classification;three 2.0 mm Kirschner wires were implanted into the talus body, talus neck, and cuboid bone, and the flap was turned upward to expose the operation area. In conventional group, there were 30 males and 7 females, aged from 19 to 67 years old with an average of (41.56±11.38) years old;17 patients with typeⅡ, 12 patients with type Ⅲ, 8 patients with type Ⅳ according to Sanders fracture classification;the operation was completed by exposing the operation area with traditional retractor. Operation time, postoperative incision complications, postoperaive American Orthopedic Foot and Ankle Society (AOFAS) ankle hind foot score at 6 months between two groups were compared. Seventy-four patients were followed up, and follow-up time in No-touch group ranged from 6 to 17 months with an average of(9.57±2.72) months, while in conventional group ranged from 6 to 16 months with an averge of(9.14±2.71) months, and no difference in follow-up between two groups (P>0.05). Operation time in No-touch group (55.67±7.94) min was shorter than that in conventional group (70.16±9.41) min (P<0.05);four patients in No-touch group occurred incision complications, while 8 patients in normal group, and had statistically difference(P<0.05). Daily activities and support, maximum walking distance (block), ground walking, limited degree of flexion, extension and valgus, foot alignment and total score of AOFAS scores in No-touch group was significantly higher than that of conventional group (P<0.05). There were no significant difference in pain degree, abnormal gait and ankle hind foot stability between two groups(P>0.05). According to AOFAS score, 19 patients got excellent result, 16 good and 2 poor in No-touch group;while 9 excellent, 24 good, and 4 poor in conventional group, and no difference between two groups (P>0.05). Compared with traditional retractor in treating calcaneal fracture, No-touch technology could significantly shorten operation time, reduce incidence of postopertive complications, while two methods could improve excellent and good rate of ankle joint function recovery after operation.

A CASE REPORT ON KAMPAVATA WITH SPECIFIC REFERENCE TO ESSENTIAL TREMOR CHANGES IN QUALITY OF LIFE IN ESSENTIAL TREMOR QUESTIONNAIRE (QUEST)

Introduction: Disease Kampavata or vepathu is explained in Ayurveda as the primary symptom of involuntary movement of body parts. It is explained among nanatmaja vyadhi of Vata dosha. Aetiology and pathogenesis are due to this increased Vata. Basti chikitsa is mentioned as the ultimate chikitsa to pacify Vata dosha. Before doing any shodhana chikitsa rookshana and sneha sveda are needed. Case Report: A case report of a patient with balance problems during locomotion and increased tremors of the hand and head was discussed. Result: After the treatment patient got improved in balance and coordination, handwriting, reduced frequency of tremors etc. This case report also explains the improvement in different domains of quality-of-life pre and post-treatment.

Treatment of Sanders typeⅡto Ⅲ calcaneal fractures with percutaneous reduction and minimally invasive calcaneal screw fixation

To investigate clinical effect of percutaneous reduction combined with internal fixation of calcaneal nail in treating Sanders typeⅡto Ⅲ calcaneal fractures. From July 2017 to August 2019, clinical data of 98 patients with Sanders typeⅡto Ⅲ calcaneal fractures treated were retrospectively analyzed, and divided into observation group and control group according to different surgical methods. In observation group, there were 35 males and 21 females, aged from 23 to 58 years old with an average of (34.50±7.81) years old;29 patients with Sanders typeⅡand 27 patients with Sanders type Ⅲ;30 patients on the left side and 26 patients on the right side;the time from fracture to operation ranged from 1 to 4 days with an average of (3.45±0.54) days;and treated with percutaneous reduction combined with internal fixation of calcaneal nail system. In control group, there were 25 males and 17 females, aged from 25 to 60 years old with an average of (35.27±7.64) years old;23 patients with Sanders type Ⅱ and 19 patients with Sanders type Ⅲ;24 patients on the left side and 18 patients on the right side;the time from fracture to operation ranged from 2 to 5 days with an average of (3.42±0.62) days;and treated with open reduction and internal fixation. Operation time, blood loss, hospital stay, fracture healing time, and postoperative visual analogue scale (VAS) at 1 day, preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Böhler angle, Gissane angle and calcaneus width, and postoperative complications were compared between two groups. All patients were followed up from 13 to 18 months with an average of (15.6±2.2) months. There were significant differences in operation time, blood loss, hospital stay, fracture healing time and postoperative VAS at 1 day between two groups (P<0.05). There was statistical difference in postoperative AOFAS score at 12 months between two groups (P<0.05), and AOFAS score at 12 months after operation was higher than that before operation (P<0.05). According to AOFAS score, 21 patients got excellent result, 30 good and 5 moderate in observation group, and 10 excellent, 22 good, 7 moderate and 3 poor in control group, which had statistical difference between two groups (P<0.05). Postoperative Böhler angle, Gissane angle and calcaneus width at 6 months were better than that before operation between two groups(P<0.05). One patient in observation and 20 patients in control group occurred skin numbness after operation, and 14 patients occurred skin necrosis in control group, there were obvious difference between two groups(P<0.01). Compared with open reduction and internal fixation, percutaneous reduction combined with internal fixation system in treating Sanders typeⅡto Ⅲ calcaneal fractures is feasible for fracture repair without waiting for foot deswelling, which could accurately restore normal shape and position of the fractured heel bone, completely eliminate fracture malunion, and reduce postoperative complications. Therefore, it could shorten operation time, hospital stay, fracture healing time, reduce amount of blood loss, promote postoperative recovery, and less complications, high safety, which could be used as a choice of orthopedic surgery for foot and ankle trauma.

Infarction in the Anterior Choroidal Artery Territory: A Retrospective Study (P11-5.029)

<h3>Objective:</h3> The aim of our study is to explore the clinical features, possible mechanism and prognosis of AchA infarcts. <h3>Background:</h3> Acute ischemic stroke (AIS) in the anterior choroidal artery (AChA) territory is commun in daily practice. But its clinical and evolutionary characteristics are not very obvious, hence the interest of our study. <h3>Design/Methods:</h3> A total of 33 AChA infarction patients were recruited in the study retrospectively from 2018 to 2021. Demographic and clinical characteristics were analyzed in all patients. <h3>Results:</h3> Among ischemic stroke, 33 of 408 patients (8.08%) were enrolled with isolated AChA infarct. Most of patients were male (78.8%). The mean age was 61 years. The most common risk factors were hypertension and diabetes, smoking followed by coronary arterial heart disease. Hemiparesis was the most common clinical manifestation (78.8%), followed by slurred speech/aphasia (63.5%), hemianesthesia (48.5%), hemianopia (9.1%) and finally ataxia (6.1%). Average NIHSS was 5.8. Only 3 patients (6.1%) received intravenous thrombolysis. 60% of patients were treated with double antiplatelet. mRankin score (mRS) was higher in patients treated with simple antiplatelet (p=0.04). The stroke etiology included large artery disease (36.4%), small vessel disease (27.3%), cardio-embolic (9.1%). Ischemic stroke is of undetermined cause in 27.2%. Among 33 AChA infarcts, 54.8% of patients got good prognosis (mRS score≤2). Prognosis of infarction of AChA stroke depend on etiology. Cardio-embolic mecanism had poor outcome (p=0.03). <h3>Conclusions:</h3> According to the results obtained in this study, and taking into account their limitations of the small sample, choroidal stroke has a good prognosis. But the interest of intravenous thrombolysis is not demonstrated yet, which requires a subsequent multicenter study. <b>Disclosure:</b> Ms. Abbes has nothing to disclose. Mariem Mhiri has nothing to disclose. Miss Saad has nothing to disclose. Dr. Ben Dhia has nothing to disclose. Dr. Gouta has nothing to disclose. Mouna Aissi has nothing to disclose. MAHBOUBA FRIH has nothing to disclose.

Defining Characteristics of Middle-Aged and Geriatric Orthopedic Trauma in New York City over a 7-Year Period

ObjectivesExamine the patterns and defining characteristics of middle-aged and geriatric patients who sustain orthopedic trauma in New York City. Study DesignRetrospective cohort study. Methods11,677 patients >55 years old treated for traumatic orthopedic injuries were grouped into cohorts based on their age group (cohorts of 55-64, 65-74, 75-84, 85-94, ≥95 years) and year of presentation (2014-2021). Each patient was reviewed for demographics/comorbidities, injury mechanism/type, mortality data. Comparative analyses were conducted. ResultsThe average age of our cohort was 74 years old. The majority of patients were female (69%) and sustained their injuries via a ground level fall. The most common injuries sustained by patients occurred at the upper extremity (40%), hip (26%), and lower extremity (25%) with 820 (7%) patients sustaining polytrauma. The incidence of hip fractures and pelvic injuries increased with older age. Older patients had a higher rate of mortality through 1-year in addition to a longer length of stay. In contrast, the incidence of injury to the upper and lower extremity decreased with older age. ConclusionsThe rate of mortality out through 1-year following orthopedic trauma increased as patients got older. Significantly more women experienced a traumatic injury during 2014-2021. As age increased, ground level falls were the most common mechanism of injury with injuries more likely to occur in the axial skeleton, notably the hip and pelvis. Younger patients experienced higher rates of upper and lower extremity trauma. Providers should keep these patterns in mind to optimize care for middle-aged and geriatric trauma patients.

A Case Report on Nairobi eye– An Ayurvedic approach

Nairobi eye is an irritant contact dermatitis, caused by beetles of the genus Paederus. It is characterized by the erythematous and oedematous lesions associated with pain, burning sensation, blisters and pustules. The ocular involvement is usually unilateral in nature. The periocular lesion can be either due to the direct contact of the toxin or by accidental transfer through fingers from elsewhere on the skin. The toxin, being a weak base, cannot penetrate the cornea and conjunctiva and hence the damage is limited. These beetles breed in hot and humid conditions and maximum cases are seen during the months of May and June. This can be correlated with Keeta dashtam which is vata and pitta dosha predominant. A 32-year-old male patient approached with Nairobi eye disease. Along with Abhishyanda chikitsa , vishahara and rakta prasadana are the treatment principles adopted here. Sweta lodra avagundana, Manjishtadi Kashaya seka, Sigrupallava rasa aschothana and Jalookavacharana were done in op base. By 2nd day of treatment burning sensation and pus discharge subsided but mild pain persisted. On 3rd day conjunctival congestion and pain relieved and by 5th day the patient got relieved from all other symptoms. Nairobi eye can be successfully treated with ayurvedic medicines and the duration of disease progression can be considerably reduced.