bluuebunny/crossref_metadata_2025 huggingface dataset:
Prescription pattern at outpatient department in a tertiary care hospital of Gujarat: a cross-sectional study
Authors: Gohil Nayana J.
Published: December 2019

Background: Evaluation of drug prescription prototype is a significant feature of patient care, which also provides as an estimate of the quality of care provided. Thus, the current study was carried out to analyze the prescriptions of patients attending outpatient department (OPD) of a tertiary care teaching hospital.Methods: Present cross-sectional study was performed in the OPD of our tertiary care teaching hospital. The study was carrying out for duration of two years. Data was obtained from 850 prescriptions. Data was analysed as per WHO prescribing indicators.Results: Total 1700 prescriptions were analysed, that includes 55.8% males and 40.1% females. The highest numbers of prescriptions were from the age group of 18-40 (53.6%) years of age. Average number of drugs in the current study was found to be (2.1). Percentage of come across with an antibiotic prescribed was 17.12%. Percentage of come across with an injection prescribed was 11.81%.Conclusions: There is necessitate of recuperating the prescribing pattern by maintaining the number of medicines as little as possible, prescribing medicines by generic names, using medicines properly after selecting and deliberately keeping the charge of treatment low.
Potentiation of general anaesthetic activity of ketamine by memantine
Authors: Umamageswari M. S. , Vasanthan K. , Karthikeyan T. M.
Published: December 2019

Background: The study was done with the objective to evaluate synergistic activity of ketamine induced general anesthesia by memantine in wistar albino rats.Methods: The wistar albino rats of either sex were divided into four groups of five animals. Group 1 received ketamine 40 mg/kg, group 2 received ketamine 80 mg/kg, group 3 received ketamine 40 mg/kg along with memantine 10 mg/kg and group 4 received 80 mg of ketamine along with memantine 10 mg/kg to evaluate the synergistic activity of ketamine induced general anesthesia by memantine. The sleep latency time and duration of sleep were measured in all the groups.Results: The sleep latency time of group 4 is significantly decreased (p<0.001) compared to all other groups. The duration of sleep of group 4 is significantly increased (p<0.001) compared to group 1 and group 3, but less than that of group 1.Conclusions: Memantine possess synergistic activity of ketamine induced general anaesthesia.
Study of resistance pattern of isolated micro-organisms towards commonly used anti-microbial agents in medical intensive care unit of a tertiary care teaching hospital
Authors: Biswas Mansij , Rege Nirmala N. , Karnik Niteen D. , Nataraj Gita
Published: December 2019

Background: The objective of the study was to find out different types of biological samples from admitted patients tested for culture and sensitivity (C&S), prevalence of different types of organisms isolated from those samples, and to analyze the resistance pattern of those isolated organisms against commonly used or tested anti-microbial agents (AMAs).Methods: Following institutional ethics committee approval and written informed consent, adult patients of both genders, receiving AMAs were enrolled from June 2014 to July 2015 and followed up daily till they were in medical intensive care unit (MICU). Demographic data, diagnosis, culture-sensitivity (antibiogram) and other investigation reports and treatment details were recorded. Descriptive statistical analysis of collected data was done.Results: Of the 514 samples (from 600 patients enrolled) sent for C&S testing, 143 were reported as sterile while from the rest 371 samples, 504 organisms were isolated; commonly isolated organisms were Pseudomonas aeruginosa (30%), Acinetobacter baumannii (23%), Klebsiella pneumoniae (16%), Providencia sp. (7.1%), Escherichia coli (5.7%), and Enterobacter sp. (4.2%). Samples were sent in 63% of enrolled patients, the commonest being broncho-alveolar lavage (48% of total). Microbial resistance was high for cephalosporins (ceftriaxone, cefepime, ceftazidime), carbapenems (meropenem, imipenem), penicillins (piperacillin), quinolones (ciprofloxacin, levofloxacin), aminoglycosides (gentamicin, netilmicin, amikacin) and cotrimoxazole. Most organisms were sensitive to colistin (100%), polymyxin B (92%) and tigecycline (69%).Conclusions: The information regarding commonly isolated organisms and their resistant pattern would aid in rational selection of AMAs and thus the present study is useful to clinicians managing MICU and the hospital infection committee to plan future policies regarding AMA use in MICU.
Prevalence of hypoxaemia and its associated factors in children with pneumonia seen at a tertiary hospital in Southeast Nigeria
Authors: Ogaziechi Kenneth Onyebuchi , Ogoke Christian Chukwukere , Chukwuka John Onuora , Nwolisa Emeka C. , Achigbu Kingsley I.
Published: December 2019

Background: Hypoxaemia is a common complication and a significant predictor of death from pneumonia in children under five years of age. Knowledge of the prevalence of hypoxaemia and clinical signs associated with it may guide use of oxygen in the management of childhood pneumonia in resource-poor settings. This study was carried out to determine the prevalence of hypoxaemia in children with pneumonia and assess the relation between hypoxaemia and age, duration of illness and clinical signs.Methods: This was a descriptive cross-sectional study undertaken between 1st July 2016 and 27th April 2017. Children with pneumonia, aged 2-59 months, who attended Federal Medical Centre, Owerri and met the inclusion criteria, were recruited into the study. Subject evaluation included history and physical examination. Their blood oxygen saturation was determined by pulse oximetry and value less than 90% indicated hypoxaemia.Results: Out of the 144 children with pneumonia, 93(64.6%) were males and 51(35.4%) females giving a male to female ratio of 1.8:1. Median age was 8 months and mean weight (SD) was 8.6 kg (3.6). The overall prevalence of hypoxaemia was 17.4%. Hypoxaemia prevalence was significantly higher in infants (p=0.026) and severe pneumonia (p<0.0001). There was statistically significant association between hypoxaemia and lower chest in-drawing, nasal flaring, suprasternal recession, grunting, lethargy, tachypnoea and tachycardia. With adjustment for confounding variables, only lower chest in-drawing (OR: 9.672; p=0.004), lethargy (OR: 8.103; p=0.020) and grunting (OR: 4.960; p=0.050) predicted hypoxaemia in pneumonia. Each of these signs had a poor combination of sensitivity and specificity.Conclusions: Hypoxaemia is common in childhood pneumonia. Though some clinical signs are significantly associated with hypoxaemia in childhood pneumonia, they may be unreliable in predicting hypoxaemia. Therefore, pulse oximeters should be provided in every health facility for accurate detection of hypoxaemia.
Foreign body aspiration in children
Authors: E. Sivakumar , P. Ramasubramaniam
Published: December 2019

Background: Foreign Body (FB) aspiration is a life-threatening problem in children. Here the demographic pattern, clinical presentation, type of Foreign Body (FB) and outcome of FB aspiration was examined.Methods: An observational case series study done in Institute of child health and research centre, Government Rajaji hospital, Madurai during November 2015 to June 2018. After a detailed history and clinical examination, children with definite evidence of FB in tracheobronchial tree were subjected to rigid bronchoscopy and with doubtful evidence were subject to FFBS. They were followed up for complications.Results: Of the 136 children, 86.03% (n=117) were under 3 years of age. A positive history of FB aspiration was present only in 51.4% (n=70). Unilateral hyperinflation was seen in 48.53% (n=66) but was normal in 13.97% (n=19). Flexible Fiber Optic Bronchoscopy (FFBS) diagnosed FBs in 61.02% (n=83) which included children with acute onset breathlessness and persistent radiological features. Peanut was the most common FB 64.71% (n=44). FBs were found in the right side in 50% (n=34) and in the left in 38.2% (n=26).  36% (n=49) developed complications due to the FBs and 2.9% (n=4) due to procedure.Conclusions: FB aspiration is most common in children less than 3 years of age. Positive history of aspiration was seen in only 51.4% and chest X-ray was normal in 13.97%. FFBS diagnosed FB in 61.02%. Peanut was the most common FB. Persistent pneumonitis is the most common complication.
Neuroimaging studies in children aged 6 months to 16 years with new onset afebrile seizures
Authors: Satyanarayan Akula , Sriram Gangina , Bhavani Ganga , Chandra T. Jaya
Published: December 2019

Background: Seizures are the most common pediatric neurological disorder. With this a study was conducted to determine the frequency of abnormal neuroimaging in children aged between 6 months to 16 years with new onset afebrile seizures.Methods: Study was conducted in the department of pediatrics, GSL Medical College. Children aged six months to sixteen years, presented with the symptoms of first episode of afebrile seizures were included in the study. After through clinical examinations, findings were recorded, and all the participants underwent imaging studies such as CT and MRI. And the findings were recorded. p<0.05 was considered statistically significant.Results: Total of 80 participants were included in the study; in this, 22.5% (18) had simple partial, 41.3% (33) had complex partial and 5% (4) had partial seizures with 20 generalization and 31.3% (25) had generalized seizures. Seizures were more common among non-vegetarians (p<0.05). Bain CT shows localization to the parietal lobe in 54% of these cases.Conclusions: Neurocysticercosis and tuberculoma are common causes of seizures. Although cysticercosis incidence is greater in pork eaters, but vegetarians shouldn’t be excluded. Studies on large sample size for long time are recommended.
Resurgence of diphtheria and its outcome among children in western Uttar Pradesh: a battle to conquer
Authors: Bhatnagar Ruchika , Sahai Lahar
Published: December 2019

Background: Considered as a rare clinical entity in immediate post-vaccination era, diphtheria has now started gaining surface in India for last few years, with an epidemiological shift involving older children owing to poor immunization coverage and waning immunity. Thus, it is imperative to quantify disease burden, analyses the clinical profile and factors affecting the outcome of diphtheria in children.Methods: A prospective observational study conducted in the Pediatric department of a teaching hospital where all children admitted with clinical diagnosis of diphtheria during the study period were included. Demographic data and clinically relevant information along with complications and outcome were recorded. Cases were managed as per standard treatment protocol providing intensive care support wherever required. Complications and factors affecting the outcome in all diphtheria cases were analysed.Results: Total 53 children were enrolled into study, and the mean age of study population was 7.55±2 years. Fever, pseudo membrane and throat pain were observed in all the cases. Palatal palsy was the earliest and the commonest complication (60.4%) followed by myocarditis (55%). Case fatality rate was 33.9% and myocarditis (77%) was the commonest complication attributing to it. Poor immunization status, late presentation and delayed ADS administration were associated with increased complication rate and unfavorable outcome.Conclusions: Robust immunization activity coupled with improved case-based surveillance would go a long way in preventing further diphtheria outbreaks in community. Sensitization about this re-emerging disease and high index of suspicion in diagnosing it, amongst primary care physicians and peripheral health workers would promote early referral and prompt management thereby reducing morbidity and high mortality associated with diphtheria.
Prevalence of hyponatremia in pulmonary tuberculosis
Authors: Dash Manoranjan , Sen Ranjan Kumar , Behera Bibhu P. , Sahu Swapna Sarit
Published: December 2019

Background: Tuberculosis is one of the most common infection in India and is associated with high mortality. India ranks 14th out of top 22 countries who are burdened with TB infections.Methods: It is a prospective study after getting the ethical committee clearance from the institute. The patients admitted to Chest and TB, Medicine Department of SLN medical college and Hospital, Koraput, Odisha from Jan 2019 to December 2019 with pulmonary tuberculosis were included in the study.Results: A total of 65 adult patients with active PTB were included in this study with age ranging from 15 to 69 years. The mean age of patients was 38.80 + 15.03 years. The total mean serum sodium levels among the subjects was 135.5+7.23. Among 65 patients, 26 (40%) patients had low sodium levels which was less than 135mmol/l out of which 21 (42%) were males and 5 (33%) were females. In all the groups of hyponatremias, majority were found to be males when compared to the females in their respective groups.Conclusions: Hence patients with PTB have to be evaluated for hyponatremia as early detection and treatment of underlying electrolyte abnormality can potentially reduce mortality and morbidity associated with tuberculosis and also can shorten the duration of hospitalization.
Role of Raktapradoshaja Nidana in the manifestation of Kushtharoga in Ayurveda: a cross sectional survey study
Authors: Singh Devendra , Mandal Sisir Kumar , Nath Rupashri , . Renu
Published: December 2019

Background: In Ayurveda all the skin diseases are described under the term Kushtha which is mentioned as a Raktapradoshaja vikara. Due to Rakta dusti several disease pathogenesis accurse in population which leads to Raktapradoshaja vikara.Methods: Present study aimed to conduct a cross-sectional survey based study for investigating the role of Raktapradoshaja nidana in the pathogenesis Kushtha (skin diseases). A duly prepared proforma was prepared based on various etiology of Raktapradoshaja vikara mentioned in classical texts of Ayurveda. Total 500 patients diagnosed as skin disease were screened on the basis of prepared questionnaires prior obtaining the ethical clearance form IEC, NIA, Jaipur (IEC/ACA/2017/60 dated 26/04/2017).Results: Based on over all observation the present survey study explains an easy diagnostic criterion for the different types of Raktapradoshaja vikara mentioned in Ayurveda. Here a unique attempt was taken for quantitative analysis of various classical nidana in relation to the pathogenesis of the disease Raktapradoshaja vikara.Conclusions: Analyzed data of all these extreme exposure of nidana may provide a significant role for diagnosis, prognosis, as well as prevention of the disease of Raktapradoshaja vikara.
Prevalence and spectrum of iron deficiency anaemia in heart failure patients
Authors: Mohan Gaurav , Mohan Gurinder , Chandey Manish , Kaur Avneet , Sikand Trimaan Singh , Kaur Ranjeet
Published: December 2019

Background: To study the prevalence and pattern of iron deﬁciency (ID)in heart failure (HF) patients with or without anaemia.Methods: This is a single-centre observational study, conducted at a tertiary care hospital of Punjab. Patients were selected based on validated clinical criteria-Framingham criteria. The iron parameters were done during the study including serum iron, serum ferritin, total iron binding capacity, and transferrin saturation (TSAT), to diagnose iron deficiency anaemia. Anaemia was defined as haemoglobin (Hb) < 13g/dl in males and <12 g/dL in females, based on WHO definition. Absolute iron deficiency is defined as serum ferritin < 100 mg/L and functional ID was defined as normal serum ferritin (100–300 mg/L) with low TSAT (<20%).Results: A total of 120 patients of Heart Failure (54% males and 46% females) were studied. Most of the patients were of high-functional NYHA class (Class IV NYHA n=45). Iron Deficiency was present in 60% patients with 31.66% patients having absolute and 28.33% patients having functional ID. Nearly one-fifth of the patients were having ID but without anemia, signifying importance of workup of Iron deficiency other than haemoglobin levels.Conclusions: Study highlights the neglected burden of ID in HF patients in India. This study suggests further large-scale studies to better characterize this easily treatable condition and considering routine testing in future Indian guidelines.
Bioecological and phytocenological assessment of Equisetum arvense L. populations in the Great Caucasus of Azerbaijan
Authors: Ibadullayeva Sayyara J. , Salmanova Narmin R. , Movsumova Nuri V. , Shiraliyeva Gulnara S. , Ahmadova Sevda Z.
Published: December 2019

Background: The use and reproduction of natural resources that are interested in improving the living standards of the population is based studing of scientifically complex. Studying the biodiversity of medicinal plants based on cenological assesments are depending on their ecological diversity is always relevant. This study was aimed to estimate population of Equisetum arvense L. phytocenologically and ecologically and registrations during in different years.

Methods: Ontogenetical descriptions of Equisetum arvense species have been shown according to form of ontogenetically periods. It has been used discrete descriptive conception of ontegenese and development stages of the individuals have been charactered. Results have been analysed by χ2 comparison of criteria.  

Results Three natural cenopopulations and cenological state of E. arvense were assessed during 2017-2019 years. It is defined that, 1st and 3rd cenopopulations were transitions and 2nd was mature in 2017, in 2018 1st was young, 2nd and 3rd were mature, in 2019 1st and 2nd were young and 3rd was mature. Restoration of 1st and 2nd cenopopulations were higher in 2019 than in 2017-2018.

Conclusions: Properties of soil-climate condition in E. arvense formation has been a cause for a determining development rhythm feature in the Equiseta vegetation. Important changes in ecology temperature, dampness and other factors influence on strongly seasonal dynamism of grasses in the Zagatala territory, but semi-shrubs tier that E. arvense dominates is constant. Seasonal distribution of the atmosphere rainfalls influences on development dynamism of populations. For this reason restoration parameters of some populations were high in compared to previous years.
Role of coblation in reducing pain and morbidity of adenoidectomy
Authors: Thomas George , Thekkethil Jathin Sam , Thomas Sumin Mariyam , Ramesh Shary , Varghese Ann Mariam
Published: December 2019

Background: Adenoidectomy is one of the most commonly performed paediatric surgical procedure by otorhinolaryngologists. Over the past few decades, adenoidectomy has evolved and different techniques have been proposed to reduce morbidity and surgical risk. Controlled ablation or Coblation® is capable of low temperature molecular disintegration within soft tissue causing its dissolution. In this study, we report our experience of adenoidectomy using Coblation®, and its role in reducing pain, morbidity and its significant outcomes are discussed.

Methods: A total number of 25 children aged 3-15 years, who underwent coblation adenoidectomy between March 2017 and April 2018 were included in this study.

Results: The mean age was 7.8 years (males 7.79 years and females 7.81 years). Pre operatively 100% patients had sleep disturbance and after coblation adenoidectomy only 12% patients have disturbed sleep and the rest 88% patients have comfortable sleep. 80% patients did not have pain in immediate post-operative period and 88% had no pain when they visited hospital for first review. 76% patients had less than one day of hospital stay and 24% patients had more than one day of hospital stay. 68% patients had no episode of upper respiratory tract infection (URTI) within the first one year after surgery.

Conclusions: Over the years, many different adenoidectomy techniques have evolved and is surgeon specific or centre specific. Endoscopic-assisted coblation adenoidectomy is a safe and effective method of adenoidectomy.

 
Merits of harmonic scalpel over conventional hemostasis in open thyroid surgery: a randomised controlled trial
Authors: Bajaj Anushree , Paike Bhalchandra , Sheikh Shahnaz , Vaze Vikrant
Published: December 2019

Background: The pioneers of thyroid surgery, Theodor Kocher and Theodor Billroth, developed an acceptable technique of standardized thyroid surgery between 1873 and 1883. The aim of this prospective randomized trial was to evaluate the efficacy and safety of harmonic scalpel use compared with conventional haemostasis in open thyroid surgery.

Methods: A total of 60 consecutive patients underwent open total thyroidectomy were randomized into two groups. Group A with harmonic scalpel and Group B with electrocautery with 30 patients each. Factors including age, sex, pathology, thyroid volume, haemostatic technique, operative time, drainage volume, thyroid weight, postoperative pain, postoperative complications and hospital stay. The results were analysed using the students t-test and x2.

Results: No significant difference was found between the two groups concerning mean thyroid weight and mean hospital stay. The mean operative time was shorter in the harmonic scalpel group. The total fluid drainage fluid volume was lower in Harmonic scalpel group shorter in. Harmonic scalpel group experienced significantly less post-operative pain at 24 and 48 hours.

Conclusions: In patients undergoing thyroidectomy, harmonic scalpel is a reliable and safe tool. AS compared with conventional haemostasis techniques, its use reduces operative times, post-operative pain, drainage volume and transient hypocalcemia.
Transnasal endoscopic eustachian tube balloon dilation: a review
Authors: Swain Santosh Kumar , Das Alok , Acharya Satyabrata , Mohanty Jatindray Nath
Published: December 2019

Eustachian tube (ET) dysfunction is a common clinical entity which often provides challenges to Otorhinolaryngologists. Patients with ET dysfunction typically present with fullness in the ear, hearing loss or plugging in the ear, which impair quality of the life. It can lead to cholesteatoma formation and severe morbidity in the life. There are limited treatment options for ET dysfunction in clinical practice. Presently transnasal endoscopic balloon dilation of ET is a promising treatment for its dysfunction. This technique causes inflation of a balloon in the cartilaginous portion of the ET which leads to local dilation. This procedure helps in reduction of the clinical symptoms and reduces the severity of the ET dysfunction such as hearing loss and cholesteatoma formation. This review article will discuss the effectiveness of transnasal endoscopic balloon dilatation of eustachian tube for treatment of chronic eustachian tube dysfunction.

 
Anterior femoral cut in total knee arthroplasty: a classification proposal
Authors: Medeiros Filipe , Duarte António , Correia Bruno , Carvalho Maria , Vide João , Fontes Ana Paula , Sousa João Paulo
Published: December 2019

Background: The cut of the anterior femur (CAF) sets the rotation of the femoral component, which could affect patellar tracking, and influence the clinical results on total knee arthroplasty (TKA). The aim of this study was to suggest a classification for anterior femoral cut in TKA.

Methods: Images of anterior femoral cuts were aggregated in different shapes and defined a classification. One-hundred femoral image’s cuts were analysed by 5 orthopaedic surgeons, which classified them twice. To analyse inter and intra-observer agreement, the Fleiss Kappa test was used.

Results: The study proposes the following CAF classification, type 1 (one peak) and type 2 (two peaks); subtypes 1 (a) a central base peak, 1 (b) a lateral base peak, 2 (a) two peaks where the smallest is in the lower half, and 2 (b) two peaks where the smallest is in the upper half. In our study, type 2 (a) was the most common type (54.5%), followed by type 1 (b). The analysis showed good intra- and inter-observer agreements (mean K of 0.774 and 0.627, respectively). The intra and inter-observer concordance was statistically significant in all the analyses.

Conclusions: The CAF classification system for TKA is considered a reproducible classification. To our knowledge, there is no study describing a shape’s classification of this cut. A slight rotation of the femoral cutting guide could change the axial rotation and positioning of the femoral component. An undesirable cut could lead to different patellofemoral offset and could consequently cause anterior pain and instability.
Dynamic hip screw technique in the management of trochanteric fracture
Authors: Rao N. V. Narasimha , Krishna C. Siva Rama , Aditya K. , Chandra T. Jaya
Published: December 2019

Background: Study was conducted to find the results of dynamic hip screw in the management of trochanteric fracture by analyzing the factors which influence post-operative mobility.

Methods: Study was conducted in the department of orthopedics, GSL Medical College. Individuals >18 years, both genders who were diagnosed having trochanteric type I and II Boyd and Griffin stable fractures were included in the study. All surgeries were performed under spinal anesthesia, internal fixation with dynamic hip screw and 135o angled blade plate. Injectable third generation cephalosporins were used 24 hours preoperatively, intra- operatively and 5 days post-operatively, and oral antibiotics till suture removal. Patients allowed to sit on bed on 2nd and 3rd day and static quadriceps exercises were started from 2nd day onwards, hip and knee flexion exercises from 6 or 7th day and weight bearing walking form 10th day.

Results: The average age was of the participants was 61.53 years, ranged between 41 to 80 years; 65% were female participants and 35% were male patients. In the study, 20 (50%) patients had right side fracture and left sided affection of trochanteric fracture to the remaining 50%. Most of the patients (67.5%) in this study were classified as type II Boyd and Griffin criteria, and 32.5% were type I. The clinical and functional outcome was calculated using the Kyle's criteria; 25% (10) showed excellent response, followed by good (50%), fair (15%) and poor (10%) results.

Conclusions: Dynamic hip screw is the operative treatment of choice for stable trochanteric fractures. However, studies on large sample for long time are recommended.
Outcome of adult proximal humerus locking plate in the treatment of paediatric subtrochanteric fractures
Authors: Chetia Naba Pallab , Medhi Himashis , Das Manasjyoti , Bidyananda Aritra
Published: December 2019

Background: Subtrochanteric fractures in children are treated by different conservative and operative methods. Patient’s age may be the single most important factor deciding treatment. Several studies have documented superior results with internal fixation compared to non-operative treatment. The aim of the study is to evaluate the outcome of proximal humerus locking plate fixation of subtrochanteric femoral fractures in children.

Methods: Between October 2015 and December 2017, 13 children with closed subtrochanteric femoral fractures including 3 pathological fractures were treated in our tertiary care teaching institute and the results were retrospectively analysed. Children of both sexes within 5–12½ years of age with isolated subtrochanteric fractures were included. There was no open fracture and fracture associated with neuromuscular disease or any systemic injury. In all cases, ORIF with proximal humerus locking plate was done using lateral approach.

Results: Average age at the time of injury was 9.35 years (range 5–12 ½ years). There were four (30.77%) short oblique, four (30.77%) long oblique, three (23.08%) transverse fractures and two (15.38%) comminuted fractures. Average operative time was 88.76 minutes and average intra operative blood loss was 86.23 ml. Average follow-up was 13 months. All fractures showed radiological union at an average of 8 weeks. One case had superficial infection which was controlled by antibiotics. Two patients had limb lengthening (average 0.75 cm) but required no intervention.

Conclusions: Internal fixation with adult proximal humerus locking plate appears as a good treatment option for paediatric subtrochanteric femoral fractures.
Primary bipolar replacement arthroplasty versus internal fixation in the management of unstable intertrochanteric fractures in the elderly
Authors: Bansal Abhishek , Beniwal Rajendra Kumar , Agarwal Saumya
Published: December 2019

Background: Management of unstable intertrochanteric femur fracture in the elderly has been always a matter of debate. There has been always a dilemma between osteosynthesis and prosthesis.

Methods: We retrospectively evaluated, 108 osteoporotic elderly patients with unstable intertrochanteric for internal fixation versus primary bipolar replacement arthroplasty in a span of 4 years.

Results: Bipolar replacement arthroplasty gives better outcome as compared to internal fixation with sliding hip screw.

Conclusions: It was found that cemented bipolar arthroplasty is the choice in freely mobile elderly osteoporotic comminuted displaced intertrochanteric fracture, though is a surgically demanding technique, it spares the postoperative complication of non-weight bearing after internal fixation of these fracture. The internal fixation is also compounded by osteoporosis, medical illness, difficulty to achieve and maintain reduction of comminuted and widely displaced unstable fractures, which restricts the mobilization and weight bearing and further increase the risk of morbidity and mortality in elderly in comparison to cemented bipolar replacement arthroplasty which allows early mobilization and weight bearing.
Efficacy of zoledronic acid infusion on bone mineral density among adult population
Authors: N. Vijay , A. Siva Kumar , S. Cyril Jonnes
Published: December 2019

Background: Osteoporosis is a skeletal disease characterised by impaired bone strength due to reduced bone mineral density. As a consequence, patients with osteoporosis are at increased risk of fractures. Zoledronic acid is an anti-resorptive agent that acts by slowing down osteoclast medicated bone resorption, thereby increasing bone density. This study was carried out to evaluate the efficacy of Zoledronic acid on bone mineral density.

Methods: This study was carried out as a record based cross sectional study among 30 symptomatic adult patients who visited the outpatient department of Orthopedics for a period of two years. Bone mineral density (BMD) parameters assessed using dual-energy X-ray absorptiometry (DEXA) scan were documented for initial period and after six months of intervention. Documentation of intervention with single dose of zoledronic acid 5 mg by intravenous infusion was verified and noted.

Results: There was a significant difference in the mean scores for both femoral neck and lumbar spine with respect to BMD values and T-score values between baseline parameters and values measured after 6 months of Zoledronic acid infusion. The difference was statistically significant (p<0.05).

Conclusions: Single dose of zoledronic acid 5 mg by intravenous infusion was found to be effective in increasing the BMD among individuals suffering from osteopenia and osteoporosis.
Management of lateral end clavicle fractures-using lateral clavicle locking plate: a prospective study
Authors: Rao V. Nageswara , V. Ravichandra , K. M. Lavanya , Swamy C. Ganapathi
Published: December 2019

Background: Lateral end clavicle fractures are one of the common upper limb fractures. They constitute 21–28% of all clavicle fractures. Of these 10–52% is displaced fractures. The management of fractures of lateral end clavicle remains debated and challenging. The objectivbe of this study is to evaluate the functional outcome following surgical treatment of unstable/displaced (Neer type II lateral clavicle fractures, and acromio-clavicular joint dislocations Rockwood grade III to V) lateral end clavicle fractures using lateral clavicle locking plate.

Methods: It is a prospective study conducted in the orthopaedics department of GSL Medical College and General Hospital for a period of 3 years (April 2016 to March 2019) among a total of 60 patients.

Results: About 23 (38.3%) belonged to 41–50 years age group, followed by 16 (26.7%) to 31–40 years age group and 13 (21.7%) to >51 years age group and 8 (13.3%) to 18–30 years age group. The time from trauma to surgery ranged from 0-15 days with a mean of 5 days and the mean operating time was 41 minutes ranging between 23-70 minutes. Mean duration to union was 13.33±2.126 weeks and the mean Constant Murley score was 88.56. Functional outcome at 6 months follow up was excellent in 8 (13.3%), good in 37 (61.7%), fair in 13 (21.7%) and poor in 2 (3.3%) patients.

Conclusions: Although there is no consensus as to a “gold standard” fixation method for unstable distal clavicle fractures, satisfactory outcomes could be obtained using the lateral clavicle locking plate resulting in sufficient stabilization and good functional outcome.
Functional outcome in displaced proximal humeral fractures in adults treated by proximal humeral locking plates
Authors: Narasimha Rao N. V. , Kanth K. Ravi , Yasam Rama Priya , Chandra T. Jaya
Published: December 2019

Background: The management of proximal humerus fractures (PHF) is a challenging task to any surgeon. Study was conducted to evaluate the clinical and functional outcome of the proximal humeral internal locking system in fixation of displaced proximal humeral fractures.

Methods: Study was conducted in the Department of Orthopedics, GSL Medical College. Informed written consent was taken from the study participants. All skeletally mature patients aged >18 years, presenting with displaced PHF according to Neer two, three and four part fracture were included in the study. Either deltopectoral or deltoid splitting approach was used for surgery, post-operative rehabilitation was started on day one.

Results: Twenty-five patients with PHF were enrolled in the study; five-holed proximal humerus locking plate (PHLP) was used for 18 patients, eight-holed PHLP for 05 and three-holed, ten-holed PHLP for 01 for one each. The Constant-Murley score was significantly improved (p=0.000) over each successive follow-up period with the average improvement of around 19 scores between 1st and 2nd follow-up and around 15 score improvement between 2nd and 3rd follow-up.

Conclusions: The proximal humeral locking plate is an adequate device for the fixation of displaced two-part, three-part and four-part PHF. Patient can regain good shoulder function, resume normal activities much earlier.
Giant cell tumor of flexor tendon sheath of little finger: a case report
Authors: T. S. Channappa , H. B. Shivakumar , Jhamb Jai Aditya
Published: December 2019

Giant cell tumor of the tendon sheath is a benign proliferative lesion of synovial origin that may affect the joints, bursae and tendon sheaths. We report the case of a giant cell tumor of the tendon sheath arising from the flexor tendon sheath of 5th finger of left hand of a 44 year old male patient. The patient underwent ultrasound examination and subsequently magnetic resonance imaging.
Design and Evaluation of Bulk Data Transfer Extensions for the NFComms Framework
Authors: Pennefather Sean , Bradshaw Karen , Irwin Barry
Published: December 2019

We present the design and implementation of an indirect messaging extension for the existing NFComms framework that provides communication between a network flow processor and host CPU. This extension addresses the bulk throughput limitations of the framework and is intended to work in conjunction with existing communication mediums. Testing of the framework extensions shows an increase in throughput performance of up to 268x that of the current direct message passing framework at the cost of increased single message latency of up to 2x. This trade-off is considered acceptable as the proposed extensions are intended for bulk data transfer only while the existing message passing functionality of the framework is preserved and can be used in situations where low latency is required for small messages.
A method for measuring verb similarity for two closely related languages with application to Zulu and Xhosa
Authors: Mahlaza Zola , Keet Catharina Maria
Published: December 2019

There are limited computational resources for Nguni languages and when improving availability for one of the languages, bootstrapping from a related language’s resources may be a cost-saving approach. This requires the ability to quantify similarity between any two closely related languages so as to make informed decisions, of which it is unclear how to measure it. We devised a method for quantifying similarity by adapting four extant similar measures, and present a method of quantifying the ratio of verbs that would need phonological conditioning due to consecutive vowels. The verbs selected are those relevant for weather forecasts for Xhosa and Zulu and newly specified as computational grammar rules. The 52 Xhosa and 49 Zulu rules share 42 rules, supporting informal impressions of their similarity. The morphosyntactic similarity reached 59.5% overall on the adapted Driver-Kroeber metric, with past tense rules only at 99.5%. This similarity score is a result of the variation in terminals mainly for the prefix of the verb.
Acquired Immunodeficiency Syndrome: A New Connotation for This Deadly Disease
Authors: Hussain Khan Zahid , Minagar Milad , Dehghan-Tezerjani Mohammad
Published: December 2019

D

uring the last century in the 80s, an outbreak of opportunistic infections and Kaposi's sarcoma was reported for the first time in homosexual men [1]. This disease had a fatal outcome and was named as acquired immunodeficiency syndrome (AIDS) due to total loss of CD4+T-lymphocytes. Shortly after it was described, the disease was rampantly found in hemophilic patients, drug addicts using injectable form of illicit drugs, recipients of contaminated blood and infants of affected mothers.
Later, in Central Africa, a heterosexual epidemic of AIDS was discovered in women [2-3]. Within a short span of time, AIDS turned out to be the greatest and deadliest pandemic of our times. A retrovirus called human immunodeficiency virus (HIV) was incriminated as the causative agent of AIDS [4]. An explosive HIV epidemic occurred in Africa, Asia and the former Soviet Union.
A global struggle was initiated to combat this highly deadly disease of AIDS. Billions of dollars were allocated and spent to ensure a decline of this malady affecting millions of people worldwide, but years since then, AIDs still hangs like a Damocles sword on our shoulders. Many other countries like the sub-Saharan Africa, Eastern Europe and the Caribbean also became a prey to the deadly virus of HIV finally culminating in a full blown picture of AIDS [5].
About two or perhaps more deaths occur each year from AIDS which is an astronomical figure. Death from AIDS remains a major challenge even today and it seems that we so far we have failed in eradicating HIV and thus AIDS despite huge expenses.
The fatal and lethal syndrome colloquially and commonly abbreviated as AIDS in the contemporary literature could be re-designed and re-abbreviated as "Allah's Illness to Destroy the Sinners" (AIDS). This latter connotation of AIDS correctly fits this abominable syndrome of AIDS, since these patients finally face an inevitable and miserable death despite an aggressive and prolonged futile treatment, reinforcing our Islamic belief that Allah (the omniscient and the omnipresent) punishes these victims in the harshest possible manner for the sins they have committed during their life time.
We may add that some unfortunate persons like hemophilic patients, recipients of contaminated blood and many others accidentally acquire AIDS and thus do not fall within the list of sinners, and thus should be excluded from the " Sinners' List".
To conclude, we may add that We was tempted to put this new concept about AIDS for all our readers and colleagues both in the surgical and the medical fields who might be interested in semantics and advanced literary terminologies.
Pre-delivery Conscious Sedation with Intravenous Low Dose Thiopental Na Bolus during Spinal Anesthesia for Cesarean Section
Authors: Nataj Majd Masoomeh , Faridi Tazeh-kand Nasrin , Hoseini Ladan , Sepidarkish Mahdi
Published: December 2019

Background: Nowadays, according to the large number of cesarean sections under spinal anesthesia, finding a simple and safe pre-delivery sedation technique which provides satisfaction for mothers with no over sedation and amnesia seems to be necessary. However, there is not enough evidence about the best choice of drug for this purpose. In the present study we aimed in evaluating the clinical effects of different concentrations (0.25, 0.5, 0.75mg/kg) of thiopental Na bolus for the mother’s satisfaction in cesarean section under spinal anesthesia.
Methods: Two hundred and forty term singleton pregnant women with normal ASA physical status were scheduled for an elective term cesarean delivery under spinal anesthesia and allocated into four groups. Groups I, II, III received 0.25, 0.5, 0.75mg/kg/IV of Thiopental Na respectively and group IV as the control group received 1.5cc of sterile water,1 min after spinal anesthesia. The level of consciousness with observer assessment of alertness/sedation score (OAA/S) and mother’s satisfaction was considered as primary outcomes.
Results: The level of mothers’ satisfaction in group II was significantly higher than other groups without any over sedation (P<0.001) and no adverse effect on their verbal contact was observed and they could easily communicate. All women could remember their infants. All babies were healthy with no complications and the Apgar scores were the same in all studied groups.
Conclusion: Based on the results of the present study and with comparison of different concenfrations and side effects indicates pre-delivery conscious sedation with 0. 5 mg/kg/IV of Thiopental Na could be a safe and appropriate technique for sedation in cesarean sections surgery under spinal anesthesia.
dictors of preoperative Anxiety Among Surgical Patients in Iran: An Observational Study
Authors: Khalili Neda , Karvandian Kasra , Eftekhar Ardebili Hasan , Eftekhar Negar , Nabavian Omid
Published: December 2019

Background: Patients undergoing surgery experience significant anxiety in the preoperative period. The aim of the present study was to identify the level of preoperative anxiety among Iranian patients in surgery clinics and its predictive factors.
Methods: In this cross-sectional study, the State-Trait Anxiety Inventory questionnaire was used to assess the patients’ preoperative anxiety. Results were analysed using the Chi-square test and binary logistic regression analysis.
Results: 246 patients were randomly selected, 222 of which were finally included in our analysis. In this study, the state and trait anxiety levels were moderate and low, respectively. Both state and trait anxiety levels were significantly higher among females (p-value 0.03 and 0.009, respectively). Also, patients with higher education had higher state and trait anxiety levels (p-value 0.001 and <0.001, respectively). Patients undergoing aesthetic surgeries had significantly higher state anxiety levels compared to other surgeries (p-value 0.04). Interestingly, the history of surgery was not significantly associated with state anxiety (p-value 0.96). Logistic regression analysis revealed that age, marital status, and education were the most predictive factors for state anxiety. These factors along with the place of residence were also predictive for trait anxiety (p-value <0.05).
Conclusion: Since these predictive factors are not amenable to change before elective surgery, identification of patients with higher anxiety levels is essential. Further studies investigating preoperative anxiety a few days prior to surgery in the Iranian population should be warranted.
Quality Improvement through Intensive Care Registries: The Value of Big Data in Clinical Decision Making
Authors: Sanaei Ali , Sepehri Mohammad Mehdi
Published: December 2019

Background: Quality of Intensive care has got more attention in case of the high cost of healthcare and the potential for harm. Poor-quality care causes high cost and quality improvement initiatives in the ICU lead to an improvement in outcomes as well as a decrease in costs. One of the crucial tools that allow physicians and nurses to monitor change in a quality improvement effort is the development of an electronic database for data collection and reporting. The objective of Intensive Care Registries is to create a high-quality registry of patients through a collaboration of academic health centers performing uniform data collection with the purpose of improving the quality and accuracy of healthcare decisions and provide a data-driven clinical decision support system for critical care medicine.
Methods: This article reviews real-world data sources in healthcare and considers registry as the main tool to address health services and outcomes research questions in critical care, and briefly describes objective, inputs and outputs of intensive care registries. As it can be comprehended from library research, the combination of patient clinical care data, quality parameters, and ICU operating costs, integrated into an electronic database, provides a valuable tool for quality improvement and overall efficiency of offered care.
Results: Using Big Data effectively within ICUs for supporting clinical decision making can lead to predict numerous diseases and help to discover new patterns in healthcare. The ability to process multiple high-speed clinical data streams from multiple centers could dramatically improve both healthcare efficiency and patient outcomes.
Conclusion: To gain this goal, developing reliable and standardized health analytics platforms as well as quality improvement processes that translate analytical results into new clinical guidelines, is recommended.
Comparing Effects of Enteral and Parenteral Nutrition in Patients Admitted to Intensive Care Units: A Systematic Review
Authors: Heydari Abbas , Keykha Aliakbar
Published: December 2019

Background: With regard to critical illness and stress, medication side effects, decreased appetite, and increased nausea and vomiting; patients admitted to intensive care units (ICUs) are at particular risk of malnutrition. Feeding behavior i.e. time and method in these patients has still remained as an unresolved issue. Thus; enteral and parenteral nutrition, with their own benefits and complications, are two commonly used methods for such individuals. The present systematic review was to compare the effects of enteral and parenteral nutrition in patients admitted to ICUs.
Methods: This systematic review investigated a total number of 1642 articles on nutrition methods in ICU patients during 2010-2019 using keywords of “enteral nutrition, parenteral nutrition solutions, parenteral nutrition, critical care outcomes, critical illness, intensive care unit, and ICU” in the databases of SID, Iranmedex, MEDLIB-ED, PubMed, Scopus, Medline, Embase, Cochrane, Web of Science, and Google Scholar; and finally, 15 articles were analyzed in relation to the research objectives.
Results: Studies indicated that patient mortality was not different in enteral and parenteral nutrition groups. The incidence rate of infectious complications was also reported higher in parenteral nutrition group. However, there was no significant difference in the incidence rate of infections in studies meeting total standards for parenteral nutrition. Besides, there was no significant difference between the duration of undergoing mechanical ventilation and hospitalization time in both groups. Furthermore, the incidence rate of hypoglycemia was higher in enteral nutrition group; but serum protein levels had much better status compared with those in parenteral nutrition group.
Conclusion: If standards for infusion are observed and provided that rates of infectious complications are reduced, patients can benefit from starting parenteral nutrition immediately after admission to ICUs in the absence of enteral method.