Background: Purpose: To report our experience with two-stage treatment of chronic osteomyelitis using a prospective protocol involving the use of the antibiotic loaded PMMA beads followed by antibiotic-loaded calcium sulphate pellets after bony debridement. Patients and methods: A single patient of age 58 years was treated according to a protocol that included surgical debridement of bone and infected tissues,local antibiotic therapy including vancomycin loaded on PMMA gentamycin loaded on calcium sulphate space filling biodegradable pelletsalong with intravenous antibiotics according to culture and sensitivity results. Results: After a minimum of one-year follow-up, infection was eradicated in the patient, the average rate of filling of the bony defect was 70.47%. Conclusion: The technique proved safety and efficacy in eradicating the infection and bony healing of the defects after debridement.

Background: Osteoarthritis is one of the leading conditions of the global disability burden.1 It is characterized by damage to the smooth joint cartilage surface and degradation of the joint's integrity can cause symptoms such as pain and lack of mobility. Total joint arthroplasty is the most successful treatment for advanced osteoarthritis of the hip or knee joint. Socioeconomic status (SES) has a significant impact on an individual's health. Socioeconomic deprivation or components hereof have been associated with worse postoperative outcomes, higher risk of postoperative complications, prolonged hospitalization and readmissions due to lower rates of surgery, higher disease severity, and worse preoperative health.6,8 Aim To evaluate the association between socioeconomic status (SES) and patient-reported outcomes before and one year after total knee arthroplasty (TKA) or total hip arthroplasty (THA), and to assess whether changes in symptoms were clinically meaningful in an Indian population.

Methods A prospective observational cohort study was conducted between September 2023 and August 2024 at a tertiary care teaching hospital in Northern India. A total of 101 patients aged ≥45 years who underwent primary TKA or THA for primary osteoarthritis were included. Socioeconomic status was stratified using the modified Kuppuswamy scale.

Patient-reported outcome measures (PROMs) included:

• Oxford Knee Score (OKS)
• Oxford Hip Score (OHS)
• Western Ontario and McMaster Universities Arthritis Index (WOMAC)
• Visual Analog Scale (VAS) for pain
• EuroQol 5-Dimensions (EQ-5D)

Linear mixed-effects regression models were used to examine the relationship between SES and both pre- and postoperative PROMs, adjusting for age and sex. Potential confounders included BMI, ASA classification, Charnley classification, smoking status, and alcohol use. Results Of the 101 patients enrolled, those from lower SES groups were more frequently female, and a greater proportion were ASA Grade III. At baseline, patients from lower SES strata reported significantly worse OKS (β = 3.52, P = 0.003). Among THA patients, lower SES was also associated with worse OHS (β = 4.63, P = 0.002), higher WOMAC scores (β = 10.9, P = 0.001), and more pain on VAS (β = −0.88, P = 0.001). No statistically significant differences in EQ-5D scores were noted across SES groups, benefits which were observed across SES groups but were most marked in patients with higher adherence, particularly from middle and higher SES backgrounds. Conclusion In this one-year study conducted between September 2023 and August 2024, patients from lower socioeconomic backgrounds presented with worse preoperative symptoms and demonstrated less clinically meaningful improvement one year after TKA or THA. We can use these findings particularly with tailored strategies to improve access and adherence among lower SES groups.

Introduction: Peripheral neuropathy is a prevalent but often neglected complication of hepatic cirrhosis. The objective of this study was to investigate the electrophysiological pattern distinguishing motor and sensory nerve involvement in cirrhotic individuals. Methods: Fifty male cirrhosis patients aged 25 to 50 were included. Bilateral motor and sensory nerve conduction studies (NCS) of the median, ulnar, tibial, and sural nerves were performed. Parameters such as conduction velocity, amplitude, and latency were compared with age-matched reference values. Results: All motor nerves demonstrated slowed conduction velocities, with the tibial and ulnar nerves being most affected. Sensory nerves—particularly the median and sural—showed markedly reduced amplitudes and prolonged latencies. The predominant pattern was symmetrical, mixed, sensorimotor polyneuropathy of axonal type. Conclusion: Hepatic cirrhosis affects both motor and sensory nerves, with sensory fibers showing earlier and more severe changes. Incorporating electrophysiological screening into the management of cirrhosis could aid in early detection and improve long-term outcomes.

Background: Surgical site infections (SSIs) significantly increase morbidity following emergency laparotomy. The efficacy of subcutaneous drains in preventing SSIs remains controversial.Methods: Prospective comparative study of 80 consecutive emergency laparotomy patients at a tertiary care center in India (July 2023-March 2025). Patients were allocated to Group A (n=40, negative suction closed drains) or Group B (n=40, no drains). Primary outcome was SSI incidence within 30 days (CDC criteria). Secondary outcomes included wound complications, hospital stay, microbiological profile, and need for surgical intervention. Analysis used χ² tests and t-tests (p<0.05 significant). Results: SSI incidence was 12.5% (5/40) in Group A versus 45.0% (18/40) in Group B (χ²=10.79, p=0.0013), representing 72.2% relative risk reduction. Group A had zero hematomas/seromas versus 10% each in Group B (p=0.005). Mean hospital stay was 5.95±1.36 vs 6.80±1.69 days. All Group A SSIs occurred early (POD 2-3) while Group B SSIs were delayed (POD 4-6). Gram-negative enteric organisms (E.coli, Klebsiella) were absent in Group A but comprised 35% of Group B SSIs (p<0.01). No Group A patients required surgical intervention versus 15% in Group B (p=0.034). Conclusions: Negative suction closed drains significantly reduce SSI rates, wound complications, and need for re-intervention following emergency laparotomy, particularly by eliminating gram-negative enteric infections associated with fluid accumulation.

Background: Extended-spectrum β-lactamase (ESBL) production represents a critical biochemical mechanism of resistance, leading to enzymatic degradation of β-lactam antibiotics and posing significant pharmacological challenges in clinical management. Objective: To assess the microbial spectrum of urinary, respiratory, and gastrointestinal infections among immunocompromised cancer patients, with a focused evaluation of urinary E. coli isolates, ESBL-associated antimicrobial resistance patterns, and pharmacological implications for therapy. Methods: A cross-sectional study was conducted among 170 patients from the oncology department at one of the tertiary care public hospitals in Karachi, Pakistan, from April 2021 to May 2023. Urine, sputum, and stool specimens were processed using standard microbiological culture and biochemical identification methods. Antimicrobial susceptibility testing of urinary E. coli isolates was performed to determine resistance patterns suggestive of ESBL activity. Data were analyzed using SPSS version 26, categorical variables were expressed as frequencies and percentages, and associations were assessed using the chi-square test with a significance level of p ≤ 0.05. Results: Escherichia coli was the predominant pathogen isolated from urinary tract infections (78.2%), whereas Staphylococcus aureus and Salmonella/Shigella species were most frequently identified in respiratory and gastrointestinal infections, respectively. Urinary E. coli isolates exhibited high resistance to β-lactam antibiotics and fluoroquinolones, consistent with the enzymatic inactivation mediated by ESBLs. Conclusion: ESBL-mediated resistance in urinary E. coli poses a significant biochemical and pharmacological challenge in immunocompromised cancer patients. Antimicrobial selection and routine susceptibility testing are essential to optimize treatment outcomes and limit the progression of antimicrobial resistance.

Background: Osteoarthritis of the knee is one of the most common degenerative joint disorders leading to pain, stiffness, and functional disability. Total knee arthroplasty (TKA) is an effective surgical treatment for advanced osteoarthritis; however, postoperative pain may delay early mobilization and rehabilitation. Intraoperative periarticular cocktail injection has emerged as an important component of multimodal analgesia aimed at improving postoperative pain control and functional recovery following TKA. Aim: To assess the functional outcome of intraoperative periarticular cocktail injection for pain control and improvement of knee motion following total knee arthroplasty. Methods: This prospective observational study was conducted in the Department of Orthopedics at Dhiraj Hospital, S.B.K.S. Medical Institute and Research Centre, Sumandeep Vidyapeeth University, Vadodara, Gujarat, from June 2023 to June 2025 after obtaining institutional ethical clearance. A total of 27 patients with osteoarthritis of the knee undergoing total knee arthroplasty were included in the study. Intraoperative periarticular cocktail injection consisting of triamcinolone, ketorolac, clonidine, bupivacaine, and distilled water was administered during surgery. Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 6 hours, 12 hours, and daily up to the fourth postoperative day, with follow-up at 1 month and 3 months. Knee range of motion (ROM) and postoperative complications were also recorded. Data were analyzed using appropriate statistical methods and a p-value <0.05 was considered statistically significant. Results: The study demonstrated significant reduction in postoperative pain following periarticular cocktail injection. Mean VAS scores decreased progressively during follow-up, indicating effective pain control. Knee range of motion improved gradually during the postoperative period, with most patients achieving satisfactory functional recovery. The majority of patients experienced uneventful recovery, and only a small proportion developed minor postoperative complications. Conclusion: Intraoperative periarticular cocktail injection is an effective and safe technique for postoperative pain management in total knee arthroplasty. It provides adequate pain relief, facilitates early mobilization, improves knee range of motion, and contributes to better functional outcomes in patients undergoing knee replacement surgery.