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Interacting Finding Processes upon Complicated Cpa networks.
Why do racial inequalities endure despite numerous attempts to expand civil rights in certain sectors? A major reason for this endurance is due to lack of attention to structural racism. Although structural and institutional racism are often conflated, they are not the same. Herein, we provide an analogy of a "bucky ball" (Buckminsterfullerene) to distinguish the two concepts. Structural racism is a system of interconnected institutions that operates with a set of racialized rules that maintain White supremacy. These connections and rules allow racism to reinvent itself into new forms and persist, despite civil rights interventions directed at specific institutions. To illustrate these ideas, we provide examples from the fields of environmental justice, criminal justice, and medicine. Racial inequities in power and health will persist until we redirect our gaze away from specific institutions (and specific individuals), and instead focus on the resilient connections among institutions and their racialized rules.The purpose of this study was to identify preoperative and intraoperative factors that influence extension-flexion gap imbalance in total knee arthroplasty (TKA). Ninety-three knees undergoing TKA with the modified gap balancing technique were included. Preoperative range of motion, intraoperative extension-flexion gap balance, thickness of the resected bone and radiological parameters were investigated. The preoperative flexion contracture, bone resection thickness in the medial proximal tibia, and the medial distal femur all correlated with the extension-flexion gap balance in TKA. Bone resection thickness in the medial proximal tibia and the medial distal femur were predictive of extension-flexion imbalance.
This study examined the possible clinical utility of "parsicle screws" in securing C2 instrumentation.

Ten patients' C2 vertebrae were virtually reconstructed using computer-aided design software. Pedicle, pars, and parsicle screws were virtually placed in the vertebrae.

In addition to establishing the trajectory and theoretical safety of parsicle screws, this study determined that parsicle screws were significantly longer than pars screws (p=0.005).

The additional length of parsicle screws may improve construct stability. As such, parsicle screws should be examined as an alternative to pars screws in patients unable to receive C2 pedicle screws.
The additional length of parsicle screws may improve construct stability. As such, parsicle screws should be examined as an alternative to pars screws in patients unable to receive C2 pedicle screws.
The purpose was to compare robotic assisted (RA), computer navigated (CN), and conventional UKA techniques.

Databases were queried for data on study characteristics, UKA systems, complications, and tibiofemoral alignment.

Four RA and six CN RCTs were identified. No significant differences were found in operative time, tibiofemoral alignment, and reoperation rates when comparing RA or CN to conventional UKA. RA UKA resulted in a significantly lower risk of complications compared to conventional UKA.

RA UKA results in fewer complications than conventional UKA with a clinically significant increase in operative time. All groups were similar in remaining evaluated parameters.
RA UKA results in fewer complications than conventional UKA with a clinically significant increase in operative time. All groups were similar in remaining evaluated parameters.
Aging populations and expanding indications will greatly increase the volume of total hip arthroplasty (THA) in all age groups, including patients over 70 years old. Minimally invasive, uncemented direct anterior THA offers potential advantages for treating elderly patients. However, literature indicates higher risks of postoperative periprosthetic femur fractures (PPFFs) with both direct anterior THA and uncemented femoral stems. This retrospective study investigates the influence of femoral stem design on PPFF incidence in uncemented direct anterior THA among patients older than 70 years.

557 primary THAs in patients aged 70 or over were reviewed for PPFFs from a consecutive series of 2011 patients undergoing direct anterior THA from a fellowship-trained adult reconstruction surgeon from 2015 to 2020. Exclusion criteria included age (<70) and posterior approach. For the first cohort of 361 patients (79 of which passed exclusion criteria) the surgeon used a single-tapered, proximally porous coated, collarless titanium stem. For the next 1650, (478 of which passed exclusion), the surgeon used a dual-tapered, collared, hydroxyapatite-coated titanium stem. Included patients were carefully monitored until March 2021 for PPFFs. A Fisher's exact test was used to compare the incidence PPFFs between the 2 implant designs.

2 of 79 (2.5%) patients had atraumatic PPFFs at an average of 19.5 days post-operatively in the first cohort. Both experienced a Vancouver type B2 periprosthetic fracture and required femoral revision. No patients (0/478, 0%) in the second group sustained a PPFF. (P=0.0199).

In this comparison, the dual-taper, hydroxyapatite-coated implant had a significantly lower PPFF rate among elderly patients than a single-taper, proximally porous stem without a collar.
In this comparison, the dual-taper, hydroxyapatite-coated implant had a significantly lower PPFF rate among elderly patients than a single-taper, proximally porous stem without a collar.
This systematic review characterizes the safety and efficacy of total knee arthroplasty (TKA) in end stage renal disease (ESRD) patients due to the unique challenges they face.

The cumulative complication rate for 3684 patients on dialysis for ESRD after primary TKA was 25%(N=925/3702), with incidence rates of 2.5%(N=92/3702) for periprosthetic joint infection, 3.7%(N=71/1895) for reoperations, and 2.5%(N=90/3578) for mortality.

Patients on dialysis for ESRD face significant mortality rates after primary TKA, in addition to other major complications. Careful counseling regarding risks and benefits should be provided prior to TKA in this population.
Patients on dialysis for ESRD face significant mortality rates after primary TKA, in addition to other major complications. Careful counseling regarding risks and benefits should be provided prior to TKA in this population.This study aims to evaluate and compare extremity-MRi with specialized radiography by measuring articular cartilage height in patients with knee osteoarthritis. A prospective study, including sixty patients. Measurements on MRi images, Rosenberg view, and coronal stress radiographs were performed. MRI was compared to specialized radiography. Measurements in the medial compartment showed negligible/weak correlation between MRi and Rosenber/varus stress. In the lateral compartment, MRi and the Rosenberg/valgus stress view were strongly correlated. We conclude that MRi cannot replace radiographs for the measurement of articular cartilage thickness. MRi should, however, be reserved for more unusual cases of atypical clinical findings.
To assess alignment for total knee arthroplasty, the center of the ankle has been used as the main reference point for the distal tibia; however, the true load-bearing mechanical axis should be determined as a line from the center of the femoral head to the lowest point of calcaneus. Thus, the purpose of this study was to compare the differences in alignment.

Patients with medial osteoarthritis who underwent primary total knee arthroplasty (Group A, center of ankle reference, or Group C, calcaneal contact reference) were recruited. We determined (1) the total number with calcaneal contact point lateral to the center of ankle and compared (2) percentage of displacement of the load-bearing axis at the level of the knee, (3) anatomical axis angle, (4) mechanical axis angle, and (5) tibial component angle.

The study included 94 patients (128 knees), with the calcaneal contact reference point located lateral relative to the center of the ankle in 88.3% (113/128 knees). Using calcaneal contact point references, displacement of the load-bearing axis at the knee was greater (p<0.0001, 38.7% vs 34.0%), and angles demonstrated significantly valgus alignment (p<0.0001, 5.6° vs. 4.8° for anatomical axis angle, -3.0° vs. -4.2° for mechanical axis angle, and 89.9° vs. 88.6°for tibial component angle).

Varus alignment measured by the ankle reference method might correspond to the neutral alignment by the amount of valgus alignment indicated by the calcaneal reference. Surgeons should take this into account when preoperative planning, performing intraoperative procedures, and during postoperative evaluation.
Varus alignment measured by the ankle reference method might correspond to the neutral alignment by the amount of valgus alignment indicated by the calcaneal reference. Surgeons should take this into account when preoperative planning, performing intraoperative procedures, and during postoperative evaluation.How to cite this article Kumar A, Kumar N, Lenin D, Kumar A, Ahmad S. Second-degree Heart Block Caused by Itolizumab-induced Infusion Reaction in COVID-19. Indian J Crit Care Med 2021;25(4)474-475.How to cite this article Paliwal B, Bhatia PK, Kamal M, Purohit A. Personal Protective Equipment and Fire. Indian J Crit Care Med 2021;25(4)473.How to cite this article Sarkar S, Khanna P. In Pursuit of Freedom from COVID-19 Awareness in India An Infodemiological Analysis. Indian J Crit Care Med 2021;25(4)470-472.Severe acute respiratory syndrome coronavirus 2 has affected millions of people worldwide. This pandemic requires newer medical management strategies to control the morbidity and mortality associated with the disease. Several approaches, including global targeting of inflammation or neutralizing a single key inflammatory mediator, are being employed to cope with cytokine storms in coronavirus disease-2019 (COVID-19). The role of anti-inflammatory biologics, such as acalabrutinib, tocilizumab, anakinra, and itolizumab can become relevant. Itolizumab is a humanized recombinant immunoglobulin G1 monoclonal antibody. It targets the extracellular, scavenger receptor cysteine-rich (SRCR) distal domain 1 of CD6 and is responsible for priming, activation, and differentiation of T-cells. Itolizumab has been approved by the Drug Controller General of India for the treatment of COVID-19 in India. Here, we shared our clinical experience of 20 patients having moderate acute respiratory distress syndrome (ARDS) due to COVID-19 on treatment with itolizumab. We observed the mortality benefit with single-dose itolizumab (1.6 mg/kg) in patients having moderate COVID-19 ARDS.
Kumari P, Kumar A, Sinha C, Kumar A, Singh PK, Arun SK. Off-label Use of Itolizumab in Patients with COVID-19 ARDS Our Clinical Experience in a Dedicated COVID Center. Indian J Crit Care Med 2021;25(4)467-469.
Kumari P, Kumar A, Sinha C, Kumar A, Singh PK, Arun SK. Off-label Use of Itolizumab in Patients with COVID-19 ARDS Our Clinical Experience in a Dedicated COVID Center. Indian J Crit Care Med 2021;25(4)467-469.Thrombocytopenia in coronavirus disease-2019 (COVID-19) can be attributed to multiple factors. Most often it is disease related. It is usually mild and if severe often associated with severe COVID-19 disease. It can also be due to drugs (Remdesivir, Tocilizumab) or coinfection with other viruses. Here we report two cases of severe thrombocytopenia in COVID-19 due to dengue coinfection. Most often the thrombocytopenia in dengue is self-resolving, and a careful "wait and watch" should suffice unlike COVID-19, where steroids can help if the cytopenia is due to cytokine storm or immune-mediated effects.
Adarsh MB, Abraham A, Kavitha P, Nandakumar MM, Vaman RS. Severe Thrombocytopenia in COVID-19 A Conundrum in Dengue-endemic Areas. Indian J Crit Care Med 2021;25(4)465-466.
Adarsh MB, Abraham A, Kavitha P, Nandakumar MM, Vaman RS. Severe Thrombocytopenia in COVID-19 A Conundrum in Dengue-endemic Areas. Indian J Crit Care Med 2021;25(4)465-466.
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