bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence of Metopic Suture in Adult Human Crania in Uttar Pradesh
Authors: Gupta Neha , Singh Durgesh , Malik Anuj , Arshad Mohd , Kumar Vinay , U. Beg Mirza R. , Singh Shashi Prabha
Published: December 2022

Introduction:

Failure of ossification in the vertical direction between the two halves of the frontal bone is called a metopic suture; this suture is present in between the superciliary arch and tubers of the frontal bone so it is also called a median frontal suture. At birth, the frontal bone present is two half, in the 1st year they contact each other, and within the 7th to 8th year, they fused together. Sometimes, bones may not be fused completely and it becomes metopic fontanelle.

Materials and Methods:

The goal of the current study was to determine the prevalence of metopic suture in adult human skulls in Uttar Pradesh. One hundred and fifty macerated skulls of undetermined age and sex were used for this. The anatomical departments of Teerthankar Mahaveer Medical College and Research Center (Moradabad), King George Medical College (Lucknow), SRMS Institute of Medical Science (Bareilly), Govt. Medical College Kannauj, and Govt. Medical College Saharanpur provided these skulls.

Results:

This study has found the incidence of metopic sutures of about 12.90%. The two types of metopic sutures were found in this study, namely complete metopic suture 4.52% and incomplete metopic suture 8.38% in which found 0.64% "V" shape metopic suture.

Conclusion:

The morphological study of metopic sutures on adult crania is useful for anatomists, experts in forensic medicine, and neurologists for performing surgical procedures in this area.
DNA Fragmentation and mRNA Expression of Bcl-2, Bcl-xL, p53, p21 and HSP70 Genes in Nondysplastic and Dysplastic Oral Lichen Planus
Authors: Jana Abhishek , Thomas Jincy , Ghosh Pratiti
Published: December 2022

Background:

Oral lichen planus (OLP) is a chronic inflammatory disease. Apoptosis of the basal keratinocytes is a causative factor for OLP pathogenesis but the detailed mechanism of apoptosis among nondysplastic and dysplastic OLP lesions is yet unraveled.

Aims:

This study aims to evaluate the involvement of cellular DNA fragmentation and alteration in the expression of Bcl-2 and B-cell lymphoma extra-large (Bcl-xL), p53, p21 and heat shock protein 70 (HSP70) in nondysplastic and dysplastic OLP lesions.

Materials and Methods:

Untreated, fifteen OLP patients each with nondysplastic and dysplastic lesions were enrolled for this study. Their DNA fragmentation was analyzed by the agarose gel electrophoresis method. The mRNA expression of Bcl-2, Bcl-xL, p53, p21 and HSP70 were measured using semi-quantitative reverse transcription-polymerase chain reaction.

Results:

Elevated DNA fragmentations were found in dysplastic lesions compared to nondysplastic type. Significantly higher expression of Bcl-2, Bcl-xL, p53 and p21 were found in both types of OLP lesion compared to the control. Expression of Bcl-2 and Bcl-xL were significantly elevated in nondysplastic lesions, whereas significantly overexpression of p53 and p21 were found in dysplastic lesions. Anti-stress protein HSP70 was overtly expressed in dysplastic lesions compared to other groups.

Conclusion:

Reduced expression of Bcl-2 and Bcl-xL, with elevated DNA fragmentation, may be associated with increased apoptosis in dysplastic lesions which aid in the resolution of the chronic inflammatory process. Higher expression of p53 and p21 in dysplastic lesions reflect its malignant potentiality. Overexpression of HSP70 in dysplastic lesions is a useful marker for higher cellular stress.
Shaping Ability and Buckling Resistance of TruNatomy, WaveOne gold, and XP-Endo Shaper Single-File Systems
Authors: Shaheen Neveen Ali , Elhelbawy Nahla Gamal Eldin
Published: December 2022

Objectives:

The target of the current study was to evaluate and compare the shaping ability and buckling resistance of various single-file systems (TruNatomy [TRN], WaveOne gold [WOG], and XP-Endo Shaper [XPS]).

Materials and Methods:

Thirty recently extracted human first mandibular molars were chosen with severely curved mesiobuccal (MB) canals. Following access cavity preparation and determination of working length, teeth were randomly divided into three groups (n = 10) according to the instrumentation technique used, Group 1 (TRN), Group 2 (WOG), and Group 3 (XPS). Preinstrumentation and postinstrumentation, cone-beam computed tomography images were recorded at 3, 5, and 8 mm from the apex representing apical, middle, and coronal levels under the same circumstances, superimposed, and then canal transportation was determined using a particular equation. For buckling resistance calculation, files were loaded in the axial direction of the shaft and the maximum load was determined during the deflection of the file. One-way analysis of variance and Tukey test at 5% significance level were used to analyze data. Pearson's correlation between shaping ability and buckling resistance was performed.

Results:

XPS and TRN displayed significantly less canal transportation than WOG at the coronal and middle levels. While WOG recorded the highest value of buckling resistance, XPS recorded the least.

Conclusions:

XPS and TRN preserved the original curvature slightly better than WOG, while WOG reported the highest buckling resistance. There was a positive correlation between canal transportation and instrument resistance to buckle.

Clinical Relevance:

Preservation of the original shape of the canal after instrumentation is beneficial.
Nonspecific Cystic Degeneration in Craniofacial Fibrous Dysplasia
Authors: Savithri Vindhya , Suresh Rakesh , Janardhanan Mahija , Subash Pramod
Published: December 2022

Fibrous dysplasia (FD) is a developmental pathology of the bones in which normal bone is replaced by fibrous tissue and immature bone. It can affect single bone (monostotic) or multiple bones (polyostotic), sporadically or in association with McCune-Albright syndrome, Jaffe-Lichtenstein syndrome, or Mazabraud syndrome. When multiple bones in the craniofacial region are affected, the term “craniofacial FD” is used. Nonspecific cystic degeneration occurring in FD of the jaws has rarely been reported in the literature. Here, we present a 52-year-old male patient who reported with a longstanding gradual expansion of the mandible unilaterally. Investigations revealed the presence of mixed radiolucent radioopaque appearance in the mandible and dense sclerotic multiple craniofacial bones. In addition, a lytic lesion in the mandible was appreciated. Histopathological examination of the mandible confirmed the diagnosis of FD with nonspecific cystic degeneration.
Soft Tissue Augmentation Using De-Epithelialized Free Gingival Graft Compared to Single-line Incision Subepithelial Connective Tissue Graft in the Management of Miller Class I and II Gingival Recession
Authors: Mashaly Mohamed , Ghallab Noha A. , Elbattawy Weam , Elarab Azza Ezz
Published: December 2022

Aims:

The purpose of this randomized controlled clinical trial was to clinically assess soft tissue augmentation and compare patients’ morbidity and root coverage outcomes of coronally advanced flap (CAF) with subepithelial connective tissue graft (SCTG) versus de-epithelialized free gingival graft (DFGG) in the management of Miller Class I and II gingival recession.

Materials and Methods:

Twenty-eight patients with Miller's Class I or II gingival recession (GR) defects were randomly assigned into two equal parallel groups treated with either CAF + SCTG, harvested using single-line incision technique (control), or CAF + DFGG (test). Gingival thickness (GT), recession depth, recession width, percentage of root coverage, keratinized tissue width, pocket depth, and clinical attachment level were measured at baseline and 3 and 6 months postoperatively. Patient-reported outcomes were assessed postoperatively, including pain, stress, bleeding, and inability to chew. Patients’ overall satisfaction and root coverage esthetic scores were recorded at 6 months.

Results:

Both groups demonstrated a statistically significant improvement in all clinical outcomes after 3 and 6 months compared to baseline. DFGG showed a statistically significant increase in GT after 6 months. No statistically significant difference was detected in other clinical outcomes between both groups at different time intervals. Both treatments achieved 92.9% complete root coverage. Patients treated with CAF + DFGG reported significantly higher stress and inability to chew scores after 2 weeks than those treated with SCTG. There were no significant differences in patient satisfaction between both groups.

Conclusions:

CAF + SCTG and CAF + DFGG were both effective and can be applied safely in treating Miller Class I and II GRs.
Accuracy of Patient-specific Soft-tissue Prediction Algorithms for Maxillomandibular Surgery in Class III Patients
Authors: Mehta Shivam Y. , Han Michael D. , Tsay T. Peter , Kusnoto Budi
Published: December 2022

Context:

Improved esthetics is an important factor for most patients undergoing orthognathic surgery. Thus, a treatment simulation that can provide patients with a realistic view of the esthetic outcome after surgery is important in clinical practice.

Aims:

To evaluate the accuracy of simulations generated using algorithms specific for patient's type of malocclusion and surgical procedure compared to nonspecific algorithms.

Settings and Design:

A total of 36 patients (average age 18.41 years) who had undergone maxillary advancement and mandibular setback for Class III malocclusion were included.

Subjects and Methods:

The presurgical and postsurgical cone-beam computed tomography scans were used to generate the lateral cephalograms and the surgical simulations were created with the patient-specific algorithm (specific for Class III patients) and the nonspecific algorithm (default algorithm not specific for any particular malocclusion or type of surgery) using the treatment simulation feature in Dolphin Imaging software. The accuracy of the simulations was examined by comparing the soft-tissue changes in the surgical simulations with the postsurgical result.

Statistical Analysis Used:

Statistical analyses were performed with SPSS-software at 0.05 significance level. For the mean difference between the postsurgical and surgical-simulation landmarks, a paired sample t-test (Student's t-test) was performed.

Results:

Patient-specific algorithms were accurate in vertical prediction of lower lip, B’, tip of nose, upper lip, and horizontal prediction of pogonion’. Whereas the nonspecific algorithm was accurate in the horizontal prediction of the lower lip, pogonion’, and menton’.

Conclusions:

Patient-specific and nonspecific algorithms for generating surgical simulations showed different accuracy for vertical and horizontal predictions of the parameters.
Health care utilization among geriatric patients with respiratory diseases – An Indian perspective
Authors: Gupta Sonisha , Asthana Smita , Gupta Atul Kumar
Published: December 2022

Background:

The elderly population is continuously growing and respiratory diseases account for 20% of chronic diseases among ageing people; these diseases are often treated imprecisely. Thus, the health-care system should adapt to the growing health needs of the elderly population.

Aims:

To study health care utilisation by geriatric patients with respiratory diseases.

Material and Methods: A cross-sectional study of the elderly aged 60 years and over was conducted in the urban and rural areas of the National Capital Region and the Ghaziabad district of Uttar Pradesh. The first part of the study included socio-demographic characteristics and self-reported co-morbidities. In this first part, suspected respiratory cases were screened out, and a questionnaire regarding health-care utilisation was administered. The effect of socio-demographic factors on health-care utilisation was analysed.

Results:

In urban areas, 282/1522 (18.5%) and in rural areas, 298/1503 (19.8%) were found to suffer from respiratory illnesses. Health-care utilisation among elderly patients was significantly higher in urban areas compared to rural areas. In both areas, a large number of elderly people (70.5% rural and 61.7% urban) were insufficiently utilising health-care services. The socio-economic status (P = 0.034) and the source of income (P = 0.002) of urban residents were found to be significant factors. Among rural residents, health security (P = 0.05) and source of income (P = 0.002) were found to be statistically significant. Among the combined population (580), socio-economic status (P = 0.020) and source of income (P = 0.002) were found to be statistically significant.

Conclusion:

Health-care utilisation was better in urban residents than in rural elderly. However, majority of the elderly were utilising health-care services insufficiently in both areas. Socio-economic status and source of income had a significant effect on health-care utilisation.
Immediate effects of Pranayama on the cardiovascular parameters in hypertensive patients
Authors: Batra Shivani , Pal Rameswar
Published: December 2022

Many clinical trials and studies have already been conducted and published to find out the effects of yogic practice as well as pranayama on cardiovascular system of hypertensive patients. Many studies also conducted to find out the immediate effects of yogic practice on hypertensive patients. However, a review is rarely been published to find out the immediate effects of pranayama on hypertensive patients. Searching was made through PubMed, Google Scholar, PsychINFO and Scopus using the keywords pranayama and hypertension. A total of seven studies were selected for this review from a 17 articles. Patients of essential hypertension performed different pranayama and showed a result of a significant decrease in various cardiovascular parameters such as heart rate (HR) and blood pressure (BP). It may be concluded that pranayama practice immediately reduce BP and HR.
Awareness and practices about menstruation among adolescent girls
Authors: Parmar Priyanka R. , Deshpande Shrikalp S.
Published: December 2022

Introduction:

Menstruation is still a taboo in India and it is common for people across society to feel uncomfortable about the subject. It is a normal physiological process.

Objectives:

The objective of this study was to assess awareness and hygiene practices amongst adolescent girls and to study the menarche age of respondents in comparison to their mother's age at menarche.

Materials and Methods:

A cross-sectional, observational and prospective study was carried out in two private high schools of Mehsana city, Gujarat. Data were collected in a form of a structured questionnaire. Adolescent girls from 10 to 19 years were enrolled in the study. Ethical approval was obtained before initiating data collection. IBM SPSS version 2.0 was used for the analysis of the data.

Results:

Out of a total of 454 screened, 398 adolescents were enrolled in the study with an 87.76% response rate. The mean menarche age of adolescent girls was 13.33 ± 1.18 years. Mothers 316 (78.4%) were the first source of information. Majority of study respondents (68.5%) rated menstruation as a part of the physiologic process caused by hormonal changes. About 18.6% knew the uterus as a source of bleeding. About 59.8% of adolescent girls were scared and discomforted at their menarche. Most (93.5%) were using sanitary pads as absorbent material. Half of the respondents were using water to clean their genitals. Nearly half of the respondents felt hesitation for discussing their menstrual-related problems with others. The mean menarche age of the participants was 13.33 ± 1.18 years with a minimum of 10 years and a maximum of 18 years, while their mother's age at menarche was 14.58 ± 1.27 years.

Conclusion:

Menstrual hygiene education must be provided to adolescent girls. Need to solve taboos and misconception amongst adolescent girls of India.
A Bridge between Diabetes and Periodontitis
Authors: Prakash N. , Melath Anil , Subair K. , Arjun M. R.
Published: December 2022

Periodontitis is a chronic inflammatory multifactorial disease that affects the supporting structures of teeth, affects the quality of life, and causes the destruction of multiple organs, on the other hand, diabetes is a group of metabolic diseases characterized by increased levels of glucose in the blood (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both. Studies have shown that periodontitis patients have three times more risk of getting diabetes and evidence shows that cytokine, neutrophil, and inflammatory activity relate to both diabetes and periodontitis. This review article intends to cover the vast dilemmas that exist in relation to the double-edged sword; diabetes and periodontitis.
Increase in the Number of MBBS Seats through the Scheme of One Medical College per District
Authors: Kumar Raman
Published: December 2022

India currently hosts the largest medical education system in the world with 650 medical colleges and 98613 MBBS (undergraduate) training seats. The reasons for Indian Medical Graduate's international migration and internal distribution within India have been multifactorial. There are push factors (with India) as well as pull factors (international host countries). Almost the same reasons are implied to the distribution and availability of the medical workforce geographically within India. To address the regional disparities in medical education and the availability of human resources in health, the policy of establishing one medical college in each district in India was initiated. Impressive progress has been achieved so far. However, the policymakers must look at it critically to be able to steer this project towards meeting the public health objectives of the country in the coming century. The discussion must include arguments on the type of doctor India needs. Indian can no longer afford the policy of having many cardiologists as compared to miniscule number of trained family physicians. All specialist system is being perused at the cost of a generalist health system. This paper critically looks at the district medical college scheme and exponential growth in the number of medical seats in India. Statistical success alone cannot address the public health needs and medical care of the Indian population. The creation of the National Medical Commission (NMC) has eased the criteria for recognition of new medical colleges; however, several limitations of the Medical Council of India are being carried forward within the functioning of NMC. Unless, there is a focus on creating employment and retaining medical graduates within the health system, it is worthless producing millions of them.
Predictive Value of Beclin1 in the Pathogenesis of Rheumatoid Arthritis in the Indian Population
Authors: Varshney Tanu , Singh Praveen Kumar , Saha Sarama , Manna Sukdev , Pai Venkatesh S. , Naithani Manisha , Mirza Anissa Atif
Published: December 2022

Background:

Rheumatoid arthritis (RA) is a systemic autoimmune disease leading to the destruction of articular cartilage and deformity of joints if not detected early. There is an unmet need to find out a highly sensitive and specific biomarker for RA. This was the first study designed in Indian setting to assess whether it can be used as a biomarker in the diagnosis of RA in the Indian population.

Aim:

To correlate serum Beclin1 in the pathogenesis of rheumatoid arthritis in the Indian population.

Patients and Methods:

Observational analytical study was conducted for 18 months at AIIMS Rishikesh, Department of Biochemistry in collaboration with the Department of Rheumatology. Beclin1 serum expression levels were estimated by the enzyme-linked immunosorbent assay and beclin1 mRNA expression was assessed by a real-time polymerase chain reaction from peripheral blood mononuclear cells (PBMCs). Beclin1 expression was compared by Mann–Whitney U-test using SPSS 22 version. Cut-off values of Beclin1 for screening of cases were analysed by receiver operating characteristic test.

Results:

Age- and sex-matched 38 RA patients (5 males and 33 females) and 39 controls (8 males and 31 females) were recruited in the study. Patients with the American College of Rheumatology

/

European League Against Rheumatism score ≥6 were recruited in this study. Serum level of beclin1 was significantly (P ≤ 0.001) lower in cases (6.30 [2.82]) compared to healthy controls (11.43 [4.62]) which were corroborated with mRNA expression. The optimal cut-off value for detecting RA cases was 7.25 with 89.7% sensitivity and 79.8% specificity.

Conclusion:

Beclin1 may be involved in the pathogenesis of RA and may be considered a diagnostic marker for RA cases.
Influence of blood pressure on internal carotid artery blood flow during combined propofol-remifentanil and thoracic epidural anesthesia
Authors: Olesen Niels D. , Egesborg Astrid H. , Frederiksen Hans-Jørgen , Kitchen Carl-Christian , Svendsen Lars B. , Olsen Niels V. , Secher Niels H.
Published: December 2022

Background and Aims:

Anesthesia often reduces mean arterial pressure (MAP) to a level that may compromise cerebral blood flow. We evaluated whether phenylephrine treatment of anesthesia-induced hypotension affects internal carotid artery (ICA) blood flow and whether anesthesia affects ICA flow and CO2 reactivity.

Material and Methods:

The study included twenty-seven patients (65 ± 11 years; mean ± SD) undergoing esophageal resection (n = 14), stomach resection (n = 12), or a gastroentero anastomosis (n = 1) during combined propofol-remifentanil and thoracic epidural anesthesia. Duplex ultrasound evaluated ICA blood flow. Evaluations were before and after induction of anesthesia, before and after the administration of phenylephrine as part of standard care to treat anesthesia-induced hypotension at a MAP below 60 mmHg, and the hypocapnic reactivity of ICA flow was determined before and during anesthesia.

Results:

Induction of anesthesia reduced MAP from 108 ± 12 to 66 ± 16 mmHg (P < 0.0001) and ICA flow from 340 ± 92 to 196 ± 52 mL/min (P < 0.0001). Phenylephrine was administered to 24 patients (0.1–0.2 mg) and elevated MAP from 53 ± 8 to 73 ± 8 mmHg (P = 0.0001) and ICA flow from 191 ± 43 to 218 ± 50 mL/min (P = 0.0276). Furthermore, anesthesia reduced the hypocapnic reactivity of ICA flow from 23 (18–33) to 14%/kPa (10–22; P = 0.0068).

Conclusion:

Combined propofol–remifentanil and thoracic epidural anesthesia affect ICA flow and CO2 reactivity. Phenylephrine partly restored ICA flow indicating that anesthesia-induced hypotension contributes to the reduction in ICA flow.
Intraoperative administration of systemic/epidural/intrathecal morphine on the quality of recovery following substitutional urethroplasty with buccal mucosal graft: A randomized control trial
Authors: Johnson Juliya Pearl Joseph , Arumugam Rajasekar , Karuppusami Reka , Mariappan Ramamani
Published: December 2022

Background and Aims:

Substitutional urethroplasty with buccal mucosal grafting for urethral stricture is associated with significant pain, and thus inappropriate perioperative pain management could delay postoperative recovery. The objective of our research was to determine the effects of analgesia with systemic or epidural or intrathecal morphine on quality of recovery (QoR) in patients undergoing substitutional urethroplasty with buccal mucosal grafting.

Material and Methods:

This prospective, double-blinded, randomized control trial was conducted over 2 years in ASA I and II patients who underwent substitutional urethroplasty with buccal mucosal graft. Patients were randomized into three groups, and Group A received systemic morphine (0.1 mg/kg), Group B received epidural morphine (3 mg), and Group C received intrathecal morphine (150 μg). The QoR between the groups were compared postoperatively using the 40-item QoR questionnaire, and the hemodynamic variations, time taken for ambulation, resumption of oral intake, and incidence of complications were also compared.

Results:

Out of the recruited 93 patients, 88 patients were analyzed. The QoR score for each domain was comparable between the three groups. The total QoR score for systemic, epidural, and intrathecal morphine groups were 189 (185–191), 189 (187–191), and 185 (183–189), respectively. Additionally, the hemodynamic variations, time taken for ambulation, and resumption of oral intake were comparable between all three groups except the incidence of postoperative nausea and vomiting (PONV) and pruritis, which were higher in the intrathecal group.

Conclusion:

All three modalities, namely systemic morphine (0.1 mg/kg), epidural morphine (3 mg), and intrathecal morphine (150 μg), offer similar QoR after substitutional urethroplasty. However, the incidence of PONV and pruritis was higher with the administration of intrathecal morphine.
Relationship between pulse pressure variation and stroke volume variation with changes in cardiac index during hypotension in patients undergoing major spine surgeries in prone position - A prospective observational study
Authors: Arumugam Rajasekar , Thomas Susan , Jacob Nisha Sara M , Nadaraj Ambily , George Sajan P. , Singh Georgene
Published: December 2022

Background and Aims:

Dynamic indices such as pulse pressure variation (PPV) and stroke volume variation (SVV) are better predictors of fluid responsiveness than static indices. There is a strong correlation between PPV and SVV in the prone position when assessed with the fluid challenge. However, this correlation has not been established during intraoperative hypotension. Our study aimed to assess the correlation between PPV and SVV during hypotension in the prone position and its relationship with cardiac index (CI).

Material and Methods:

Thirty patients aged 18–70 years of ASA class I–III, undergoing spine procedures in the prone position were recruited for this prospective observational study. Hemodynamic variables such as heart rate (HR), mean arterial pressure (MAP), PPV, SVV, and CI were measured at baseline (after induction of anesthesia and positioning in the prone position). This set of variables were collected at the time of hypotension (T-before) and after correction (T-after) with either fluids or vasopressors. HR and MAP are presented as median with inter quartile range and compared by Mann-Whitney U test. Reliability was measured by intraclass correlation coefficients (ICC). Generalized estimating equations were performed to assess the change of CI with changes in PPV and SVV.

Results:

A statistically significant linear relationship between PPV and SVV was observed. The ICC between change in PPV and SVV during hypotension was 0.9143, and after the intervention was 0.9091 (P < 0.001). Regression of changes in PPV and SVV on changes in CI depicted the reciprocal change in CI which was not statistically significant.

Conclusion:

PPV is a reliable surrogate of SVV during intraoperative hypotension in the prone position.
Correlation between depth of subarachnoid space in the lumbar region estimated by Stocker’s formula, ultrasound, and depth of needle insertion: A prospective observational study
Authors: Nair Nayantara , Gnanasekar Rajiv , Joshi Reesha , Lakshmi R
Published: December 2022

Background and Aims:

The main challenge in administration of spinal anesthesia in patients is the unpredictability of the exact skin to subarachnoid space depth (SSD). Approximation of SSD and needle length comes at the expense of patient comfort and multiple attempts increases complications. Our study aimed to evaluate the validity of Stocker’s formula to estimate SSD in comparison to ultrasonography and depth of needle insertion. We also aimed to determine an equation to describe the relationship between patient weight and SSD in an Indian population.

Material and Methods:

This was a prospective observational study. A total of 234 adults of American Society of Anesthesiologists (ASA) category 1 and 2 were selected for the study. The patients underwent spinal anaesthesia and SSD data were determined using weight-based Stocker’s formula (DS), ultrasonography (DU), and actual depth of needle insertion (DA). Correlation analysis was performed to determine variables that can predict the SSD. A linear regression was calculated to describe the relationship between patient weight and SSD. SSD data were determined using weight-based Stocker’s formula ultrasonography, and actual depth of needle insertion.

Results:

Mean SSD using Stocker’s formula, ultrasonography, and actual depth of needle insertion was 4.92 ± 0.6 cm, 4.47 ± 0.6 cm, and 4.81 ± 0.6 cm. Our study showed a significant correlation between Stocker’s formula and SSD measured by actual depth of needle insertion (R
2 = 0.376). This was described by the derived formula: SSD (cm) =2.522+ [0.031 × weight (kg)].

Conclusion:

SSD correlates well with the weight of adult patients. Measurement with Stocker’s formula and actual depth showed better correlation than Stocker’s formula and ultrasonography. This is valuable in resource-poor areas with a lack of ultrasound machines or expertise in training.
Ultrasound-guided single needle tip placement below axillary artery in the infraclavicular area: A cadaveric study
Authors: Diwan Sandeep , Feigl Georg , Nair Abhijit
Published: December 2022

Background and Aims:

The parasagittal ultrasound-guided infraclavicular block (ICB) aims to cover all the elements of brachial plexus for the surgeries at and below the elbow. Our aim was to demonstrate the spread of 20 ml latex in vicinity of brachial plexus cords after injecting posterior to the axillary artery in Thiel embalmed cadavers.

Material and Methods:

A blunt insulated needle was inserted posterior to the axillary artery in a traditional parasagittal infraclavicular in 2 Thiel embalmed cadavers, on both the sides (four specimens). A day later cadaver 1 was dissected and cadaver 2 was frozen at ‒20ºC for 2 weeks and sectioned. Both cadavers were photographed.

Results:

In cadaver 1, dissection revealed a spread of red latex on the lateral cord extending onto the musculocutaneous nerve, the posterior cord engulfing the radial and axillary nerves distally. In cadaver 2, a cross-section revealed latex engulfed all three cords.

Conclusion:

Single injection of 20 ml latex aimed posterior to the axillary artery in the parasagittal infraclavicular approach engulfed the posterior, medial and lateral cord in Thiel embalmed cadavers. This needs to be investigated in patients who receive ICB clinically and using contrast studies.
Comparison of intranasal and nebulized dexmedetomidine for premedication in pediatric patients: A non-inferiority randomized controlled trial
Authors: Verma Shilpi , Bhatia Pradeep Kumar , Sharma Vandana , Mohammed Sadik , Saran Anita
Published: December 2022

Background and Aims:

Dexmedetomidine is a highly selective α-2 adrenoreceptor agonist and has been found to be an effective premedication agent when administered via the intranasal route. We aimed to compare the efficacy of dexmedetomidine premedication administered via intranasal route and through nebulization in pediatric patients.

Material and Methods:

This non-inferiority randomized controlled trial was conducted after getting approval from institutes ethics committee and informed written parental consent. Sixty-four children aged 2-8 years scheduled for elective surgery under general anesthesia were enrolled and were divided into two groups. Group I (Intranasal, n = 33) received 2 mcg/kg dexmedetomidine via intranasal route and group N (Nebulized, n = 31) received 2 mcg/kg dexmedetomidine through nebulization. The primary outcome was number of patients with satisfactory sedation 30 minutes after premedication at separation from parent. The secondary outcome included ease of medication acceptance, anxiety at parental separation, acceptance of anesthesia mask, perioperative hemodynamics, emergence agitation during recovery and adverse effects. Data collected was analyzed using Chi-square test, Student “t” test and Mann-Whitney U test with the help of SPSS 22. A one tailed P value < 0.025 was considered significant.

Results:

Demographic profile was comparable between groups. On arrival in OR 27 (81.8%) patients in group I and 21 (67.7%) patients in group N had satisfactory sedation score (P = 0.19). The median (IQR) sedation score was comparable between group I and group N (P = 0.057). Patients in Group I showed significantly better medication and mask acceptance scores (P < 0.0001, P = 0.001 respectively), parental separation anxiety score (P < 0.0001) and emergence agitation score (P = 0.001). There were no significant differences in hemodynamic parameters and adverse effects between the groups.

Conclusion:

Although nebulized dexmedetomidine is non-inferior to intranasal dexmedetomidine in providing desired level of sedation but intranasal administration had better acceptance of medication and anesthesia mask with lesser anxiety at parental separation and postoperative emergence agitation.
Dual Mobility Cup in Total Hip Replacements
Authors: Kumar Santhosh , Kulshrestha Vikas , Sood Munish , Datta Barun , Mittal Gaurav
Published: December 2022

Objective:

Prosthetic joint dislocation remains a significant cause of revision following total hip replacement (THR). To prevent this complication, emphasis has been on choosing the optimum surgical approach, accurate implant alignment, bigger femoral head size, and implementing postoperative hip precautions. In the last decade, a newer acetabular design concept; the “Dual Mobility cup” (DM cup) was introduced to reduce the prosthetic dislocation. Although the concept of the use of such a device is well accepted, there remains apprehension regarding its precise indications, the outcome in terms of wear and ability to decrease the incidence of prosthetic dislocation. We reviewed the early results of a particular DM cup design.

Materials and Methods:

This study shares a single center experience of using a monoblock DM cup (Captiv DM, Evolutis, Briennon, France) in THR. It is a prospective cohort study that looked at indications, handling issues, complications including prosthetic dislocations at 24 months follow-up.

Results:

We followed up results of uncemented and cemented DM cup used in 129 patients who underwent primary THR or revision THR (RTHR). There was one (1.6%) prosthetic dislocation amongst primary THR and 2 (3%) in the RTHR group. There were handling issues with monoblock uncemented DM cups of occasional improper seating and acetabular rim fracture. Three cases in which revision was performed, were due to component to component impingement and resulted due to inappropriate acetabular version.

Conclusion:

The use of DM cups while performing THR or RTHR significantly decreased the incidence of instability. While placing DM cups an attempt should be made to maintain the native version of the acetabular cup to decrease the risk of component impingement and instability.

Level of Evidence:

Level III, therapeutic study.
Evaluation of Functional Outcome Following Transportal Arthroscopic Anterior Cruciate Ligament Reconstruction using Quadrupled Hamstring Graft
Authors: Sakale Harshal Suhas , Agrawal Alok Chandra , Balakrishna Martha , Kar Bikram Keshari , Moti B Raj Kiran
Published: December 2022

Introduction:

The anterior cruciate ligament (ACL) has an important role in preserving the function and stability of the knee joint, and it prevents anterior translation of the tibia. The ACL is the most commonly injured structure of the knee following posttraumatic and sports-related injuries. The treatment of modality for ACL insufficiency was arthroscopic ACL reconstruction. In this study, we followed the transportal approach for ACL reconstruction using a Quadrupled Hamstring graft, and we reported the functional outcome of ACL reconstruction at a minimum follow-up of 6 months.

Materials and Methods:

This was a prospective outcome study conducted on 32 patients who met the inclusion and exclusion criteria. All patients in this study underwent arthroscopic reconstruction of ACL using quadrupled hamstring tendon graft through transportal technique. The graft was fixed with an endobutton on the femoral side and an interference screw on the tibial side. Patients were assessed for the functional outcome for a minimum of 6 months using the Tegner-Lysholm knee scoring system.

Results:

The mean age of the patient was 27 years. The majority of involved patients were males. The left side (77.14%) was involved more than the right side (22.86%). The most common cause of ACL injury in this study was road traffic accidents. Preoperative Tegner-Lysholm scores were 20 (62.5%) patients had poor and 12 (37.5%) patients had fair scores. Post-operatively, at 6 months follow-up, 27 patients had excellent, four patients had good scores, and one patient had a fair score. There was a significant improvement in the Tenger-Lysholm scoring system after 6 months of follow-up when compared to preoperatively. Three patients had knee pain and thigh muscle wasting (2 – 3 cm) during follow-up.

Conclusions:

Transportal arthroscopic ACL reconstruction using Quadrupled Hamstring graft gives excellent functional outcome and knee kinematics.
An Innovative Three Stitch Technique in Tibia Interlocking Nailing a Retrospective Analysis
Authors: Butala Rajendraprasad Ramesh , Patil Maitreya Jagdish , Samant Prakash Datta , Parelkar Kedar Anil
Published: December 2022

Introduction:

More recent advances are about the incision technique for intramedullary interlocking (IMIL) nailing, a 3 cm stab incision is sufficient for the procedure of IMIL nailing as compared to commonly used suprapatellar incision of 5–7 cm with splitting of patellar tendon which might result in chronic knee pain restricted range of movement, risk of infection, longer duration of postoperative rehabilitation, and poor wound healing.

Objective:

A retrospective study and analysis of three stitch technique in posttraumatic shaft tibia fractures to assess the range of motion.

Background:

Tibial shaft fractures have peaked in incidence in the past decade with sky rocketing amount of road traffic accidents. With the mainstay of making any patient of such traumatic incident being early mobilisation, IMIL nailing for tibia remains one of the finest treatment modalities among plating or external fixator applications. With the increased demands in the field of cosmetology and minimally invasive scar techniques, the 3-stitch technique would have a major impact not only on the early healing of surgical scar but also reduced chances of acquired infections along with advancements in weight-bearing exercises.

Materials and Methods:

A retrospective analysis of midshaft tibia fractures who were treated with IMIL nailing with 3-stitch technique with a sample size of post op 100 patients. A study was held at a tertiary care hospital and research center.

Results:

Sample size of postoperative 100 patients out of which 76 showed conclusive results and 24 were lost at follow-up.

Conclusion:

Good to excellent outcome with a small healed scar was observed in patients who underwent 3-stitch technique IMIL nailing for shaft tibia fractures.
Forearm Rhabdomyosarcoma in Neurofibromatosis Type 1
Authors: Kakkar Vikas , Makkar Dheeraj
Published: December 2022

Rhabdomyosarcoma (RMS) is the most common soft sarcoma in kids, with alveolar and embryonal variants distinguishable by histopathology and, more significantly, molecular biology. RMS occurs intermittently in a substantial proportion of cases without a predisposing condition. Nevertheless, it is well established that certain hereditary factors enhance the likelihood of developing RMS. Beckwith–Wiedemann syndrome, Gorlin syndrome, Costello syndrome, neurofibromatosis type 1 (NF1), and Li-Fraumeni syndromes are some of them. These syndromes present with RMS during childhood. A 47-year-old female with NF1 discovered a lump in her right forearm 1 year before presentation. When the patient noticed ulceration on the swelling, she sought medical attention. A tumor was detected in the center of the right forearm through magnetic resonance imaging, and it was suspected to be a cystic or myxoid soft-tissue tumor, RMS, or a peripheral neural tumor. We classified the tumor as stage IV due to axillary lymph node involvement and lung metastasis. Histopathology confirmed RMS. The patient then received radiotherapy and chemotherapy, and her tumor went into remission. After confirming NF1 syndrome, we advise patients to adhere to the standard cancer screening protocol. The screening would assist in the earlier diagnosis of tumors, leading to a reduction in complications.
Functional Outcome of Arthroscopic Bankart Repair With or Without Remplissage in Recurrent Anterior Shoulder Instability
Authors: Chodavarapu Lalithmohan , Kumar K K Kiran , Bitla Venkatesham , Patnala Chandrashekhar
Published: December 2022

Background:

Arthroscopic Bankart repair is now the standard procedure for shoulder stabilization in patients with recurrent anterior shoulder instability with Bankart lesion with minimum glenoid bone loss.

Aims:

The aim of this study is to evaluate the postoperative shoulder motion and functional outcome following arthroscopic repair of Bankart lesion with suture anchors with or without remplissage.

Materials and Methods:

This is a prospective study done between May 2019 and April 2021. A total of 20 patients with recurrent anterior shoulder instability were stabilized arthroscopically by the same surgical team over time. All patients met the inclusion criteria and were assessed with the American Shoulder and Elbow Surgeons (ASES) and Rowe scoring systems. The range of motion, postoperative function, recurrence rate, and return to preinjury activities were evaluated.

Results:

In our study, all 20 patients were followed up for a minimum period of 1 year. All patients had a good range of motion. The two shoulder scores (ASES and Rowe) significantly improved after surgery (P < 0.05). There was only one recurrence (5%). Patients were able to return to their previous activities or physically demanding jobs.

Conclusions:

Arthroscopic Bankart repair for traumatic anterior shoulder instability is a good procedure with less postoperative morbidity and excellent functional outcome. It allows return of patients to previous activities without any restriction.
Intra-Articular Osteotomy for Correction of Neglected Malunion of Medial Femoral Condyle Hoffa's Fracture
Authors: Shetty Karan , Mittal Prabhat , Darshan M. S.
Published: December 2022

Hoffa fractures are distal coronal femoral fractures which are intra-articular and involve one or both of the condyles. The lateral condyle is three times more likely to sustain an injury than the medial condyle. Malunion is one of the late complications in neglected instances or following nonoperative management. Medial femoral condyle injuries are quite uncommon. In this case study, a 23-year-old male with a neglected medial Hoffa's malunion is discussed. The patient presented with pain, deformity, and restriction of movements in the left knee for 6 months. Pain aggravates walking and was affecting his daily activities. He allegedly had a past trauma 18 months back for which he took osteopathic treatment. On examination, fixed 10° varus knee deformity is noted, and there is a fixed flexion deformity of 10° with further flexion up to 100°, i.e., there is an extension block terminally. X-rays and computed tomography scan showed medial condyle Hoffa's malunion with obvious intra-articular step. Treatment aims to reduce the articular surface anatomically and provide rigid and stable fixation. Treatment's objectives included easing pain and addressing deformities and improving the range of movements and early mobilization. The patient was assessed clinically with a Knee Society Score. The primary method of treatment for Hoffa's malunion is surgical. Intra-articular osteotomy should be taken into consideration as a salvage option in the younger population to prevent arthritis. The use of an antiglide plate in conjunction with screws provides rigid and stable fixation.
Posterior malleolus fracture fixation in ankle injuries
Authors: Dave Rutvik D. , Tank Parag M. , Patel Nimish B. , Shah Poojan V.
Published: December 2022

Introduction:

Posterior Malleolar fractures are relatively rare and a part of complex ankle injuries. Trimalleolar fractures affect the stability of the weight-bearing ankle joint. Management of posterior malleolar fractures is a challenge.

Aims:

This study aimed to examine the radiological and clinical outcomes of the management of posterior malleolar fractures in adults.

Settings and Design:

This is an original research retrospective study

Materials and Methods:

Eleven patients underwent fixation of ankle fractures with fixation of posterior malleolus as needed using screws or plates. Surgical outcomes were examined in follow-up with an average follow-up of 21 months using the American Orthopedic Foot and Ankle Score (AOFAS) score and with radiological correlation at each follow-up.

Results:

In our series, 27% of patients had 44B type injury and 73% of patients had 44C type injury as per AO/OTA classification. The average AOFAS score was 90.45 for the series and the score for patients treated with direct reduction of the fragment was better than for those treated with indirect reduction. The average score for patients managed with screws was better than for those treated with plates in our series. 82% of patients showed excellent to good outcomes with one patient having an infection and one patient having moderate to severe pain.

Conclusion:

Anatomical reduction of posterior malleolar fragment leads to better long-term functional outcomes and a stable ankle joint with early mobilization.
Epidemiological study to assess the status of measles vaccination in under five children and factors associated, in a peri-urban area, Asudgaon village, in Raigad district, Maharashtra, India
Authors: Riswadkar Neha , Waingankar Prasad J. , Relwani Nisha Ram , Sanjeev Sunila
Published: December 2022

Background:

Measles continues to be a major cause of childhood morbidity and mortality in India. Measles is considered one of the leading vaccine-preventable causes of child mortality worldwide. Major reasons for low vaccine coverage exist within the health care system itself, which creates barriers to obtaining immunization.

Materials and Methods:

A cross-sectional, descriptive, epidemiological study that aimed to examine the coverage of measles vaccination among under-five children of Asudgaon village. All under-five children residing in every 5th household of the village were included(n = 445). After obtaining consent from the mother, data was collected from her using a pre-designed and pre-tested questionnaire. The data was entered and analyzed in SPSS 23.

Results:

There was a total of 100 children eligible for the study. Overall, 41% of children were fully immunized against measles, 37% were partially immunized, 5% were immunized to date and 17% were not immunized. The most reasons for partial or non-immunization for measles were inadequate knowledge about immunization (19%), unawareness of days of vaccination(n = 14%), the child being ill at the time of vaccination, husband or mother-in-law against vaccination, fear of effects, and others. The Chi-square test indicates a significant association between mothers’ education and measles vaccination.

Conclusion:

Immunization status needs to be improved through education, increasing awareness, and counseling of parents regarding immunization and associated misconceptions as observed in the study.