bluuebunny/crossref_metadata_2025 huggingface dataset:
Aetiological profile of non-traumatic epistaxis: a two-year retrospective analysis in a tertiary care hospital
Authors: Manappattu Najmudheen , Bashir N. K. , Raj Girish
Published: February 2019

Background: Epistaxis is one of the commonest rhinological emergencies. Studies from different parts of the world show wide variation in aetiological profile. Idiopathic epistaxis is the most common form in most western studies while in many developing countries trauma is the predominant factor. Rhinosporidiosis is an important cause for epistaxis in certain parts of Malappuram district of Kerala. Hence this study was designed to analyze the non-traumatic causes for epistaxis in study location with a special emphasis on age and sex distribution and the role of rhinosporidium in epistaxis.

Methods: Retrospective analysis of case records of epistaxis patients was done in a tertiary care teaching hospital in Malappuram district of Kerala, India. Patients with epistaxis reported through OP, IP and referrals from other departments were included as the study population. Age and sex distribution of idiopathic epistaxis and systemic and local cause of epistaxis with its age and sex distribution were analysed.  

Results: Total of 110 patients were studied, 74 males and 36 females, between the ages of 4 and 80. Predominant age group was 11-20 years followed by 21-30, with male dominance in almost all age ranges. Right side predominance was noted in unilateral cases. Thirty-six patients had primary epistaxis. Among the systemic causes, 15 had hypertension, four platelet dysfunction and three altered coagulation. Local causes were found in 51 cases; rhinosporidiosis being the commonest followed by infection.

Conclusions: Non-traumatic epistaxis is more common among young males. Nasal rhinosporidiosis and infection are the two prominent local causes for epistaxis.
Cross sectional study of prevalence of LPRD at tertiary care hospital
Authors: Gaur Raghvendra Singh , Patra Paromita
Published: February 2019

Background: Reflux means return or regurgitation of fluid. When symptoms arise due to reflux of stomach contents into the pharynx and larynx it is termed as laryngopharyngeal reflux disease (LPRD). GERD and LPRD are two different entities and the management principle of GERD doesn’t apply to LPRD. We designed a cross sectional study to evaluate the prevalence of laryngopharyngeal reflux among the patients visiting the ENT outpatient department over a duration of one year.

Methods: Patients presenting with throat and voice symptoms for more than a month were included in the study. The reflux symptom index (RSI) put forward by Belafsky et al was used to assess the symptoms of reflux. A diagnosis of reflux was made if the patient had an RSI score >13.  

Results: A total of 2669 patients included in study period, out of which 1316 (49.3%) were males and 1353 (50.7%) were females. Out of the 2669, 1938 (72.6%) patients were found to have a RSI of >13. Out of the 1938 patients subjected to 70 laryngoscopy 1842 patients (95%) were found to have a RFS >7. Of the 1842 patients with RFS >7, 1234 were males (67%) and 608 were females (33%).

Conclusions: In a developing country like India, where resources and man power are limited, symptoms of laryngopharyngeal reflux might often be overlooked. The diagnosis and treatment protocol for LPRD needs to be standardized through more long term studies in the manner it has been done for GERD.
Development of multiple choice question bank in otorhinolaryngology by item analysis: a cross-sectional study
Authors: Khilnani Ajeet Kumar , Thaddanee Rekha , Khilnani Gurudas
Published: February 2019

Background: Multiple choice questions (MCQs) are routinely used for formative and summative assessment in medical education. Item analysis is a process of post validation of MCQ tests, whereby items are analyzed for difficulty index, discrimination index and distractor efficiency, to obtain a range of items of varying difficulty and discrimination indices. This study was done to understand the process of item analysis and analyze MCQ test so that a valid and reliable MCQ bank in otorhinolaryngology is developed.

Methods: 158 students of 7th Semester were given an 8 item MCQ test. Based on the marks achieved, the high achievers (top 33%, 52 students) and low achievers (bottom 33%, 52 students) were included in the study. The responses were tabulated in Microsoft Excel Sheet and analyzed for difficulty index, discrimination index and distractor efficiency.  

Results: The mean (SD) difficulty index (Diff-I) of 8 item test was 61.41% (11.81%). 5 items had a very good difficulty index (41% to 60%), while 3 items were easy (Diff-I >60%). There was no item with Diff-I <30%, i.e. a difficult item, in this test. The mean (SD) discrimination index (DI) of the test was 0.48 (0.15), and all items had very good discrimination indices of more than 0.25. Out of 24 distractors, 6 (25%) were non-functional distractors (NFDs). The mean (SD) distractor efficiency (DE) of the test was 74.62% (23.79%).

Conclusions: Item analysis should be an integral and regular activity in each department so that a valid and reliable MCQ question bank is developed.
Evaluation of the benefits of functional endoscopic sinus surgery on bronchial asthma in patients with concomitant nasal polyposis
Authors: Gupta Vijay , Gupta Arindam
Published: February 2019

Background: It is important to understand the relationship between diseases of the upper and lower respiratory tracts because of the prevalence of nasal polyp and asthma, their impact on patients’ lives, the resultant burden on the health care system, and the potential benefits of functional endoscopic sinus surgery. Objective of the study was to evaluate the benefits of functional endoscopic sinus surgery (FESS) on bronchial asthma in patients with concomitant nasal polyposis.

Methods: A total of 30 patients having nasal polyposis with asthma were taken up in the study. Patients were evaluated in reference to radiographic study of nose and PNS, pulmonary function by spirometry and asthma symptoms by ACT score. FESS was performed in all patients. Post-surgery spirometry and ACT score was done at 3 and 6 months.  

Results: Maximum patients belonged to the age group of 35-49 years. When compared pre and post-operative ACT score, we observed a mean of 15.7 (pre-operative), 13.6 (at 3 months) and 19.8 (at 6 months). FEV1% score was 74.6 pre-operatively, which was 90.2% at 3 months and 95.5% at 6 months of follow up.

Conclusions: FESS has a positive influence in the lower airways function of asthmatic patients. Recorded improvement of the subjective and objective parameters measured, should not only be attributed to alleviation of upper airway symptoms and to concomitant improvement of a patient's quality of life, but also to the positive influence of FESS on the intrinsic mechanisms.
Efficacy of local and systemic corticosteroid and hyaluronidase therapy in oral submucous fibrosis: a histopathological study
Authors: Bansal Mohan
Published: February 2019

Background: As the etiopathogenesis of OSMF is not well established, a myriad of different medical and surgical modalities of treatment are reported however studies on histopatholgical changes after treatment are very sparse. There are reports on various regimens of steroids using different molecules, doses and routes of administration and their combination with other drugs. These were the driving factors to conduct this study. This histopathological study was conducted to know the efficacy of various forms of steroid therapy in various combinations.

Methods: This prospective randomized single blinded outcome based study was conducted in the department of Otorhinolaryngology (ENT) and Pathology in a tertiary care medical college hospital. The 150 clinically diagnosed patients were divided into 5 groups: A, B, C, D and E. Each group was treated differently with different modes of administration of steroids with and without combinations of other medicines. To study histopathological changes before and after treatment, biopsy was taken in 100 patients who gave their consent for the same.  

Results: The various histopathological changes observed in the tissues taken after the treatment in 100 patients, were in terms of changes in the epithelium towards normalisation, decrease in fibrous tissue in the submucosa, decrease in the cellular infiltration, appearance of new capillaries, restoration of glandular activity and decrease in the fibrosis of muscles. The calculated Chi square value (p>0.05) was found less than table value.

Conclusions: Local and systemic corticosteroid and hyaluronidase therapy in patients with OSMF were found effective. However, histopathologically, it was not found statistically significant whether corticosteroids are given locally and/or systemic with or without injection hyaluronidase.
Carotid body tumour: an enigma that remains
Authors: Lim Rachel C. A. , Saniasiaya Jeyasakthy , Japar Jaafar Rohaizam Bin , Yahaya Zakinah Bt , Hailani Iskandar B.
Published: February 2019

Carotid body tumour is a form of paraganglioma which arises from the carotid body. This tumour is known for its rich vascular supply mainly contributed by the ascending pharyngeal artery, a branch from external carotid artery. Surgical excision preceded by pre-operatic embolization remains the definitive treatment despite the countless feared complications. We present our experience with a case of carotid body tumour which was embolised prior to surgical excision, unfortunately complicated with a thromboembolic event. This patient was found to have an anatomical variation in the cerebrovascular anatomy known as a fetal posterior cerebral artery which led to a paradoxical PCA infarction post-embolization. We would like to highlight this rare presentation along with its management as there were scarce evidence of this case in the literature.
A rare case of direct cervical skin involvement from metastatic cervical lymph node in carcinoma of oral cavity
Authors: Lakshmi Narayana M. , Swetha V. , Kumarguru B. N.
Published: February 2019

Carcinoma of the oral cavity is becoming more prevalent in India owing to increased betel nut chewing, beedi smoking, consumption of hans, gutka and other tobacco products. In the tumor spread, first it metastasizes to cervical nodes and then to distant sites. We report a rare case of direct skin involvement from metastatic cervical lymphadenopathy.  A 60 years old lady came with the complaints of swelling on the left side of the neck since 3 years. She was a betel nut chewer since childhood. On examination, the swelling was tender, firm, fungating with erythema over the swelling. Oral cavity examination showed a 2×3 cm ulcerative growth in the left gingivobuccal sulcus with grade III trismus. CECT scan showed irregular heterogeneously enhancing necrotic mass of size 5.1×4.2×3.7 cm, in the submandibular region showing skin infiltration.  There was an irregular heterogeneously enhancing lesion in the left gingivobuccal sulcus. Biopsy from the growth showed features of well-differentiated squamous cell carcinoma. The patient underwent composite resection and left modified radical neck dissection with complete excision of the fungating tumor with tumor-free margins. The defect in the oral cavity and neck was closed with pectoralis major myocutaneous flap and deltopectoral flap. Histopathology showed pT2N3bM0 with stage IVb and patient was advised adjuvant chemo-radiation. In conclusion, cervical skin involvement from cervical metastasis is rare compared to facial skin involvement from the tumor. Patients with N3b nodal staging should be planned in a multidisciplinary setting for a better treatment outcome.
Mucoepidermoid carcinoma of buccal mucosa: an unusual presentation
Authors: S. Shetty Shravan , Pareek Ankur , Devckar Yash , Pathan Sameer
Published: February 2019

Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of the salivary glands. This tumor usually occurs in the parotid gland and hard palate but rarely in the buccal region. We report the case of a 51 year old lady with mucoepidermoid carcinoma of left buccal mucosa. She was treated successfully with multimodal treatment including surgery, chemotherapy and radiotherapy. MECs have a female predilection and occur most commonly on the hard or soft palate or both and rare in the buccal mucosa.
Castleman’s disease presenting as parotid mass: a case report
Authors: Batra Ankur , Goyal Megha
Published: February 2019

Castleman’s disease is a rare, benign, lymphoproliferative disorder of unknown etiology. It can involve any lymph node group in the body with mediastinum being the commonest site. Salivary glands are affected rarely. We report a 35 year old male patient who presented with slowly progressive, painless right sided parotid swelling for 3 years. Clinical examination showed a 4×3 cm single, firm, non-tender, non-pulsatile swelling with smooth surface and normal overlying skin present in the right parotid region. Magnetic resonance imaging (MRI) revealed a well-defined hyper-intense mass lesion on T2 measuring 3.9×3×2.8 cm and Fine needle aspiration cytology (FNAC) showed intense lymphoplasmacytic infiltrates. No conclusive diagnosis could be made on the basis of FNAC. So, the excision of parotid mass with facial nerve preservation was done. The final histopathology confirmed the diagnosis as Castleman’s disease. Although Castleman’s disease in the parotid gland is rare, clinicians should consider it as the differential diagnosis of any solid tumors that exhibit non-specific presenting characteristics and surgical excision is preferred treatment for unicentric disease.
Migrating foreign body of oesophagus: an enigmatic presentation
Authors: Sood Amit , Gupta Vikas , T. Philip Suresh , Patnaik Uma , Dwivedi Gunjan , Kumar Manoj
Published: February 2019

Ingested foreign bodies are medical emergencies that test the clinical acumen and skill of the otolaryngologist. The foreign body may be intra-luminal, intra-mural (penetrating the wall) or extra-luminal. The migration of an ingested foreign bodies extraluminally from the upper aero-digestive tract is a rare occurrence which may be difficult to diagnose and treat. Time is of essence in detection and management of these cases so that life threatening complications can be prevented. We present a case of a 51 years old female patient with a metallic foreign body in the oesophagus which migrated extraluminally. Surgical Exploration via transcervical approach was done to gain access for removal of the foreign body.
Felinosis: the elusive-cat scratch disease
Authors: Arulmozhi S. , Kumar Sithananda , Divakaran Shilpa , Kurian Susy Sophia , Kurien Mary
Published: February 2019

Cat-scratch disease or felinosis is an infection caused by Bartonella henselae which is characterized by chronic inflammation of the lymph nodes. It is one of the causes of regional, unilateral adenitis in children and adolescents. Axillary lymph nodes followed by cervical, pre-auricular and submandibular lymph nodes are the most common sites of involvement. We report a 14 year old male patient with cat scratch disease in whom the initial clinical manifestations were indistinguishable from those of acute bacterial suppurative lymphadenitis.
Unusual case of mobile phone simulation SIM card’s outer case ingestion: wedged at laryngeal surface of epiglottis
Authors: Dhingra Rachna , Davessar Jai Lal , Sharma Shruti , Kaur Kanwalpreet
Published: February 2019

Accidental ingestion of foreign bodies in the pediatric population is usually small pieces from toys or other household objects and subsequent emergency department attendance is a common occurrence. Here we describe an unusual case of accidental swallowing where the foreign body is outer case of mobile phone simulation (SIM) card.
Lacrimal sac rhinosporidiosis mimicking soft tissue sarcoma: a case report
Authors: Kumar S. Sathish , Sreedevi N. T. , Premchander Aarudhra
Published: February 2019

Rhinosporidiosis is a granulomatous disease caused by Rhinosporidium seeberi, usually affecting the nasal mucosa. Involvement of other sites of body in rhinosporidiosis especially, the lacrimal sac involvement is very rare. Hence, we report a case of lacrimal sac rhinosporidiosis in an adult male patient who presented with infraorbital swelling.
An unusual cause of dysphagia in elderly, dysphagia caused by cervical osteophytes: a case report and review of literature
Authors: Kiran Katari Uday
Published: February 2019

Dysphagia may occur in various pathological, inflammatory diseases of esophagus. It may also occur due to motility disorders of esophagus, benign and malignant diseases of mediastinum, cervical spine diseases. Dysphagia secondary to compression of esophagus by a cervical osteophyte is rare. The most common causes of osteophyte (bony outgrowth) in the cervical spine are diffuse idiopathic skeletal hyperostosis (DISH), ankylosing spondylitis (AS), and cervical spondylosis. Patients with cervical osteophytes are mostly asymptomatic. Hence, when considering cervical osteophytes as a cause of dysphagia other pathologic entities in the esophagus (e.g. tumors, webs, rings, strictures) should be excluded. We present a 68 year female patient who presented with complaints of dysphagia and neck stiffness since 3 months. She has been evaluated and found that dysphagia is due to large anterior cervical osteophytes compressing pharynx at C2/C3 and esophagus at C5/C6 and C6/C7 vertebral levels respectively. The objective of this case report is to emphasize the importance of anterior cervical osteophyte as a cause of dysphagia in elderly.
Risk factors for a post-operative neutrally aligned total knee arthroplasty in the sagittal plane developing fixed flexion deformity at 2 years follow up study
Authors: Silva Amila , Tan Sharon , Tay Adriel , Nee Pang Hee , Nung Lo Ngai , Jin Yeo Seng
Published: February 2019

Background: The incidence of fixed flexion deformity (FFD) following total knee arthroplasty (TKA) has been reported to be as high as 17%, increasing demand on the quadriceps and hindering mobility. The aim of this study is then to identify these predictors for the development of FFD.

Methods: In this retrospective study, all patients who underwent primary TKA from January 2008 to June 2009 at a single institution were identified. All patients with neutral alignment in the sagittal place of the knee intra-operatively were identified and followed up. The knee motion was measured in both operated and contralateral knees and followed-up for a minimum of 24 months post-operatively.

Results: Multivariate analysis demonstrated pre-operative FFD of the non-operated knee (p-value 0.03), pre-operative range of motion of the operated knee (p-value 0.01) and non-operated (p-value 0.01) knee and pre-operative maximum flexion of the operated knee (p-value 0.001) to be independent risk factors for development of FFD at 24 months.

Conclusions: Independent risk factors for the development of post-operative FFD in TKA are pre-operative FFD of the operated knee, FFD of the non-operated knee and the maximum flexion of the operated knee. The relative risk of a male developing FFD is also as high as 1.34.
A comparative study of the fracture union between long and short proximal femoral intramedullary nails antirotation in the treatment of intertrochanteric femur fractures in the elderly: a multicentric analysis
Authors: Hari Krishnan B. , Rai S. K. , Vikas Rohit , Kashid Manoj , Mahender Pramod
Published: February 2019

Background: The objective of the study was to compare the fracture union of long vs. short proximal femoral intramedullary nail antirotation (PFNA) in the treatment of intertrochanteric fractures in elderly patients who was more than 60 years old.

Methods: A retrospective analysis of 170 cases of intertrochanteric fractures of the femur (AO type A1 and A2) in the elderly was conducted. There were 64 males (37.6%) and 106 females (62.3%) with the age of 60–90 (mean age 75) years. The general demographic data of patients, operation time, intraoperative blood loss, length of hospital stay, blood transfusion rate, anterior thigh pain, postoperative complications like periprosthetic fractures, infections were recorded.

Results: The short nail group also had a significantly shorter operation time (41.5±15.3 minutes vs. 62.5±25.3 minutes, p=0.002) and lower rate of postoperative transfusion (31.3% vs. 58.7%, p=0.041). However the length of hospital stay showed no significant differences. After surgery in short group there were 03 cases of periprosthetic fracture with a total incidence of 03%, however there were none in long nail group. At the end of the follow-up, all patients achieved bony union. The average fracture union time of the long nail group was (8.5±3.2) months, and the short nail group was (7.8±4.7) months, revealing no significant differences (p=0.09).

Conclusions: Both the proximal femoral intramedullary long and short nail fixation has a good result in the form of fracture union in treating intertrochanteric femur fractures in the elderly. They showed no significant difference in terms of fracture union, hospital stay, and postoperative complications. The incidence of periprosthetic fractures and anterior thigh pain was slightly high in short nail group. In short intramedullary nailing group there was obvious decrease in the intraoperative blood loss, operation time and postoperative blood transfusion.
Longitudinal follow up of patients undergoing mini-open repair of rotator cuff tear
Authors: Kassim Mohammed Shabir , Mohapatra Amlan , Kuberakani Karthikraj
Published: February 2019

Background: Shoulder pain is a common presenting complaint. This study is aimed to understand the role of mini-open repair in the treatment of rotator cuff tear and to assess the functional outcome in such patients over a period of two years.

Methods: This prospective study was conducted on patients who were operated by mini-open repair for rotator cuff tear at the Department of Orthopedics, AJ Institute of Medical Sciences January 2017 till June 2018. Using a pre-designed case report form, demographic and clinical information was noted for all patients. Functional outcome of the patients was assessed by the Constant and Murley score at post-operative follow up at 3 weeks, 6 weeks, 12 weeks, 6 months, 1 year and 2 years.

Results: Partial thickness tear was present in 57% of the pateints and rest had a full thickness tear. Mean Constant and Murley score at the time of presentation was 59.50 which improved during the follow up period and at the final follow up the score was 91.80. The score was not significantly different at one year and second year follow up. The score was consistently higher among patients with partial thickness as compared to those with full thickness, though the difference was significantly different only at 6 month follow up (p=0.007).

Conclusions: Significant improvement in range of motion was seen in our patients at 6 months post-operatively. Full range of motion was observed at the end of 1 year and functional outcome did not improve after that.
Efficacy of intraarticular steroid injection in knee osteoarthritis using knee society score and visual analog score
Authors: Sampath Shriram , Harshavardhan J. K. Giriraj
Published: February 2019

Background: Osteoarthritis of knee is a chronic degenerative joint disease which leads to pain, swelling, stiffness and decreased quality of life. The purpose of this study was to assess the effect of intra-articular steroid injection for osteoarthritis knee by using knee society score (KSS) and visual analog scale (VAS).

Methods: A prospective study of 38 patients (44 knees) diagnosed with osteoarthritis of knee were given 80mg of intra-articular methylprednisolone injection. The outcome was assessed using KSS and VAS before the injection and 3 months post injection.

Results: The mean VAS improved 3 months post injection whereas there was no improvement in the mean KSS. The scores of VAS 3 months post injection were statistically significant whereas the KSS scores were statistically insignificant compared with the pre injection values.

Conclusions: Intra-articular steroid injection for osteoarthritis of knee produces significant pain relief for most patients even in severe cases but this not translate to better functional outcomes.
A clinical study to evaluate the effectiveness of the short proximal femoral nail in the management of unstable intertrochanteric fractures
Authors: Rayan Jelani Ahmed , Hathiwale Mohammed Ismail , Mundewadi Vishwas Vittal , Ahmed Owais
Published: February 2019

Background: The objective was to study the effectiveness and drawbacks of short proximal femoral nail in the management of unstable intertrochanteric fractures.

Methods: This prospective study was conducted in the department of orthopaedics Al-Ameen medical college, Vijayapura, Karnataka, India from July 2010 to June 2017. Total 175 patients (130 males and 45 females) aged between 41 to 80 years with unstable Intertrochantreric fracture (155 had type IV and 20 had type III according to Boyd and Griffin classification). All patients were operated using Short proximal femoral nail and followed at least for a minimum period of 6 months and were evaluated radiologically and clinically by Kyle’s Criteria.

Results: Anatomical reduction was achieved in 125 patients, 105 (60%) had no complications post operatively. Complications included 5 cases of avascular necrosis and screw cut out, 5 cases of delayed union, 5 cases of Z-effect, 20 cases of varus malunion, 10 cases of antirotation screw breakage, 5 cases of distal bolt breakage and 15 cases with lateral thigh discomfort. 125 patients had No shortening and the average shortening was 0.34 cm, average time of union was 19.26 weeks (15-30 weeks) in 170 cases. At the end of 6 months, good to excellent results were seen in 71.5% of cases, 57% patients returned to their pre injury functional level.

Conclusions: Short proximal femoral nail provides good fixation for unstable intertrochanteric fractures, if proper pre-operative planning, good reduction and surgical techniques are followed leading to high rate of bone union and minimal soft tissues damage especially for Asian patients with relatively small femora.
Analysis of clinicoradiological parameters following fixation of paediatric supracondylar humerus fractures with three lateral pins
Authors: Daga Saurabh , Sarkar Pushpal , Kumar Banka Paras
Published: February 2019

Background: Supracondylar humerus fractures are one of the commonest fractures encountered in children. This fracture has been managed both conservatively with a long arm plaster and operatively by fixing with Kirschner wires. Debate still remains regarding the pin configuration to be used for fracture stabilisation. This study analyses the clinical and radiological parameters following fixation of supracondylar humerus fractures in paediatric patients with three lateral pins.

Methods: It is a prospective study with 30 patients conducted between April 2016 and September 2016 conducted in Medical College and Hospital, Kolkata. All the said patients underwent closed reduction and percutaneous pinning with three laterally placed divergent kirschner wires.

Results: Most of the patients in this study had clinicoradiological parameters well within normal limits, barring a few. The baumann’s angle was well within normal limits in these cases as found in subsequent follow-ups.

Conclusions: In this study, it was found that lateral pinning can be safely employed for fixing supracondylar humerus fractures in children with lesser chances of iatrogenic ulnar nerve palsy which was encountered with crossed pin configuration.

 
A non-interventional, prospective, multicentric real life Indian study to assess safety and effectiveness of un-denatured type 2 collagen in management of osteoarthritis
Authors: Mehra Apurv , Anand Pankaj , Borate Mangesh , Pal Prosenjit , Kamble Sanjay , Dev Mehta Kapil , Qamra Amit , Shah Agam , Jain Rishi
Published: February 2019

Background: Osteoarthritis (OA) is the most common musculoskeletal conditions affecting the quality of life. Undenatured collagen type II has emerged as one of the promising treatment options in treatment of OA. Despite being available in India, clinical safety and efficacy have not been evaluated. We performed a non-interventional, real-life study to determine its safety and efficacy in Indian population.

Methods: A non-interventional, real-life study was performed in patients with OA of knee by 18 orthopaedicians in India. Patients enrolled were followed-up at day 30 (visit 2), day 60 (visit 3) and day 90 (visit 4). Efficacy was assessed by Western Ontario McMaster Osteoarthritis Index (WOMAC) and Visual Analogue scale (VAS) on each visit. Safety was assessed by incidence of suspected adverse events (AEs), and abnormal laboratory parameters.

Results: Among 291 enrolled patients 226 patients completed the study. Mean age of the population was 56.2±8.7 years and 53.3% of them were females. In 291 patients included in safety analysis, at least one treatment emergent adverse event (TEAE) was seen in 4.47% patients. None of the AEs were serious or resulted in termination of patient from the study. Nausea (1.37%) and headache (1.03%) were the common AEs. Treatment with undenatured collagen type II was associated with significant reduction in WOMC score (p<0.0001) and VAS scores (p<0.0001) from baseline to day 90.

Conclusions: Undenatured collagen type II is safe and efficacious in Indian patients with OA. This can be considered early in the initial management of OA.
Anteromedial versus trans-tibial technique for anterior cruciate ligament reconstruction using quadrupled hamstring graft: a comparative study
Authors: Singh Barunkumar , Gaurav Sharma , Akshay Bhardwaj
Published: February 2019

Background: Femoral tunnel position plays a pivotal role for successful outcome in anterior cruciate ligament (ACL) reconstruction surgeries. Recently, the anteromedial techniques have gained popularity over the trans-tibial technique due to better anatomical position and better stability rotationally and antero-posteriorly then the later. The aim of the present study was to compare the technical difficulty and ease, functional and radiological outcome of trans-tibial and anteromedial portal techniques in ACL reconstruction.

Methods: Thirty patients between March 2015 and February 2016 with ACL tear underwent arthroscopic reconstruction using quadrupled hamstring graft and were divided into two groups A (anteromedial) and group B (trans-tibial) as per the technique used. Patients with multiligament injuries, revision surgeries, and osteoarthritis knee were excluded. All the patients were followed-up for 24 months and clinical Lysholm and IKDC scores along with radiological outcome were calculated.

Results: The mean age of patients were 32.4±6.3 years. Isolated ACL tear was seen in 16 (53.4%) cases followed by medial meniscus injury in 11 (36.6%) patients. The mean duration between injury and surgery was 14.8±8.99 and 21.6±3.23 days in group A and B respectively (p=0.0122). The radiological position of femoral tunnel in sagittal and coronal plane was statistically significant in both the groups. The Lysholm and IKDC scores showed statistically significant difference at 3 months post-operatively.

Conclusions: Anteromedial and trans-tibial techniques have similar long term functional outcomes. However, more anatomical position of the graft through the anteromedial technique and better rotational and anteroposterior stability makes it theoretically to be superior to the trans-tibial technique.
A comparative study of functional outcome of external fixation and volar plating in unstable distal radius fractures
Authors: Kumar Mishra Anil , Deep Sud Ajay , Prasad Manish , Kaul Rajiv , Mohan Singh Chander
Published: February 2019

Background: Distal radius fractures are amongst the most common injuries seen in the emergency department. It is imperative to restore the anatomy as much as possible in order to restore wrist function. Identifying a fracture as ‘unstable’ is critical in predicting the final outcome of treatment. The present study compares two primary modalities of treatment: external fixation and volar plating in terms of the functional outcome post-surgery.  Aim of the study was to compare the functional outcome of fixation of unstable distal radius fractures by external fixation to that of volar plating by the Disabilities of the Arm, Shoulder and Hand (DASH) scoring system and analysis of recovery of grip strength and range of motion. Settings and design: Hospital-based; randomized control trial.

Methods: 80 patients presenting with unstable distal radius fractures were randomized into two groups of 40 each. One group received external fixation and the second received open reduction with volar plate fixation as the primary intervention. DASH scores were obtained and compared at specified time intervals following surgery.

Results: The results of our study show a better improvement in the mean DASH scores at 3, 6 and 12 months in the volar plating group as compared to the external fixation group.

Conclusions: Volar plating, with its definitive advantage of direct fracture visualization, has an overall better functional outcome with greater postoperative wrist motion and a lower incidence of complications. 
A comparative study of effectiveness of local injection of autologous platelet rich plasma and injection corticosteroid solution in treatment of plantar fasciitis
Authors: Prakash Puri Vithal , Kumar Gaur Anil
Published: February 2019

Background: The heel pain is the most common problem worldwide and it was associated with plantar fasciitis (PF). The condition of treatment is very complex. Platelet-rich plasma (PRP) and injection of corticosteroids is the treatment of PF. This study was designed to access the effect of local PRP and local corticosteroid injection in PF patients.

Methods: Sixty patients (between 29 to 60 years of age) with chronic PF were randomized prospectively in single tertiary care center in India. The study conducted from December 2013 to December 2015. All the patients were enrolled according to inclusion criteria and divided into two groups randomized. In group A (n=30) received PRP and group B (n=30) received corticosteroids injections. Visual analog scales (VAS) were filled by all the included patients. The follow-up scheduled at one and six months after complete enrolment of patients.

Results: Between both the groups the significantly different observed at one and six months follow-up from the baseline. At one month follow-up significantly improvement in mean VAS score were observed in group B (p<0.001). At six months follow-up significantly improvement in mean VAS score were observed in group A (p<0.001).

Conclusions: The present study concluded from the significance difference between both the groups proved promising form of treatment in chronic PF patients. Both the treatment was safe and effective in relieving pain improving function at different time period.

 
Open reduction internal fixation with triceps-sparing approach in distal humerus fracture: an experience from a tertiary level hospital in Mangalore
Authors: Bhandary Bhaskar , Shetty Sachin , Kassim Mohammed Shabir , Mohapatra Amlan
Published: February 2019

Background: Fractures of the distal humerus represent challenging problems to an orthopaedic surgeon. The present study aimed to assess the range of movement after performing open reduction and internal fixation of distal humerus fractures treated with triceps sparing approach.

Methods: This prospective study included all skeletally mature patients with distal humerus fractures and operated at our center with open reduction and internal fixation of distal humerus with triceps on or triceps sparing approach were included in the study. During the study period 30 cases underwent surgery and were included in the final analysis. Fractures were classified according to the AO/OTA classification. Patients will be followed up at 6 weeks, 12 weeks and at 6 months. Mean range of motion of the fractured elbow at different follow up points were compared.

Results: The mean age of the total population was 37.7±13.8 years, 57% males and left side was affected in 60% of the patients. Majority of the patients had a range of motion in normal elbow in the range 0 to 140 degrees. There was an increase in the mean range of movement from 63.4±14.2 at 6th week to 120±6 at 24th week, and this change was statistically significant (p<0.001).

Conclusions: Future multicentric randomized studies, specially comparing triceps-sparing with olecranon osteotomy, are needed to support the results of our study.
An unusual occurrence of giant primary osteosarcoma of chest wall in adult: case report and review of literature
Authors: Paryani Jeetendar , Gupta Sameer , Suryavanshi Parijat , Singh Pawar Shashi
Published: February 2019

Osteosarcoma is most frequently occurring bone malignancy which commonly occurs in the ends of the long bone. Usually osteosarcomas do not involve the bones of the chest wall. 22 year old patient presented with swelling in left anterior chest wall gradually enlarging over the period of 1 year accompanied by dull aching pain in the same. On examination there was 30×25 cm large hard irregular swelling which was fixed to chest wall. CECT Thorax was suggestive of 30×25×18 cm sized soft tissue lesion involving 3, 4, 5 rib involvement with sunburst periosteal reaction. Mass is having large extrathoracic with small intrathoracic extensions. Moderate pleural effusion was noted. Core biopsy of mass identified the tumor as osteosarcoma. Primary malignant bone tumors of the chest wall are very rare entity. Of these tumors chondrosarcomas are the most frequent. Chondrosarcoma are chemo-resistant as compared to osteosarcomas. Management of such tumors should follow the same oncological principles of resection with wide margins whenever possible. Neoadjuvant chemotherapy may be given in cases of responsive etiologies like Ewing sarcoma or osteosarcoma. These malignancies generally have poor prognosis.

 
A rare case of metallic foreign body in the knee of a 16 year old boy
Authors: Filip Florin , Tataranu Adrian , Stefan Violeta
Published: February 2019

Foreign bodies at the knee level are related to local trauma with subsequent retention. Removal of the foreign body is curative. We present the case of a 16 year old boy with a foreign body (metallic screw) inside the left knee joint related to an unusual home accident. The outcome was favorable after removal of the foreign body and appropriate antibiotic coverage.
The use of polymerase chain reaction in the diagnosis and management of prosthetic joint infections: a debatable issues at this time
Authors: Ogunleye Temi , Ponce de Leon Marlina , Antony Suresh J.
Published: February 2019

Joint replacement surgery is increasing due to its success in decreasing pain and restoring function. Prosthetic joint infections (PJI) is one of the most detrimental complications of the surgery. These infections can either be acute or chronic and can be caused by a variety of organisms. Effective and efficient identification of the cause of infection is vital so that proper treatment can be provided. The use of polymerase chain reaction (PCR) is a possibility for diagnosis and management of PJI with a reduction in the use of incorrect antibiotics. This is due to its ability to quickly diagnosis viral, bacterial, rickettsia, mycobacterial, and protozoal infection in hours. It also has high sensitivity and specificity even with antimicrobial usage and biofilm production. However, more studies need to be done in order to be able to classify it as a possible gold standard.
Kesiapan Hakim dalam Penyelesaian Sengketa Ekonomi Syariah Pasca Keluarnya PERMA No. 14 Tahun 2016
Authors: Rahmawati Naili
Published: February 2019

AbstractSupreme Court Regulation (PERMA) No. 14 of 2016 concerning Procedures for Settling Sharia Economic Disputes requires the readiness of the handling of professional religious justice apparatus, including in the Giri Menang religious court, NTB, where this research was conducted. The jurisdiction of the religious court covers two districts, namely West Lombok and North Lombok. The high economic activity of the people in contact with sharia financial institutions in the two districts allows many cases to be accepted. This study uses a descriptive qualitative approach with a focus on the response of the judges about their authority in handling sharia economic cases and to see their readiness to settle cases after the issuance of PERMA. Data collection methods used are observation, documentation, interviews and questionnaires were distributed to 12 respondents, namely all judges in the PA. The results of the analysis show that in general the judges responded positively to the authority to handle sharia economic cases. In addition, they were ready to settle the sharia economic dispute after the issuance of PERMA.AbstrakKeluarnya Peraturan Mahkamah Agung (PERMA) No. 14 Tahun 2016 tentang Tata Cara Penyelesaian Sengketa Ekonomi Syariah menuntut kesiapan penanganan dari aparatur peradilan agama secara profesional termasuk di pengadilan agama Giri Menang, NTB, tempat penelitian ini dilakukan. Wilayah yurisdiksi dari pengadilan agama tersebut meliputi dua kabupaten, yaitu Lombok Barat dan Lombok Utara. Tingginya aktifitas ekonomi masyarakat yang bersentuhan dengan lembaga keuangan syariah di kedua kabupaten tersebut memungkinkan munculnya banyak perkara yang akan diterima. Penelitian ini menggunakan pendekatan kualitatif deskriptif dengan fokus pada respon para hakim tentang kewenangannya dalam menangani perkara ekonomi syariah dan untuk melihat kesiapan mereka dalam menyelesaikan perkara pasca keluarnya PERMA tersebut. Metode pengumpulan data yang digunakan, yaitu observasi, dokumentasi, wawancara dan kuesioner yang disebar kepada 12 responden, yaitu seluruh hakim yang ada di PA tersebut. Hasil analisis menunjukkkan bahwa secara umum para hakim merespon positif atas kewenangan untuk menangani perkara ekonomi syariah. Selain itu, mereka telah siap dalam menyelesaikan perkara sengketa ekonomi syariah pasca keluarnya PERMA tersebut
(Re)Encountering Walls, Tattoos, and Chickadees: Disrupting Discursive Tenacity
Authors: Whitty Pam , Hewes Jane , Rose Sherry , Lirette Patricia , Makovichuk Lee
Published: February 2019

In this article, three pedagogic encounters—“Encountering the Wall,” “Encountering Young Tattooed Parents,” and “Encountering Chickadees”—conceptualized as curricular meeting places, are theoretically reconceptualized within alternative bodies of literature. Theoretical reconceptualization revealed complexities of early childhood pedagogies and the tenacity of dominant discursive practices of developmentalism, constructed, in these instances, through age-segregated settings, parenting programs, and nature pedagogy. Theoretical reconceptualizing of these encounters worked to disrupt embodied subjugations of age-segregated children, mothers and fathers, chickadees, educators, families, and researchers.
Children’s Moral Agency: An Interdisciplinary Scoping Review
Authors: Montreuil Marjorie , Noronha Crystal , Floriani Nadia , Carnevale Franco A.
Published: February 2019

Inconsistencies have been noted in how moral agency is conceived in childhood, leading to variations in children’s levels of inclusion/exclusion from discussions and decisions affecting them in children’s services and research. Through a scoping review of 261 articles, we examined the different ways in which children’s moral agency is imagined in the literature across different disciplines: education, health, law, psychology, and social services. A developmental psychology perspective dominated the results, while other viewpoints were less prevalent (e.g., children as active moral agents). We discuss how the different perspectives could be bridged to advance more integrated perspectives on interdisciplinary knowledge and practices related to childhood ethics.
Quiet Kindness in School: Socially and Emotionally Sophisticated Kindness Flying Beneath the Radar of Parents and Educators
Authors: Binfet John-Tyler , Enns Camilla
Published: February 2019

This paper profiles the different ways in which elementary and middle school students report on their acts of kindness and introduces the concept of quiet kindness, a socially and emotionally sophisticated form of kindness that does not draw attention to the initiator, where the recipient remains potentially unaware of the act, and the kind act is not likely acknowledged or reinforced by external agents. Examples from surveys of over 3,000 Canadian elementary and middle school students help illustrate how children enact kindness in school. The developmental implications of quiet kindness for children are discussed alongside implications for parents and educators.
A Narrative Inquiry Into the Experiences of Urban Indigenous Families As They Ready Their Children For, and During, Kindergarten
Authors: Huber Janice , Caine Vera , Murphy M. Shaun , Lessard Sean , Menon Jinny , Clandinin D. Jean
Published: February 2019

In this paper we draw on a study alongside urban Indigenous families in western Canada that inquired narratively into their experiences as they readied their children for, and their children participated in, kindergarten. We built relationships with eight urban Indigenous families. As we looked across their experiences, six resonant threads became visible: each family and their life situations are unique; families wish for mutual respect and collaboration between school and family; respect is significant; families are invested in their children doing well in schools; siblings shape stories of school readiness; and intergenerational stories and places shape readiness.
Supporting Emergent Writers Through Guided Play in a Kindergarten Classroom
Authors: Friedrich Nicola , Wishart Kristen , Stagg Peterson Shelley
Published: February 2019

In this paper, we describe a teacher-initiated imaginative-play scenario that took place in a kindergarten classroom in a small northern town in Ontario, Canada. The Fairy Door scenario afforded the 3- to 5-year-old children the opportunity to become writers in order to communicate with and make sense of an elusive visitor to the classroom. It presented the teachers with opportunities to scaffold the children’s writing attempts and provided them with valid assessments of the children’s understanding of texts and writing. We offer this unique form of pedagogical practice as a means to fulfill the play-based learning mandate of the Ontario provincial curriculum.
Il était une fois des éducatrices en petite enfance engagées dans une formation continue en ligne : histoires d’apprenantes
Authors: Moreau Claire , Royer Nicole , Royer Chantal
Published: February 2019

Au fil d’une recherche qualitative, six éducatrices en petite enfance ont pu s’exprimer sur leur cheminement personnel et professionnel au sein d’une formation continue en ligne les menant à un diplôme universitaire (certificat de 30 crédits). Une analyse par catégories conceptualisantes a permis à leur histoire de prendre forme à travers différentes dimensions ayant influencé leur développement professionnel. De leurs débuts comme apprenantes jusqu’aux différents enjeux vécus pendant leur formation continue en ligne et leur perception de la pédagogie, l’article met en lumière l’histoire de ces éducatrices en petite enfance inscrites comme apprenantes dans une formation continue en ligne.
Animating a Curriculum Framework Through Educator Co-Inquiry: Co-Learning, Co-Researching, and Co-Imagining Possibilities
Authors: Hewes Jane , Lirette Tricia , Makovichuk Lee , McCarron Rebekah
Published: February 2019

The shift toward a pedagogical foundation for professional practice in early childhood along with the introduction of curriculum frameworks in early learning and child care, calls for approaches to professional learning that move beyond transmission modes of learning towards engaged, localized, participatory models that encourage critical reflection and investigation of pedagogy within specific settings. In this paper, we describe ongoing participatory research that explores educator co-inquiry as an approach to animating a curriculum framework. A story of curriculum meaning making that opened a hopeful space for critical pedagogical reflection and changed practice serves as a basis for deeper reflection.