JK Practitioner

Diagnostic Accuracy of Ultrasonography in the Evaluation of Knee Joint Injuries Compared to Magnetic Resonance Imaging and Arthroscopy

Imran Nazir Salroo, Muzammil Rasool, Mohd Farooq Mir, Zahoor Ahmad Raina — Sat, 10 May 2025 00:00:00 +0530

Introduction: Knee joint injuries are common, especially in sports persons. Injuries to soft tissues, such as ligaments, cartilage and tendons are commonly encountered. Ultrasound has become very popular modality in recent years for evaluation of knee joint injuries because of easy availability, non-invasiveness and possibility of dynamic imaging assessment.

Aim: To evaluate the role of ultrasound in evaluation of knee joint injuries compared to MRI.

Materials and methods: The prospective study included 60 patients with knee joint injuries. Ultrasound was done on both injured as well as normal knee, including dynamic assessment. It was followed by MRI of injured knee in all patients. MRI was used as Gold standard for comparison.

Results: Knee injuries are commonly seen in young age with maximum number of patients in the age group of 21-40 years. Most common cause of knee injuries is sports related trauma fallowed by road traffic accidents. It has been observed that Knee injuries show a definite male preponderance with male to female ratio of approximately 05: 01. Right knee was involved more frequently than left knee. Most frequent finding in knee injuries in our study was joint effusion. Medial meniscal tear was most common injury seen in this study.

Conclusion: Based on our results, it can be concluded that USG is an effective imaging modality that has positive effect on the management of many patients presenting with knee injuries. Knee USG has high accuracy in diagnosing menisco-ligamentous injuries. A broad availability, lower cost and fair reliability make it a modality of first choice for evaluation of knee injuries. MRI can be reserved for patients with suspicious USG results.

CyBorD vs. VRD as Induction Therapy in Multiple Myeloma: A Retrospective Study on Kashmiri Patients

Fri, 01 Aug 2025 00:00:00 +0530

Background: Multiple Myeloma (MM) is a clonal plasma cell malignancy that commonly presents with anemia, bone pain, renal dysfunction, and hypercalcemia. While combination regimens like VRD (bortezomib, lenalidomide, dexamethasone) are globally preferred as first-line induction therapy for transplant-eligible patients, real-world data comparing VRD with CyBorD (cyclophosphamide, bortezomib, dexamethasone) remain limited in specific ethnic and resource-constrained settings, including the Kashmiri population.
Objective: To compare the clinical profile, treatment response, and survival outcomes of CyBorD versus VRD as induction regimens in newly diagnosed multiple myeloma patients from Kashmir.
Methods: This retrospective observational study included 101 MM patients treated between January 2015 and June 2022 at a tertiary care center in Kashmir. Patients received either CyBorD (n = 81) or VRD (n = 20). Baseline characteristics, biochemical parameters, response rates, and survival outcomes were analyzed. Kaplan-Meier analysis was used for progression-free survival (PFS) and overall survival (OS).
Results: The median age was 60-years in both groups, with a male predominance. A higher proportion of CyBorD patients presented with ISS Stage III disease (65.4% vs. 40%) and renal dysfunction, reflected by elevated creatinine levels. Lenalidomide, a key component of VRD, was either contraindicated in renal impairment or not freely available during the early study period, influencing treatment selection. The overall response rate (ORR) was comparable between the two regimens (64.3% for CyBorD vs. 68.7% for VRD). The three-year PFS was 67.2% for CyBorD and 60% for VRD. Despite the unequal group sizes, CyBorD showed efficacy even in patients with poor-risk features such as renal impairment.
Conclusion: CyBorD is an effective, accessible, and well-tolerated alternative to VRD in the real-world management of multiple myeloma, especially in patients with renal dysfunction or in settings with limited access to lenalidomide. This study provides valuable regional data and supports the use of CyBorD in resource-constrained environment while highlighting the need for prospective studies with balanced group sizes.

Clinical and Biochemical Effectiveness of Ursodeoxycholic acid and S-adenosylmethionine in Intrahepatic Cholestasis of Pregnancy: An Observational Study in Kashmiri Population

Fri, 01 Aug 2025 00:00:00 +0530

Background: Intrahepatic cholestasis of pregnancy (ICP) occurs in the last trimester of pregnancy1 and is characterized by pruritus and raised biochemical markers. Currently, used drugs for treating ICP include ursodeoxycholic acid (UDCA) and S-adenosyle methionine (SAMe). In our study we are comparing both the drugs in pregnancy induced cholestasis in terms of clinical effectiveness, biochemical changes, as no such study has been done so far in our setup.
Materials and Methods: Patients were divided into two groups A and B. Group A was given 300 mg of (UDC) twice daily. Group B was given 400 mg (SAM) twice daily. Both the groups were first evaluated for clinical and biochemical changes at day one and record was kept. Patients in both the groups were given the drugs as described above. After two weeks both the groups were monitored for clinical improvements and after four weeks both groups were investigated for clinical and biochemical improvements. The efficacy of two drugs was established.
Results: In our study we discover that both the drugs used in the study were effective in terms of both clinical and biochemical improvement in ICP. The bilurubin, ALT, AST and ALP levels in SAM group before treatment were 1.70 ± 0.17 mg/dL, 39.31 ± 8.45 IU/L, 54.1 ± 9.09 IU/L and 175.96 ± 22.12 IU/L, respectively. After treatment, the respective values were 1.54 ± 0.66, 36.67 ± 7.67, 56.17 ± 7.45, and 169.67 ± 19.98. The bilurubin, ALT, AST and ALP levels in UDC group before treatment were 1.80 ± 0.07, 49.25 ± 4.92, 54.35 ± 5.13, and 166.5 ± 18.23, respectively. After treatment the values were 0.84 ± 0.06, 36.25 ± 7.67, 35.67 ± 5.64, and 95.55 ± 23.12, respectively. Pruritus improved in both the groups, but more in UDCA group.
Conclusion: UDCA is a better drug for improving biochemical and clinical parameters as compared to SAM.

A Quantitative Estimation of Piperacillin and Tazobactam in Generic and Branded Pharmaceutical Formulations by Reverse Phase High Performance Liquid Chromatography

Athar Shabir, Sameena Farhat Hakak, Naser Shaheen, M Y Rather — Fri, 01 Aug 2025 00:00:00 +0530

Background: In India the incidence of sub-standard drugs has risen from 0.04% to 2.3% in 2012 as per Drug Controller General of India (DCGI). There are 66 substandard drugs found in Jammu and Kashmir (India), as per Drugs and food control organization, Jammu and Kashmir 2013. Looking at the rising incidences of sub-standard drugs in the local market of our state, we have chosen piperacillin and tazobactam, used extensively in tertiary care hospital, to verify quality and quantity by employing High Performance Liquid Chromatography (HPLC) based analytical technique

Methods: Chromatographic separation of the two drugs was achieved using analytical column C18 250/4.6 mm, 5µm particle size, 20 µL sample loop size. The mobile phase consisted of a mixture of acetonitrile, methanol and 1% orthophosphoric acid (50:30:20). The drugs were analyzed using UV detector (Diode array detector, DAD) at wavelength 226 nm. The flow rate was maintained at 0.5 mL/min. Column temperature was at 25⁰C by in built column thermostat. The injection volume was 20 µL, with a run time of 8 minutes.

Results and conclusion: Amongst the six formulations (Tazar, Tazomac, Zosyn, Durataz, Jan Aushadhi and Jammu and Kashmir Medical Supplies Corporation Limited, i.e., JKMSCL), all the formulations contained piperacillin within the standards specified by the Indian Pharmacopoeia (94-115%), except JKMSCL, which had slightly higher concentration. Further, tazobactam was present in all the formulations. However, the standards for comparison of tazobactam have not been specified within the Indian Pharmacopoeia.

Cytological Analysis of Body Fluids in A Tertiary Care Hospital of Jammu Region: A One-year Retrospective Observational Study

Syed Aanif, Deepti Gupta — Fri, 01 Aug 2025 00:00:00 +0530

Introduction: Exfoliative cytology of body fluids involves the analysis of cells present in fluids such as cerebrospinal fluid, pleural fluid, peritoneal fluid, pericardial fluid and synovial fluid. The cytological interpretation of individual cells exfoliated into these fluids provides an insight into the diagnosis, prognosis and therapeutic aspects of various pathological conditions. It also helps in staging of malignancies.

Objective: To evaluate the significance of fluid cytology for various pathological conditions, including malignancies.

Materials and Methods: This observational retrospective study was carried out for a period of one year from 31^st May 2023 to 1^st June 2024. A total of 392 cases of peritoneal, pleural, cerebrospinal, synovial, and pericardial fluids received during the study period in the cytology section of Department of Pathology, Government Medical College and Hospital, Jammu, J&K, India were included in this study. Gross and clinical findings were noted from the requisition forms. The fluids were centrifuged at 2000 rpm for 5 minutes and the sediment was used to prepare smears that were stained by May-Grunwald-Giemsa (MGG) stain and Papanicolaou (Pap) stain.

Results: A total of 392 cases of serous effusions were studied. The most common fluid was peritoneal fluid, 230 (58.67%) cases, followed by pleural fluid, 145 (36.99%) cases, CSF, 15 (3.83%) and least common were pericardial fluid and synovial fluid, 1 (0.26%) case each. The age ranged from 4 years to 98 years. Most cases, 85 (21.68%) belonged to 51-60 years age group. Female preponderance was observed with M: F ratio of 1:1.23. 43 (10.97%) of the total effusions were malignant, out of which 23 were malignant peritoneal effusions. 23 (5.87%) cases were suspicious of malignancy of which 13 (56.52%) cases were peritoneal fluids. Carcinoma ovary was the most common primary site causing malignant peritoneal effusion.

Conclusions: Exfoliative cytology is a valuable tool in evaluation of body cavity fluids. It is relatively painless, simple, cost effective, rapid technique that yields quick and reliable results. Some cases may present major interpretative challenges to the pathologist like presence of reactive mesothelial cells which at times poses difficulty in diagnosis, being close mimicker of malignancy. It is especially helpful in evaluation and staging of malignancy.

Biomechanical Correction by Lateral Wedge Outsole in Osteoarthritis Knee Joint

Ruquiya Ali, U Singh, Sonu Singh, Ali Mohammad Buhroo — Fri, 01 Aug 2025 00:00:00 +0530

Background: Osteoarthritis (OA) Knee is one of the leading causes of pain and functional disability among painful joint conditions in adults. The overall prevalence of OA in India has been estimated to be around 28.7% which has been calculated based on data from five Indian states. Worldwide, the prevalence of OA is estimated to be around 9.6% in men and 18% in women aged over 60 years. Nearly, 45% of women over the age of 65-years have symptoms while radiological evidence is found in 70% of them. OA of knee joint is diagnosed using American College of Rheumatology Criteria (ACR).
Lateral wedges reduce the peak knee adduction moment and are advocated for knee osteoarthritis. However, some patients demonstrate adverse biomechanical effects with treatment. Clinical management is hampered by lack of knowledge about their mechanism of effect. We evaluated effects of lateral wedges on frontal plane biomechanics, to elucidate mechanisms of effect.
Materials and Methods: This prospective observational study was conducted on 80 patients between 40-65 years of age, 56 were females and 24 males. With grade II & grade III osteoarthritis according to Kallgren-Lawrence grading scale, who reported to OPD of PMR Department of MGMCH, Jaipur from April 2022 to September 2024.
- Diagnosis of knee osteoarthritis was established clinically based on ACR criteria.
- Pain was recorded on Visual Analogue Scale (VAS) and quality of life by SF-36.
- History, clinical examination and X-rays were taken in all patients.
- Biomechanical correction was given by using ¼ inches lateral wedge outsole in the footwear.
- Follow up was conducted on monthly bases from 1 ½ months and on 6 months for evaluation of results. Patients improved
symptomatically with pain and in quality of life.
Results: The mean age of the patients included was 52-years. All our patients presented with chronic pain in the knees and stiffness. The mean duration of symptoms at the time of presentation was 8-years. All of our patients had bilateral involvement of the knees showing medial joint space narrowing in radiographs. 56/80 patients were females, mostly housewives, and 24/80 were males with a history of prolonged standing at workplace. The mean weight of the patients was 60 ± 10 kg. The majority of our patients (50/80) were overweight having a BMI between 25 and 30 kg/m², (18/80) were obese, and (12/80) had a BMI < 25kg/m².
Conclusion: Use of lateral wedge outsoles signifies the redistribution of pressure and change in the ground reaction forces after shoe modification. Hence, lateral wedging provides symptomatic benefits in the mild and moderate OA knee.

Recent Development in the Journal

G M Malik — Sat, 10 May 2025 00:00:00 +0530

This issue publishes some original research studies such as diagnostic accuracy of ultrasonography (USG) in the evaluation of the knee joint injuries compared to MRI and arthroscopy, CyBorD vs. VRD as Induction Therapy in Multiple Myeloma, clinical and biochemical effectiveness of Ursodeoxycholic acid and S-adenosylmethionine in intrahepatic cholestasis of pregnancy, quantitative estimation of piperacillin and tazobactam in generic and branded pharmaceutical formulations by RP-HPLC, cytological analysis of body fluids, and biomechanical correction by lateral wedge outsole in osteoarthritis knee joint.

Further, this issue brings an interesting case study presenting a silent muscle story focusing on clinical insights from Amyopathic Dermatomyositis

A Silent Muscle Story: Clinical Insights from Amyopathic Dermatomyositis

Abir Aijaz, Judat Tasawoor, Manzoor Wani, Mariya Manzoor — Fri, 01 Aug 2025 00:00:00 +0530

Amyopathic dermatomyositis (ADM) is a rare subset of dermatomyositis accounting for ~20% of dermatomyositis cases. The prevalence is higher in females and peaks in middle age. Diagnosis relies on hallmark skin manifestations such as heliotrope rash and Gottron’s papules, supported by skin biopsy, serologic markers (anti-MDA5, anti-TIF1γ), and imaging.
Unlike classic dermatomyositis, muscle enzymes and electromyography findings are typically normal. A 15-year-old female with no significant medical history presented with a one-month history of lowgrade fever and a progressive rash, along with oral ulcers for 15-days. The rash initially began as ill-defined macular to maculopapular lesions with fine scaling, predominantly involving sun-exposed areas, including the face (sparing the eyelids), ears, chin, anterior neck, and extensor surfaces of the arms, which extended later).
There is currently no specific randomized controlled trial that primarily involves ADM only. Further, treatment is often guided by the extent of cutaneous and systemic involvement. A better understanding may improve prognostication and therapeutic strategies, reducing morbidity and malignancy-associated mortality