Introduction: Tumor necrosis factor alpha (TNF-α) mediated inflammation has been implicated, in knee osteoarthritis, despite being a predominantly degenerative condition. Patient Concerns: A 56-year old female, a case of left knee pain not responding to conventional conservative strategies. Diagnosis: A diagnosis of primary osteoarthritis of the left knee, grade 3 osteoarthritis as per the Kellgren-Lawrence Scale was established. Interventions: She was administered an intra-articular injection of 10 mg of Adalimumab, a commonly used anti-TNF agent. Outcomes: The patient was evaluated at baseline, 1 month, 3 months, and at 6 months. There was a marked improvement in pain intensity (visual analog scale) and quality of life, despite no objective change on the parameters seen on ultrasound of the knee. Conclusion: Injection of adalimumab via the intra-articular route into the knee joint in primary osteoarthritis yields promising results.

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Background: The health-related problems of the tribal population depend on their ecology and culture. Often the tribal people do not utilize the medical and preventive health services available to them. Health problems in tribal groups need special attention because many tribal communities are backward. The current study was planned to determine the healthcare-seeking behavior of the tribal population in India. Method: A descriptive, cross-sectional study, conducted by interviewing key respondents of each participating family. Result: Two-thirds of the key respondents were literate and half (53.8%) of the total households in the three villages had a per capita monthly income between Rupees 500-1499. More than half (57%) of all respondents preferred government institutions for moderate illness, and the rest equally opted for private practitioners and quacks. However, for emergencies, dog bites, and snake bites, all key respondents in the three study villages unanimously preferred government institutions. A significant population (38.5%) got their children delivered at home. The majority of illiterate respondents (86.1%) preferred government institutions for health care of under-five children, while 60% of literates expressed a similar view. The choice of government institutions as a source of health care was increasingly favored with decreasing per capita monthly household income. Conclusion: Traditional healers are no longer preferred among the tribal population but they are reluctant to avail them because of the loss of valuable time. Home delivery is still prevalent. With improving socioeconomic status, people are going further away from government services as private practitioners, and quacks take less time.

The concept of functional disability is aligned with the biopsycho-social model of disability. However, there are reasons why the antiquated measurement of medical impairment continues to be in use. We propose solutions for a fairer process using the International Classification of Functioning, Disability, and Health (ICF) at the level of the medical boards augmented by telemedicine and artificial intelligence (AI). The proposed technologies (Level 1 and Level 2 AI) need to be tried in pilot projects. It will accomplish two goals, the first being the measurement of disability and not merely the impairment. Second, and perhaps more importantly, making the process more transparent in creating a “just” society.

Pain, a protective mechanism turns into a pathologic response when it becomes chronic.Recent evidences are pointing towards neuroplastic brain changes as the primary factor for the persisting pain in chronic nonspecific low back pain (cLBP). To summarise the previous fMRI studies, a coordinate-based ALE meta-analysis of resting functional brain imaging studies is carried out to identify the clusters activated in the brain in cLBP.Literature survey: 'PubMed', 'Scopus' and 'Sleuth' were searched for studies with resting functional whole-brain imaging in cLBP. Till October 2020; 258, 238, and 7 studies were found respectively after search. The activity pattern was documented in 'without stimulation' and 'with stimulation' groups. The risk of bias was assessed by Joanna Briggs Institute critical appraisal checklist for analytical cross-section studies. Total seven (224 cLBP patients, 110 activation foci) and six studies (106 cLBP patients, 66 activation foci) were selected among 277 studies for metanalysis in the 'without stimulation' and 'with stimulation' group respectively. In the 'without stimulation' group 8 statistically significant clusters were found. The clusters are distributed in the prefrontal cortex, primary somatosensory cortex, and primary motor cortex, anterior cingulate cortex, insular cortex, putamen, claustrum, amygdala, and associated white matters in both hemispheres. On the other group, 3 statistically significant clusters were found in the frontal cortex, Parietal cortex, and Insula. In the 'with stimulation' group, significant lateralization was observed and most of the clusters were in the right hemisphere. The white matter involvement was more in All rights reserved. No reuse allowed without permission.(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.