bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors associated with childhood tuberculosis: a case control study in endemic tuberculosis area
Authors: Zuraida Zia Faizaty , Wijayanti Siwi Pramatama Mars
Published: October 2018

Background: Tuberculosis (TB) in childreen is still considered as important public health problems in various countries, including Indonesia. Risk factors related to childhood tuberculosis is crucial to identify in order to conduct prevention effort effectively. The purpose of this research is to determine the effect of environmental health in house, contact history and nutritional status toward childhood tuberculosis.Methods: This research is an analytical observational study using case-control design, with 35 samples of the case and 35 samples of the control. Several variables such as house environment, contact history and nutritional status were obtained by questionnaire and observation in house of respondents. Data analysis was conducted using Logistic Regression test to determine correlation between independent and dependent variables.Results: This research highlighted that contact history and nutritional status were correlated with childhood tuberculosis. While house environment variables such as lighting level, floor type, house occupancy density were not related to the incidence of tuberculosis in children.Conclusions: Contact history and nutritional status were the factors which determined childhood tuberculosis in Banyumas. It is important for parents to maintain good nutritional status of their children and to avoid them from contact with tuberculosis patients.
Outbreak investigation of viral exanthem in Jharkhand, India: an eye opener for surveillance managers and vaccine policy makers
Authors: Pall Sahir , Kumar Dewesh
Published: October 2018

Background: Chicken pox outbreaks are frequent in tribal state of Jharkhand but rarely they are reported and investigated. Based on the preliminary information from field about the spurt of fever with rash cases in the inmates of a residential school, an outbreak investigation was undertaken to establish the disease outbreak and take appropriate steps of control and prevention of further transmission.Methods: The outbreak investigation using shoe-leather epidemiology was carried out in the month of March 2016 accordingly the standard steps of investigation in Chakulia block of Jharkhand, India and a fixed number of blood samples were sent to the apex medical institute of Jharkhand for its confirmation by laboratory tests. Concurrently control and preventive steps were taken to check further transmission of the viral exanthem.Results: A total of 79 cases satisfying the case definition occurred in the present outbreak and serum samples were collected from 7 patients for detection of VZV IgM antibodies by ELISA. Out of the total samples tested, five samples showed positive serology for VZV IgM. This confirmed the outbreak of Chickenpox in the KGBV, Chakulia.Conclusions: There is a desperate need of strengthening surveillance mechanism and field workers should be motivated for reporting cases timely so that the transmission of any viral exanthem may be checked at the earliest by application of control measures.
Nutritional status assessment of elderly using MNA tool in rural Belagavi: a cross sectional study
Authors: Patil D. J. , Shindhe M. M.
Published: October 2018

Background: Worldwide the elderly population gradually increasing and that will definitely pose several challenges. Malnutrition is one of the major but neglected problem in elderly. They are at risk of malnutrition due to physical, psychological, social, dietary and environmental risk factors. Malnutrition in elderly is associated with adverse health effects. Hence to study the nutritional status of elderly.Methods: The study was carried out between January 2016- June 2017. 545 elderly were included in the study. Out of the 6 subcentres, 1 subcentre (Uchagaon) was selected by simple random sampling technique and house to house survey was carried out to select eligible elderly participants in the villages of selected subcentre. Data was collected from eligible elderly by using mini nutritional assessment (MNA) tool.Results: Majority of the participants (65.1%) were between the age group of 60-69 years. 55% were females. 23.5% were malnourished, 49% were at risk of malnutrition and 27.5% had normal nutritional status.Conclusions: The present study concluded that majority of the elderly were at risk of malnutrition. There is a need of actions to improve the nutritional status of the elderly.
A study of factors affecting weight gain among tuberculosis patients under DOTS in district Amritsar
Authors: Sadana Pooja , Kaur Harpreet , Verma Vishal
Published: October 2018

Background: Wasting is a common feature in tuberculosis and treatment is aimed at achieving weight gain in pulmonary tuberculosis patients. The aims and objectives of the study were to study the extent of body weight gain during treatment and to identify the effect of different factors on weight gain among TB patients.Methods: The study was conducted on a total of 326 patients residing in the area of PHC Verka and registered with District Tuberculosis Centre, Amritsar. Weight change was assessed by taking the difference of weight at initial diagnosis and after completion of continuation phase therapy.Results: A total of 228 patients participated in the study. The mean (±SD) body weights (in kg) for the patients were 44.92±12.7 at diagnosis and 48.79±12.9 at the end of treatment. The mean (±SD) weight gain was 3.86±4.55 kgs at the end of treatment. The gain in weight at the end of treatment was associated with supervision of treatment and outcome of the TB patient.Conclusions: The findings showed that there is an association between gain in weight with supervision of treatment and outcome of the TB patient.
A study on awareness of universal precautions among house surgeons
Authors: Kulkarni Rajesh R. , Biradar Mallikarjun
Published: October 2018

Background: Health-care workers are at risk of many infections at their workplace through airborne, blood borne, fecal-oral transmission and direct contact. Universal precautions are not well understood or implemented by health care practitioners. The knowledge and understanding of UPs among HCWs in developing countries is inadequate. The study was done to assess the awareness of universal precautions among the house surgeons and knowledge about precautionary measures.Methods: The present questionnaire based cross sectional study was carried out on the house surgeons who were posted in the department of community medicine, KLE University’s J N medical college, Belagavi. A total of 136 house surgeons were interviewed. Pretested, pre designed multiple response type questionnaire were administered to them.Results: Out of 136 study participants, 118 (87%) have heard about the term universal precautions, 118 (87%) self protection against body and blood fluids. 113 (83.1%) have correctly answered about precautionary measures for internal body fluids. Disposal of sharp items, 117 (86.1%) have told puncture proof container should be used, 128 (94.1%) have answered to use gowns, face mask to avoid splashing of blood while doing procedures. and 100 (73.5%) have told to apply universal precautions even on HIV–ve patients.Conclusions: The awareness about universal precautions among the study subjects was good in some aspects but not satisfactory in many others.
A study of personal hygiene among food handlers in Panaji city, Goa
Authors: Pradhan Saili S. , Cacodcar Jagadish A. , Akarkar Nikhil S.
Published: October 2018

Background: Food is an elementary requirement for human survival. Food handlers are essential components in the link between the environment of cooking food and the prepared or served food. Food handlers with poor personal hygiene employed in food establishments could be likely sources of infection. Hence this study was undertaken to evaluate the personal hygiene among various food handlers in the city of Panaji, Goa.Methods: This cross sectional study was carried out among 227 study participants in 12 food establishments registered under corporation of city Panaji for duration of 18 months (September 2015 to February 2017). Sampling was done by stratified random sampling.Results: Out of the 227 food handlers, only 65 (28.6%) of the study participants used head caps while cooking. Only 70 (30.8%) had clean nails at the time of examination. As per the scale of scoring it was observed that majority i.e. 112 (49.4%) had fair personal hygiene, 77 (33.9%) had poor personal hygiene and only 38 (16.7%) had good personal hygiene. There was significant statistical association between the personal hygiene of the study participants and the training received in food safety.Conclusions: Personal hygiene levels among the food handlers were found to be sub-standard indicating essentiality of creating awareness among the food handlers regarding importance of maintaining good personal hygiene and food hygiene.
Association between sociodemographic status and pulmonary tuberculosis: a case control study
Authors: Ratta Amandeep Kaur , Kubde Sanjay S. , Patle Rupali
Published: October 2018

Background: The case control study, an analytical approach of epidemiology is a very important tool to detect the strength of association of risk factors with a disease. The objective of the study was to evaluate association between sociodemographic profile and pulmonary tuberculosis.Methods: This was case control study carried out in tertiary care hospital and urban field practice area from July 2010 to November 2012. Total 150 cases, 150 hospital control and 150 community controls were included in the study according to predefined inclusion and exclusion criteria. The study participants were interviewed and examined according to the preformed and pretested proforma in the respective OPDs.Results: Mean age of cases was found to be 35.94 years and those of hospital controls and community controls were 36.12 and 36.08 years respectively. Maximum cases and controls were Hindu, married, from urban area and belongs to upper lower socioeconomic class. Low socioeconomic status was found to be associated with risk of pulmonary tuberculosis and this association was statistically significant (OR=4.45, 95% CI 2.53–7.82, p<0.0001).Conclusions: Low socioeconomic status showed significant association with pulmonary TB with both the control groups.
Use of Kirkpatrick’s model for evaluation of reaction and learning of participant of national level workshop on linear regression
Authors: Chatterjee Kunal , Yadav Arun Kumar , N. Ananad , Malik Awadesh , Kotwal Atul , Kunte Renuka
Published: October 2018

Background: Workshop is a very useful learning method for increasing the understanding and knowledge of participant. We conducted a workshop and evaluated it using Kirpatrick's model for evaluation.Methods: A national level workshop was conducted for MBBS and MD students. Feedback about the reaction of the participant was taken at the end of the participant and also a pre-test and post-test assessment was done.Results: Out of total 28 participants 19 (67.9%) were females and 9 (32.1%) were males. All (100%) attendee said that they liked, enjoyed and considered the training relevant. For learning evaluation the pretest score and posttest score were taken. The average pretest score was 4.1 (SD=2.1). The average posttest score was 6.5 (SD=2.1). The difference was statistically significant (p=0.0002). On question of rating of overall conduct of the workshop 11 (39.3%) rated the workshop excellent, 13 (46.4%) good and 4 (14.29%) did not answer the question. On asking the question on the topic on future workshop they would like to be conducted 16 (57.1%) said multiple linear regression, 12 (42.3%) each on logistic regression and met-analysis, 09 (32.1%) on cox proportional hazard ratio, 3 (10.7%) on SPSS, and 01 (3.5%) on infectious disease modeling.Conclusions: Evaluation of workshop is important for continuing improvement of teaching learning process. Participant positive feedback and objective evidence of improvement in learning proves effectiveness of the workshop. Kirpatrick’s offers a model for various stages of learning process and can be used for assessment of workshops.
Blast injury to the ear: management and long term follow up at a tertiary care hospital in a terrorism affected area of North India
Authors: Kumar Subodh , Mishra Awadhesh Kumar , Mallick Ajay , Sethi Ashwani
Published: October 2018

Background: A large proportion of blast victims suffers ear injuries; however, these injuries are often overlooked.

Methods: We assessed 411 blast victims to detect ear injury employing detailed history, otological examination, pure tone audiometry, auditory steady state response and distortion product otoacoustic emissions. TM perforations were managed by thorough cleaning of ear by suctioning, edges approximation and gelfoam splinting in group A and only suctioning in group B. Prednisolone in tapering doses was prescribed for managing hearing loss in all except those in whom it was contraindicated.  

Results: Out of 411 blast victims, 228 (55.47%) had aural trauma. All cases were males (being serving soldiers) between ages of 21 and 57 years. (Mean 37.77 years, SD 10.38). 285 ears had a perforated TM. Of these, 145 were assigned to group A while 140 were in group B. There was no significant difference in spontaneous healing of perforation between the two groups but at 5 years’ follow up group A had significantly higher number of unscarred, healthy TMs than group B (Z score=2.2111, p=0.0271). Mean pure tone average was 51.16 dB (SD 8.79 dB) at presentation and 38.91 dB (SD 7.86 dB) at 5 years. Recovery of SNHL component was significantly better in steroid treated patients.

Conclusions: Edges approximation and gelfoam splinting helped in reducing scarring of TM on healing, on long follow up. Steroid treated group showed better recovery of hearing loss.
Efficacy of mitomycin c in endoscopic dacryocystorhinostomy
Authors: Shinde Vinod , Unnikrishnan Anju , Fatma Shad , Thomas James
Published: October 2018

Background: Endoscopic dacryocystorhinostomy is a procedure done to drain the lacrimal sac due to post saccular lacrimal obstruction. The most common cause of failure of dacryocystorhinostomy is blockage of ostium created in lacrimal sac. Various methods are employed to prevent the blockage such as stenting, mitomycin C and steroidal nasal sprays. In this study we evaluated the efficacy of mitomycin C in reducing the stomal closure following dacryocystorhinostomy.

Methods: Fifty patients who were diagnosed with chronic dacryocystitis due to nasolacrimal duct obstruction were chosen for the study. They were randomly divided in to two groups. In group I 25 patients under went endoscopic dacryocystorhinostomy with intraoperative mitomycin C application and in group II 25 patients underwent endoscopic dacryocystorhinostomy without application of mitomycin C. Patients were followed up at the end of one week, three weeks, three months and six months. Surgical success was evaluated objectively at the end of six months.  

Results: The success rate of endoscopic dacryocystorhinostomy with use of mitomycin c was 86% in group where mitomycin c was used and 62% in group where mitomycin c was not used.

Conclusions: Mitomycin C is a safe drug which can keep the stoma created patent and reduces the chance of recurrence following endoscopic dacryocystorhinostomy.
Correlation of plasma lipid levels and histopathological grading in patients with oral squamous cell carcinoma and its pre-cancerous lesions
Authors: Singh Mohini , Singh Abhishek Bahadur , Singh Abhijeet , Agarwal S. P.
Published: October 2018

Background: Lower levels of lipid in proliferating tissues and in blood compartments may occur due to ongoing process of oncogenesis. The evidence regarding hypolipidemia as a predisposing factor for malignancy is scarce. Therefore, this study was undertaken to study alteration of plasma lipid levels in patients diagnosed with oral squamous cell carcinoma (OSCC) and its oral pre-cancerous (OPC) lesions and also to compare the plasma lipid profile in different grades of OSCC.

Methods: A single centre prospective cross sectional study was carried out among 150 consecutive patients of OSCC and OPC lesions. The diagnosis of all lesions was confirmed histopathologically and grading was also done for each lesion based on degree of differentiation and keratinization of tumour cells. Serum total cholesterol, HDL, TG, LDL was estimated by using semi-automated chemical analyzer. The lipid levels were compared by using unpaired t-test between two strata whereas one way analysis of variance (ANOVA) with Tukey’s post-hoc tests was used among more than two strata.  

Results: Total cholesterol, TG, HDL, and LDL were significantly reduced in OSCC and OPC groups when compared with the reference values. Serum TC, LDL and HDL levels were found to be decreased with the loss of differentiation in histological grading but with no statistical significance.

Conclusions: It can be inferred that there is an inverse relationship between the serum lipid profile values of TC, HDLC, TG, LDL and OSCC as well as OPC patients. The lower serum lipid status may be considered a useful indicator for initial changes occurring in neoplastic cells.
Spectrum of premalignant oral lesions in rural North Indian population at a tertiary care hospital
Authors: Faiz Syed Mohd. , Agarwal Ekta , Bhargava Anuja , Varshney Prasoon , Patigaroo Abdul R. , Rizvi Darakhshan
Published: October 2018

Background: The objective of the study was to study the spectrum of premalignant oral lesions in rural North Indian population at a tertiary care hospital.

Methods: A total of 340 patients with oral lesions for more than 2 weeks were enrolled in the study. Patients with proven malignancy, white patch in the oral cavity which can be scrapped off, e.g. oral candidiasis and urban patients were excluded. Biopsy specimen was obtained from all the patients and evaluated histopathologically. Site, nature and type of oral lesion were determined. Demographic data and exposure to different risk factors was also noted. Findings were correlated using Chi-square test.  

Results: Premalignant lesions were seen in 191 (56.18%) cases. They included leukoplakia (n=87; 45.5%), OSMF (n=62; 32.5%), Erythroplakia (n=18; 9.4%), lichen planus (n=15; 7.9%), melanoplakia/ melanosis (n=8; 4.2%) and DLE (n=1; 0.5%) respectively. Most common sites affected by premalignant lesions were buccal mucosa (n=173; 90.6%), retromolar area (n=42; 22%). Majority of patients with premalignant lesions were aged 26-50 years (78.5%), males (62.8%), farmers/labourers (56%) and illiterate/educated upto primary level (57.1%). Almost all the patients had two or more adverse oral habits with areca nut chewing being most common (69.6%) followed by tobacco chewing (66%) and smoking (60.2%) respectively. Majority had these addictions for >5 years (66%).

Conclusions: Leukoplakia and OSMF dominated the premalignant lesions in rural patients having low education and high prevalence of adverse oral habits for prolonged duration.

 
A study on newer technique for reconstruction of pre auricular soft tissue defect with temporo-parietal fascia flap (Khabeer’s flap)
Authors: Khabeer Ahmed Abdul , Ivaturi Phani Bhushan , Jadhav Y. L. Ravi , Dasoju Venkatesh
Published: October 2018

Background: A pre auricular sinus is a congenital abnormality, which occurs due to failure of fusion of primitive tubercles from which pinna develops. Pre auricular sinuses are usually asymptomatic and when symptomatic present usually as discharging sinus, associated with abscess formation anterior to root of helix. Symptomatic pre auricular sinus requires surgical excision to prevent recurrence and reinfection. Treatment of pre auricular sinus by conventional methods usually presents a dead space due to removal of sinus tract. The present study is to overcome this defect by a superficial temporalartery based temporo-parietal fascia flap or Khabeer’s flap. The objective of this study is to describe a novel technique for excision of pre auricular sinus using supra auricular approach and using a temporo-parietal fascia flap for covering the defect created after excision of pre auricular sinus.

Methods: A prospective study was carried out in Department of Otorhinolaryngology, Gandhi Medical College/Gandhi Hospital Secunderabad from 2014 to 2017. All the patients admitted with symptomatic pre auricular sinus underwent surgical excision by supra auricular approach and at the end superficial temporal artery based flap was placed to fill the dead space.  

Results: A total of 20 pre auricular sinuses were operated during the study period. There were no recurrences, no collection of serous fluid and no cosmetic defect post operatively in any of the study subject.

Conclusions: The newer approach was found to be safe as it does not confer any complications post operatively and can be used for management of pre auricular sinus.
Synovial sarcoma masquerading as thyroglossal cyst carcinoma
Authors: Manohar M. Babu , Vikram P. S. J. , Rao R. Soorya
Published: October 2018

Synovial cell sarcoma is very rare in head and neck. It is usually seen in the extremities in close relation to the bursae and joints. In head and neck, most of the cases reported are in the retrohyoid, parapharyngeal and retropharyngeal areas. Reporting the case of a 18 year old man who presented with signs and symptoms of thyroglossal cyst. Radiological findings were suggestive of a haemorrhagic thyroglossal cyst or a cystic neoplasm. Frozen section revealed a malignant spindle cell neoplasm of mesenchymal origin. A Sistrunk operation was done. Histopathological and immunohistochemical analysis yielded a diagnosis of monophasic synovial sarcoma. Patient underwent intensity modulated radiotherapy according to tumor board decision. Follow up PET Scans were negative. We are reporting this case to highlight the rarity of the condition and the high index of suspicion required to diagnose such a synovial sarcoma in this area. Treatment should be aimed at complete surgical resection of the tumor and appropriate adjuvant radiotherapy.
A life-threatening case of drug-induced agranulocytosis
Authors: Dutta N. N. , Datta Dhruba Jyoti , Koduru Praneeth Kumar , Rajpurohit Megha
Published: October 2018

A 26 year old hyperthyroidic female with prescribed carbimazole intake from 1 month presented with intermittent low grade fever, sore throat and dysphagia since last 15 days. She appeared very weak and pale. On clinical evaluation, TLC was found very low and DLC showed decreased neutrophil percent. Carbimazole was suspected as the cause and immediately stopped. G-CSF (Filgrastim) was started along with other conservative management and TLC started to rise gradually. On 12th day from admission, she developed acute pain abdomen and diagnosed as having intestinal perforation for which she was immediately operated but unfortunately expired 6 hours after surgery. Drug-induced agranulocytosis can be so fatal that if not diagnosed and treated early, can lead to death due to its widespread rapid systemic derangement. 
Functional and radiological outcome of proximal femoral nailing versus dynamic hip screw in unstable intertrochanteric femur fractures
Authors: Parikh Kushal Nikhil , Parmar Chintan , Patel Mitesh , Shah Shalin Bharat
Published: October 2018

Background: Intertrochanteric femur fractures account half of the hip fractures in elderly, the other majority being neck of femur fracture. 35-40% of intertrochanteric are unstable (Tronzo’s classification type 3, 4 and 5). The dynamic hip screw (DHS) has achieved widespread acclaim in the last few years and is currently considered to be the standard device for outcome assessment. Though, the DHS has been shown to produce good results, but complications are frequent, particularly in unstable inter-trochanteric fracture. The advantage of Proximal Femur Nailing fixation is that it provides a more biomechanically stable construct by reducing the distance between hip joint and implant. The goal of this study is to assess the clinical and radiographical outcomes of the DHS (load bearing implant) and PFN (load sharing implant) for the treatment of Intertrochanteric hip fractures.

Methods: We assessed the same in 52 cases of unstable femur fracture 26 operated with DHS and 26 with PFN and followed up with sequential radiographs for radiological union and sequential interview with Harris hip score calculation for functional outcome assessment.

Results: Patients operated for unstable intertrochanteric femur fracture with Proximal femoral nailing had better Harris hip scores (excellent 4, good 14) compared to dynamic hip screw group (Excellent 6, good 5) and earlier weight bearing (At 18 weeks, 100% in PFN compared to 65.5% in DHS). PFN has lesser incidence of postoperative complications (15% in PFN compared to 38% in DHS).
Conclusions:The proximal femoral nail has better functional outcome in terms of Harris hip score and early radiologic union in unstable intertrochanteric fractures of femur. 
 
Functional outcome in reconstructions with fibula autograft in tumors of appendicular skeleton
Authors: Philipose Joji Joshua , Jayachandran Renjit Kumar
Published: October 2018

Background: Resection by a limb-sparing surgery and restoration of bone and soft tissues makes a successful limb salvage. Several reconstructive procedures that maintain limb length and provide acceptable cosmetic and functional results include endoprosthetic reconstruction, use of allografts and/or autografts like vascular or avascular fibula graft. The objective of the study was to assess and compare the preoperative and postoperative functional and radiological outcome in patients treated with wide resection of tumors of the appendicular skeleton followed by reconstruction with fibula graft.

Methods: This retrospective and prospective comparative study was conducted in 17 patients in Amrita Institute of Medical Sciences, Kerala. The patients were followed up for a minimum of 9 months ranging to 65 months. Functional and radiological assessments were done. Wilcoxon signed ranks test was done to assess significant differences between preoperative and postoperative functional scores. The SPSS software was used to analyze the data collected.

Results: There was statistical significance as well as improvement in the postoperative functional scores (p=0.004) when compared to the preoperative status. There was no significance (2 tailed test) in postoperative functional scores between vascular and avascular fibula graft (p=1.000).

Conclusions: Fibula grafting after resection of appendicular tumors offers a wonderful technique in filling bony defects. It provides good functional outcome and better bony union. Even though the postoperative outcome is significant, there is no significant difference between vascularized and avascular fibula in terms of functional outcome, bony union and graft hypertrophy.
Comparison of functional outcome of ultrasound guided glenohumeral and subacromial methylprednisolone acetate injections in frozen shoulder
Authors: Chopra Mayur , Vasdev Attique
Published: October 2018

Background: Frozen shoulder also known as adhesive capsulitis is a common cause for limitation of motion and pain of the shoulder joint with an incidence of 2-5% in the general population. The aim of the study was to assess the functional outcome of ultrasound guided glenohumeral and subacromial methylprednisolone acetate steroid injection in patients with frozen shoulder.

Methods: 120 patients with frozen shoulder were randomly divided into 2 groups according to site i.e. glenohumeral and subacromial. Ultrasound-guided methylprednisolone acetate (80 mg) injection was administered. At follow up pain was being measured using VAS scale and functional outcome was measured using the DASH score and Constant score at day 0, 1 followed by 1, 3, 6 weeks and  at 3 months.

Results: The VAS score of glenohumeral decreased from 6.5±0.95 to 2.25±0.86 at 3 months and in subacromial it decreased from 6.37±1.07 to 2.3±0.72. DASH score in glenohumeral group decreased from 66.95±9.9 to 27.45±9.31 at 3 months and in the subacromial group it decreased from 67.52±10.65 to 26.81±11.14 at 3 months. In glenohumeral group Constant score increased from 46.63±7.18 to 72.66±7.38 at 3 months and in the subacromial group it increased from 47.92±6.91 to 70.28±6.97 at 3 months.

Conclusions: Spontaneous recovery does not necessarily occur even after a long period, so we recommend that these modalities should be offered to all patients with frozen shoulder and it would be of more value if carried out at an early stage of the disorder.
Managing lateral end clavicle fracture at a tertiary level hospital in India
Authors: Solunke Swaroop , Patole Vivek
Published: October 2018

Background: With numerous methods and recommendations for managing fracture of lateral end of the clavicle, it always creates a clinical dilemma for the treating surgeon. This study is aimed to compare the functional outcome in patients with lateral end clavicle fracture treated either with operative and non-operative modalities.

Methods: This non-randomized comparative study was conducted at Department of Orthopedics, DY Patil Medical College, Pimpri between September 2017 till June 2018, in which all patients with lateral end clavicle fracture were included. Patients were managed either non-operatively or with precontoured locking compression plate was fixed with 4 mm locking screw or 3.5 mm cortical screw. At the final follow up (at least one year) patients’ functional outcome was assessed using the Constant and Murley score.

Results: A total of 57 patients were included in the study and 93% of the patients with operative management and 66% with non-operative treatment had a union time of 8 weeks or less. Out of the 27 patients who underwent non-operative treatment, three had malunion, two had non-union and five had deformity. Based on the Constant and Murley score, 27% of the patients in the operative group had an excellent outcome, and in the non-operative group, 8% had excellent functional outcome. The functional outcome was significantly better in the operative group (p=0.034).

Conclusions: A better understanding of the risk factors for nonunion would help us to make decision between operative and nonoperative treatment. Randomized trials comparing the operative and non-operative treatments would help in understanding the merits of one method over other.
Split hand/foot malformation with longitudinal deficiency of tibia: novel rehabilitation approach of a rare syndrome
Authors: Sahoo Pabitra Kumar , Sahu Mamata Manjari , Das Sakti Prasad
Published: October 2018

Background: Split hand/foot malformation with longitudinal deficiency of tibia (SHFLD1) is an extremely rare congenital anomaly, even rarer are the descriptions in the literature of suitable techniques of treatment. Most of the literature available are case reports, based on genetic studies. This study highlights on functional management rather than anatomic correction of deformity. A clinician may not come across a patient with such a rare congenital disorder during his entire career.

Methods: On retrospective review of hospital record from July 2008 to July 2018, we observed 5 cases of tibial deficiency associated with split hand and or split foot anomalies and diagnosed as SHHLD syndrome. Clinical and radiological analysis was done to plan out surgical and rehabilitation protocol for individual cases.

Results: As per Flatt’s grouping of split hand, 3 limbs (37.5%) were group-1 type, 3 limbs (37.5%) of group-2 type and group-3 type was seen in 2 limbs (25%) of a patient with bilateral involvement. With respect to Jone’s radiological classification system, 4 limbs (57%) were of type Ia, 2 limbs (29%) were having type IV deformity and 1 limb (14%) was with type II deformity. One case agreed for amputation was fitted with above knee prosthesis and another one with custom designed bend knee prosthesis. Eldest case was rehabilitated with tricycle and modified orthosis. Surgical correction was tried in one case.

Conclusions: Functional rehabilitation instead of anatomic correction should be tried at late presentation. Cleft closure should be done before development of functional adaptability.
Role of tourniquet in post-operative pain after total knee replacement surgery: a case control study
Authors: Rai Mayur , Mohapatra Amlan , . Radhesh , Bhandary Bhaskar
Published: October 2018

Background: Intraoperative use of tourniquet to double the systolic blood pressure during total knee replacement (TKR) is used commonly for maintaining bloodless field. The aim of this study is to understand the role of tourniquet in post-operative pain after a TKR.

Methods: Using a case-control design we enrolled 20 patients who underwent TKR with intraoperative use of tourniquet and 20 age and gender matched controls who underwent TKR without the use of tourniquet, from November 2014 till May 2016 in the Department of Orthopedics at the A.J. Institute of Medical Sciences, Mangalore. Baseline demographic information was collected for all patients and pain was measured using simplified verbal scale (SVS). Statistical analysis was performed using unpaired t-test and ANOVA.

Results: Average age of cases and controls was 62.8±7.47 and 63.1±7.21 years respectively, with no significant difference between them. The average SVS score on Day 1 was significantly different between the cases and controls, p value 0.0032. On Day 2 and Day 3 SVS scores were not different significant. For cases the mean difference was 0.77 and -1.3 when we compared scores of SVS on Day 2 and Day 1. For control subjects mean difference was 0.939 and 0.760 when we compared SVS scores on Day 3 and Day 1.

Conclusions: We found significantly lower post-operative pain upto Day 3 in patients who underwent TKR without a tourniquet.

 
Incidence and management of incidental durotomy during thoracic and lumbar spine surgeries: a retrospective review in a tertiary care centre
Authors: Solomon Prince , Murugan Yuvaraja , Arockiyaraj Justin , Amritanand Rohit , Krishnan Venkatesh , Sundararaj Gabriel D.
Published: October 2018

Background: Incidental durotomy is among the most common complications of spine surgery with reported incidence ranging from 1.7% to 16%. Various management options including primary repair, fascial or fat graft, epidural blood patch, fibrin glue sealant, etc., have been proposed. The purpose of this study is to evaluate the incidence of incidental durotomy and the efficacy of different management options during a five year period at a tertiary care center.

Methods: All patients who underwent various surgical procedures in thoracic and lumbar spine from January 2006 - December 2010 in our centre were retrospectively reviewed. Data on demographics, primary diagnosis, associated co morbidities, details of surgical procedure, training level of the operating surgeon, details of the incidental durotomy, the treatment, complications and the postoperative stay were recorded.

Results: Of 2270 patients, 1401 patients were included in the study. The incidence of incidental durotomy was 3.49% (49 patients). We found a very high incidence of 33.33% incidental durotomies among patients who underwent revision procedures as compared to 3.23% for patients who underwent primary surgeries. 5.10% of incidental durotomies were caused by fellows under training, 4.27% by junior consultants and 2.92% by senior consultants. Of 49 durotomies, complication were 5 cases of intracranial hypotension, 5 postoperative neurological deficits, 2 deep wound infection, 2 pseudomeningocele and 1 meningitis.

Conclusions: The risk of incidental durotomy in thoracolumbar surgeries is high in revision surgeries and when performed by fellows in training. Intraoperative identification and primary repair with suturing or sealant reduces postoperative complications.
A prospective study on results of bacterial culture from wound in type III compound fractures
Authors: H. Ashwin , Thomas George
Published: October 2018

Background: Open fractures still represent a major challenge for the treating surgeon. Sound knowledge of the bacteriological epidemiology and antimicrobial susceptibility helps to prevent complications. Our aim is to study about the common bacteria causing open fracture infection and their antibiotic sensitivity in patients who are admitted in the department of Orthopedics, Government medical college, Kottayam.

Methods: A prospective study on 130 patients with type III open long bone fractures were studied for infection during study period of June 2016 to July 2017. After initial debridement and at third day during follow up wound inspection, swabs were taken from wound site. Swabs were send for microscopic examination, culture and antimicrobial susceptibility testing.

Results: Out of 130 type III open long bone fractures, 7.7% were having day 0 infection and 25.4% were having day 3 infection. 19.2% of patients developed infection from day 3 onwards. Staphylococcus aureus (37.1%) was the most commonly isolated bacteria from wound. Other organisms isolated were Acinetobacter, Pseudomonas, Klebsiella, E coli, Enterococcus, Streptococcus and Enterobacter. 100% of diabetic patients developed infection on day 3. Gentamicin, amikacin doxycycline, ciprofloxacin, vancomycin, piperacillin + tazobactum and cefoperazone + sulbactum were found to be effective against isolated organisms.

Conclusions: Gram positive Staphylococcus aureus was found to be the most common cause of wound infection in type III open fractures. An early adequate wound debridement, proper antibiotic therapy and aseptic post-operative wound care are essential for wound healing and fracture union in an open fracture.
Devastating complications of intravenous line/drugs extravasation in hand
Authors: Maharaj Ramesh Chandra , Sethy Ram Chandra , Chand Dillip Kumar , Mishra Nihar Ranjan , Panigrahi Sibasish
Published: October 2018

Background: Peripheral intravenous (IV) line insertion for treatment purpose is a common practice and a very simple procedure in hospitals undertaken worldwide. These intravascular lines are crucial in resuscitation, allow vital medication to be administrated, and can be used to monitor the patients vital parameters. Thus the complications due to it like phlebitis, leaking or extravasation are usually we come across. This study reviews some serious complications of peripheral intravenous infusion in hand and discusses the treatment approaches and its an endeavour to provide information regarding healthy practise of IV line insertion, recognising complications at the earliest and treat them accordingly.

Methods: In our study, we have received 30 cases with devastating complications due to post IV line extravasation in hand in which most of them intervened surgically. Though these complications most of the time subside of its own for which these are frequently underestimated but sometimes there may be serious enough to endanger the limb at risk and threaten the life with devasting complications like septicaemia.

Results: In our series, we have got abscess or necrotising fasciitis in (17%), compartment syndrome with VIC (10%), Gangrene (13%), cellulitis (30%), non-healing ulcer (20%), suppurative thrmbophlebitis (10%) etc.

Conclusions: Hence, this study should encourage the health personnel to have good knowledge about the drug to be used, to practice healthy technique of IV line insertion, to diagnose the complication if any, at a earliest possible time and if the complication is already established, then they should not hesitate to take the help of proper speciality dealing with hand. 
Outcome assessment of two stage reduction and fixation in neglected trans scaphoid peri lunate fracture dislocation
Authors: Dayma Ratan Lal , Temani Rahul , Modi Prashant , Yadav Vijay Prakash , Jain Jitesh
Published: October 2018

Background: Perilunate instability is a type of carpal instability complex. Perilunate injuries occur after high-energy traumas to the wrist or falls on the outstretched hand.

Methods: The hospital based prospective study was held in the department of Orthopaedics, SMS medical college and Hospital, Jaipur from April 2016 to November 2017. It included 25 cases of neglected trans scaphoid peri lunate fracture dislocation treated in 2 stages surgical procedures.

Results: Median nerve was involved in 6 (24%) patients. Pain was also graded as subjective pain. Most of patients had pain free wrist at 1 year follow up post surgery while 2 patients had pain on routine activity, 5 patients had pain on sternous activity and pain was permanent in 1 patient. Mean scapholunate and radiolunate angles were 54 degrees (range 40 to 60 degrees) and 9.8 degrees (range 5 to 15 degrees) on the immediate postoperative radiographs and 54.8 degrees (range 40 to 65 degrees) and 10.6 degrees (5 to 20 degrees) at 1 years follow up. Mild degenerative changes were seen in the radiocarpal joint in 3 patients and in midcarpal joint in 4 patients one patient had both radiocarpal joint arthritis and midcarpal joint arthritis two patients developed superficial pin tract infection.

Conclusions: On the basis of our study we finally conclude staged reduction should be considered for neglected trans scaphoid peri lunate dislocations.
A randomized, open label, comparative, five-arm, controlled study evaluating the benefit and tolerability of oral superoxide dismutase combined with gliadin as add-on neutraceutical therapy with standard therapy in Indian patients with melasma
Authors: Vedamurthy Maya , Humbert Philippe
Published: October 2018

Background: Melasma management is often difficult and unsatisfactory, and there is need to explore newer modalities for melasma treatment. Disruption in antioxidant balance occurs in melasma. Superoxide dismutase (SOD) is a cellular antioxidant and restores this balance. Our hypothesis is that the oral SOD-Gliadin can replenish the SOD stores in body and quench the ‘reactive oxygen species’-induced damage in melasma.

Methods: A randomized, open label, single centre, comparative, five arm study was conducted in 90 patients with facial mixed melasma, for 12 weeks to evaluate the efficacy, safety and tolerability of two regimens (BD & OD) of oral SOD as add-on treatment with triple combination cream in melasma patients compared with two regimens (BD & OD) of beta-carotene (BC) and placebo. Primary outcome measure was improvement in Melasma Area and Severity Index (MASI) score, and secondary outcome measures were quality of life score, patient satisfaction score, global assessment by investigator and patients. Pair-wise comparisons were performed on adjusted mean using SAS v9.1.3.

Results: There was significant reduction in MASI score with add-on treatment with SOD BD (67.97%) as compared to BC BD (43.04%), BC OD (33.68%) and placebo (22.60%). There was significant reduction in MASI score with SOD OD (51.93%) as compared to placebo (22.60%). The subjective assessments reported by patient and evaluator also ranked SOD BD as a superior regimen.

Conclusions: By inhibiting oxidative stress, nutraceutical SOD-Gliadin Combination offers significantly better efficacy and higher treatment satisfaction as add-on treatment compared to beta-carotene in Indian patients.
Prevalence of vitiligo at the tertiary health care centre, Mc Gann’s teaching district hospital Shivamogga
Authors: Anupama Y. G. , Bhaktha Geetha , Manjula B. , Dadapeer H. J. , Govinda Swamy K. S. , Jyothi R. S. , Halesh L. H.
Published: October 2018

Background: Vitiligo is a common depigmentation disorder involving persons of all ages and both genders uniformly throughout the races. The highest incidence of vitiligo has been recorded in Indians from the Indian subcontinent, along with Mexicans and Japanese.

Methods: Patients visiting Dermatology OPD were recruited for the study at the tertiary health care centre, Mc Gann’s teaching district hospital Shivamogga. Data regarding health-related status and other factors were collected between May 2016 and October 2017.

Results: Among the potential candidates, 8.6% of our study population was with the positive family history of vitiligo and 50.9% were females and 49.1% were males. Patients with age from 27-36 years were found to be affected mostly. The most common site of onset was the lower limbs (30%) followed by head and neck (25.4%) with the commonest pattern to be of acro-facial type.

Conclusions: This study suggests that local epidemiological behavior of vitiligo was not the same across different regions. Variations did exist and may possibly be due to certain clinico-epidemiological parameters of Shimoga viz., prevalence of associated diseases and its extent of involvement.
Bone Resorption of the Jaws and Occlusal Disturbances in Parry-Romberg Syndrome
Authors: Mendez Luis Alberto , Martinez Ricardo , Briones Alejandro Manuel , Sosa Luis Ricardo
Published: October 2018

Parry – Romberg Syndrome is a very rare condition with a very low prevalence. Therefore, it is important to report particular cases that will continue helping the medical community with the identification of such condition. We present a case of a young woman worried because she has observed a decrease in size of one side of her face as well as other symptomatology.
Role of Nutritional Supplementation with Vitamin B12 and Folic Acid on Serum Homocysteine Levels of Deep Vein Thrombosis
Authors: Kharb Simmi , A Khandelwal , K Singh , MG Vashist
Published: October 2018

Deep vein thrombosis is a common vascular disorder and association of Homocysteine with DVT is known. Evidence of decrease B12 and folic acid levels in DVT with Hyperhomocysteinemia has also been reported. Scanty data is available regarding role of folate and vitamin B12 on Homocysteine levels in DVT patients. The present study was undertaken in 100 patients. Study group comprised of 50 patients who had clinical features suggestive of DVT and 50 patients, who did not have clinical features suggestive of any venous or arterial disorder, were labelled as control group. All the patients of study group were given vitamin B12 and folic acid treatment along with standard treatment of DVT. Serum Homocysteine, folate, vitamin B12 were measured in all the patients in both the groups and estimated by chemiluminescence technology. After 12 weeks of vitamin B12 and folic acid therapy, serum Homocysteine levels, folic acid levels and vitamin B12 levels of study group were again estimated. The collected records and data was analysed statistically by Student t-test and Chi-square test. Mean Homocysteine level in study group was significantly higher as compared to control group (19.63 ± 19.14 µmol/mL vs. 7.0 ± 4.94 µmol/mL). Mean Homocysteine levels before treatment were 19.63 ± 19.14 µmol/mL and after treatment they were significantly reduced. Hyperhomocysteinemia is a risk factor for deep vein thrombosis. Folic acid and B12 therapy reduced the level of Homocysteine suggesting that this may decrease the chances of recurrence of DVT.