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1.  Association between single nucleotide polymorphism in collagen IX and intervertebral disc disease in the Indian population 
Indian Journal of Orthopaedics  2012;46(4):420-426.
Background:
Symptomatic intervertebral disc degeneration is being recently reported in younger population, questions the basis of its degenerative etiology. Latest evidences show that genetics play a significant role. Collagen IX, an important constituent of disc, is found to be altered in genetically predisposed individuals. Mutations have been reported in COL9A2 and COL9A3 genes, which encode Collagen IX, in Finnish and various other populations. The purpose of the present study is to test the significance of these genes in the Indian population.
Materials and Methods:
One hundred proven cases of intervertebral disc disease (IDD) of various regions of spine were selected for the study, along with matched controls. They were tested for the above mentioned alleles by allelic discrimination method with real-time polymerase chain reaction (PCR) study after isolation of DNA from blood sample. Each blood sample was classified into one of the three types – homozygous, heterozygous, and wild (normal) type allele – separately for COL9A2 and COL9A3 genes.
Results:
Homozygosity for COL9A2 allelic variation was associated with 100% occurrence of the disease. Heterozygous allele of COL9A2 was significantly higher in the study group (42%) as compared to the control group (17%). In contrast, allelic variation in COL9A3 gene was found to have no significant correlation with disc disease. There was no single patient with homozygous allelic variation for COL9A3, suggesting predominance of COL9A2 variation in the Indian population.
Conclusion:
This candidate gene strategy approach adds considerably to our knowledge of genetic makeup of Indian populations in relation with disc disease. This study highlights importance of COL9A2 gene variation especially of homozygous variety in contrast to COL9A3 variation in causing disc disease in Indian population.
doi:10.4103/0019-5413.97261
PMCID: PMC3421932  PMID: 22912517
Allelic discrimination; COL9A2 and COL9A3 genes; intervertebral disc disease; real time PCR
2.  Clinical Comparative Study: Efficacy and Tolerability of Tolperisone and Thiocolchicoside in Acute Low Back Pain and Spinal Muscle Spasticity 
Asian Spine Journal  2012;6(2):115-122.
Study Design
We performed a multicentric, randomized, comparative clinical trial. Eligible patients were randomly assigned to receive 150 mg of Tolperisone thrice daily or 8 mg of Thiocolchicoside twice daily for 7 days.
Purpose
To assess the efficacy and tolerability of Tolperisone in comparison with Thiocolchicoside in the treatment of acute low back pain with spasm of spinal muscles.
Overview of Literature
No head on clinical trial of Tolperisone with Thiocolchicoside is available and so this study is done.
Methods
The assessment of muscle spasm was made by measuring the finger-to-floor distance (FFD), articular excursion in degrees on performing Lasegue's maneuver and modified Schober's test. Assessment of pain on movement and spontaneous pain (pain at rest) of the lumbar spine was made with the help of visual analogue scale score.
Results
The improvement in articular excursion on Lasegue's maneuver was significantly greater on day 3 (p = 0.017) and day 7 (p = 0.0001) with Tolperisone as compared to Thiocolchicoside. The reduction in FFD score was greater on day 7 (p = 0.0001) with Tolperisone. However there was no significant difference in improvement in Schober's test score on day 3 (p = 0.664) and day 7 (p = 0.192). The improvement in pain score at rest and on movement was significantly greater with Tolperisone (p = 0.0001).
Conclusions
Tolperisone is an effective and well tolerated option for treatment of patients with skeletal muscle spasm associated with pain.
doi:10.4184/asj.2012.6.2.115
PMCID: PMC3372546  PMID: 22708015
Tolperisone; Thiocolchicoside; Skeletal muscle relaxant; Low back pain; Muscle; Spasm
3.  The split tibialis anterior muscle flap – A simple solution for longitudinal middle third tibial defects 
Background:
The tibialis anterior flap is an underused flap, mainly because it is not an expendable muscle and is small in size.
Aim:
To study the use of the tibialis anterior muscle flap for longitudinal middle third tibial defects.
Materials and Methods:
We have analysed the use of tibialis anterior flap in five patients by the function preservation technique.
Results and Conclusion:
Function preservation techniques used in the harvesting of this flap will be able to cover narrow and linear defects on middle third of tibia comfortably. Size and pliability of the muscle must be assessed before initiation of harvesting of the flap. Flap harvesting is initiated by a saggital split incision to preserve maximum blood supply to the muscle. Transverse incisions may be employed to obtain the desired reach of the flap. This flap is a simple alternative for linear wounds with small transverse dimensions on middle third of the leg, where the tibialis anterior muscle is uninjured.
doi:10.4103/0970-0358.96585
PMCID: PMC3385399  PMID: 22754153
Longitudinal tibial defect; tibialis anterior function preservation; tibialis anterior flap
4.  Polyarthritic, symmetric arthropathy in reactive arthritis 
Reactive arthritis (ReA) is an immune mediated disease, clinically associated with oligoarthritis of the lower limbs and sometimes with urethritis and conjunctivitis. In our case, a 24-year-old male presented with severe mutilating arthritis involving both upper and lower extremities in contrast to conventional Reiter's syndrome which presents with asymmetric oligoarthritis. He had multiple well-defined, irregular, erythematous, hyperkeratotic, scaly and itchy plaques, not easily distinguishable from pustular psoriasis. The patient also gave history of circinate balanitis and urethritis. He was started on methotrexate (7.5 mg/week, later escalated to 15 mg/week with 15 mg/day folinic acid supplementation) to which he responded. But when he stopped it on his own, the symptoms recurred. Hence, methotrexate was restarted, but still the patient suffers from fixed flexion deformities in affected joints. Histopathological examination of skin lesions is also suggestive of ReA. Thus, this case report suggests that diagnosis of Reiter's should be considered in symmetrical, mutilating polyarthritis patients with typical skin lesions.
doi:10.4103/0976-9668.92312
PMCID: PMC3276018  PMID: 22346240
Mutilating arthritis; reactive arthritis; Reiter's syndrome

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