Acute ankle injuries: association between sprain severity and ancillary findings

ABSTRACT Objective To correlate the significance of osseous, chondral, tendon, and ligamentous injuries with anatomical variations in low-grade versus high-grade acute ankle sprains. Methods We retrospectively identified the magnetic resonance imaging findings of acute ankle sprains (<15 days). Participants with a history of previous sprains, arthritis, tumors, infections, or inflammatory conditions were excluded. Images were independently evaluated by two musculoskeletal radiologists and assessed for osseous, chondral, tendon, and ligamentous injuries and anatomical variations. Participants were divided into low-grade versus high-grade sprain groups, according to the presence of a complete tear in at least one component of the lateral ligament complex. Results The final study group comprised 100 magnetic resonance images (mean age, 36 years), the majority of males (54%), the right ankle (52%), and a mean sprain duration of 5 days. Participants with high-grade sprains presented with increased rates of medial malleolus edema (p<0.001), moderate and large articular effusions (p=0.041), and shorter calcaneonavicular distance (p=0.008). Complete tears of the anterior talofibular ligament and calcaneofibular ligaments were observed in 100% and 51.2% of the participants in the High-Grade Group, respectively. The deltoid ligament complex was partially torn in this group (55.8% versus 8.8%, p<0.001). Extensor tendon retinaculum lesions occurred significantly more frequently in this group (41.9%) compared to the overall study population (23%) (p<0.001). Conclusion Participants with high-grade ankle sprains presented with shorter calcaneonavicular distances and increased rates of medial malleolus edema, deltoid complex partial tears, extensor retinaculum lesions, and articular effusion.

Health status of tribes of Uttar Pradesh with special reference to health-seeking behaviour of uncharted Tharu tribe: A mappingreview

Background & objectives: The tribal population in India is considered as one of the vulnerable groups with respect to their achievements in health and other developmental issues. In this context, this mapping review attempted to understand the health profile of the Tharu tribal community residing in the northern State of Uttar Pradesh, India through literature mining. Tharu tribe is one of the indigenous groups living in the Terai plain on the Indo-Nepal border. In 1967, this tribe was documented as a Scheduled Tribe by the Government of India. The present review aimed to map the health-seeking behaviour of the Tharu population and review other factors pertaining to their health such as socioeconomic, developmental, employment, education, etc. Methods: Online data search was carried out on PubMed and Google Scholar using search terms ‘Tharu’ AND ‘India’. In addition, official reports avaibale in public domain and grey literature was also searched. Results: Twenty seven studies including reviews, articles, books/book chapters were evaluated along with 13 reports (including reports from government organizations and grey literature) were retrieved and analyzed. Of the 27 published reports, 16 were found relevant to Tharu tribe in India. A total of 29 (16 articles + 13 reports ) were included in this review. Interpretation & Conclusions: This mapping review highights the health seeking behaviour of the Tharu tribe in India that can help inform future interventions to improve the health status of the Tharu tribe as well as other aspects of their development.

Gas Under Right Hemidiaphragm: A Rare Presentation of Unruptured Liver Abscess

A perforated liver abscess mimics hollow viscus perforations. It may be accompanied by pneumoperitoneum and peritonitis. A hollow viscus perforation appears to be the most common cause of gas under diaphragm. In about 10% of the cases, it can be due to rare abdominal and extra-abdominal causes. One of the causes could be intra-abdominal infection caused by gas-forming organisms. We are reporting a rare case of pneumoperitoneum resulting from an unruptured liver abscess in an old male with no comorbidity. An unruptured pyogenic right lobe liver abscess in a 70-year-old male was accompanied by X-ray flat plate abdomen features suggestive of free gas under the right hemidiaphragm. Culture of the pus drained from liver abscess grew Klebsiella sensitive to piperacillin and tazobactam, and antibiotic treatment was administered.

Incidence of adhesive capsulitis of the shoulder during the beginning of the COVID-19 pandemic

ABSTRACT Objective Adhesive capsulitis is an inflammatory disease of the joint capsule, clinically manifested as pain, stiffness, and dysfunction of the shoulder. We subjectively observed an increased incidence of adhesive capsulitis, and raised the hypothesis that adhesive capsulitis was more frequent in magnetic resonance imaging examinations performed during the COVID-19 pandemic as compared with examinations prior to this period. Methods Data from medical records and magnetic resonance imaging of the shoulder presenting typical imaging findings of adhesive capsulitis, performed in our organization from March to June 2020, were evaluated and compared with data and imaging from the same period of the previous year. To this end, an organizational business intelligence tool called "search reports" was used, searching for the term "adhesive capsulitis" in the radiological report, results were tabulated, and corresponding magnetic resonance imaging exams were analyzed. Results Our search found a total of 240 and 1,373 cases of adhesive capsulitis in the 2020 and 2019 periods, respectively. The mean age of patients was 53.9 years in the 2020 group and 49.9 years in 2019 (p<0.001). Magnetic resonance imaging findings were positive for adhesive capsulitis in 40 out of 240 shoulders (16.7%) in the 2020 group versus 127 out of 1,373 shoulders (9.2%) in the 2019 group. This difference was statistically significant (p=0.001). Conclusion Our study findings suggest a relative increase in the proportion of magnetic resonance imaging findings suggestive of adhesive capsulitis cases during COVID-19 pandemics based on data from our organization.

Pelvic incidence and osteitis pubis in professional soccer players / Incidência pélvica e osteíte púbica em jogadores profissionais de futebol

ABSTRACT Introduction. Osteitis pubis is a common inflammatory disease of the pubic symphysis, defined as a chronic pain syndrome caused by repetitive microtrauma. Since adaptative changes are necessary in the pelvis to adjust the equilibrium of the myotendinous structures, the aim of this study was to evaluate the correlation between pelvic incidence and osteitis pubis among professional soccer players. Materials and Methods. An observational, cross-sectional study was performed with professional soccer players from five teams during pre-season. Athletes with previous congenital pelvic abnormalities or a history of surgery were excluded. Radiographs of the pelvis were analyzed by two radiologists and assessed for findings consistent with osteitis pubis, and the following parameters were measured: pelvic incidence (PI), sacral inclination (SI), and pelvic version (PV). Results. A total of 107 subjects were included in the study, with a mean age of 25.6 ± 3.1 years. Findings compatible with osteitis pubis were present in 74.8% of the subjects (80/107). There was no statistical correlation between osteitis pubis and PI (52.3°±12.7° vs. 48.4°±10.8°; p=0.156), SI (43.1°±9.8° vs. 39.9°±10.1°; p=0.146), or PV (9.2°± 6.3° vs 8.6°± 7.5°; p=0.649). Agreement between readers was excellent (p<0.0001). Conclusion. There was no significant correlation between pelvic parameters and radiographic diagnosis of osteitis pubis. Leve of Evidence II; Diagnostic study.

RESUMO Introdução. A osteíte púbica é uma doença inflamatória comum da sínfise púbica, definida como síndrome de dor crônica causada por microtraumas de repetição. Uma vez que são necessárias mudanças adaptativas na pelve para adequar o equilíbrio das estruturas miotendíneas, o objetivo deste estudo foi avaliar a correlação entre e a incidência pélvica e a osteíte púbica em jogadores profissionais de futebol. Materiais e Métodos. Estudo transversal, observacional, conduzido com jogadores profissionais de futebol de cinco times profissionais durante a pré-temporada. Foram excluídos do estudo atletas com anormalidades congênitas prévias ou com história de cirurgia. As radiografias de pelve foram avaliadas por dois médicos radiologistas quanto aos achados compatíveis com osteíte púbica, e os seguintes parâmetros foram medidos: incidência pélvica (PI), inclinação sacral (SI) e versão pélvica (PV). Resultados. Foram incluídos 107 participantes, com média de idade de 25,6 ± 3,1 anos. Achados compatíveis com osteíte púbica estavam presentes em 74,8% dos indivíduos (80/107). Não houve correlação estatística entre osteíte púbica e PI (52,3°± 12,7° vs. 48,4° ± 10,8°; p = 0,156), SI (43,1° ± 9,8° vs. 39,9° ± 10,1°; p = 0,146) ou PV (9,2° ± 6,3° vs. 8,6° ± 7,5°; p = 0,649). A concordância entre os médicos radiologistas foi excelente (p < 0,0001). Conclusões. Não houve correlação significativa entre os parâmetros pélvicos e o diagnóstico radiográfico de osteíte púbica. Nível de Evidência II; Estudo diagnóstico.

Epithelioid inflammatory myofibroblastic sarcoma: the youngest case reported

Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a rare variant of the inflammatory myofibroblastic tumor. It has an aggressive clinical course and a high rate of recurrence. EIMS primarily affects children and young adults. Hereby, we report this entity in a 4-month-old infant who presented with an abdominal mass. Imaging studies revealed a large hypodense mesentery-based lesion involving the right half and mid-region of the abdomen. The mass with an attached segment of the small bowel was excised in toto. Grossly, a large encapsulated tumor was identified arising from the mesentery of the small bowel. The histological examination showed a tumor consisting of epithelioid to spindle cells loosely arranged in a myxoid background with numerous blood vessels and lymphoplasmacytic inflammatory infiltrate. On immunohistochemistry, the tumor cells showed positivity for ALK1 (nuclear), desmin, SMA, CD68, and focal positivity for CD30. A final diagnosis of EIMS of the small intestine was rendered. To the best of our knowledge, this case is the youngest reported case in literature.

Stage-specific expression analysis ofMMP-2 & MMP-9 in laryngeal carcinoma

Aim of the Study: Both matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) is involved in degradation of extracellular matrix and found to stimulate invasion and metastasis in cancer patients. However, studies on the stage-specific expression of MMPs at different stages of larynx carcinoma are still lacking. In the present study, we compare the expression level of MMP-2 and MMP-9 at different stages of laryngeal carcinoma. Material and Methods: Tumor tissues samples were taken from larynx cancer patients by deep biopsy during direct laryngoscopy. Gene expression for MMP-2 and MMP-9 was analyzed using RT-PCR. Results: Significantly high expression of MMP-2 was observed compared to the MMP-9 at stage IV compared to the less advanced stages of the disease. Conclusion: Present study concluded that the MMP-2 expressed with a greater magnitude as compared to the MMP-9 in advance stages of laryngeal carcinoma

Emphysematous pyelonephritis: is conservative management effective? Our experience and review of literature

Background: Emphysematous pyelonephritis (EPN) is a urologic emergency caused by a life-threatening necrotizing infection of the kidney leading to an accumulation of gas in the renal parenchyma and perirenal tissue. we present the clinical details and outcome of twelve patients of managed at our institute and discuss their management and outcomes.Methods: Twelve consecutive patients with EPN were managed in our institute from July 2014 to July 2018. Data on demographic profile, clinical features, laboratory investigations, imaging studies, outcome of patients and follow up details were recorded.Results: Out of 12 patients with EPN, nine were female and three were male. Ten patients were diabetic (83%). All the diabetic patient had raised blood sugar at the time of admission ureteric stone was present in two nondiabetic patients. All the patients had fever at the time of presentation while localized flank pain was present in 6 (50%) patients. On examination, renal angle tenderness was present in ten patients while abdominal mass found in three patients. Pyuria was found in all patients while leukocytosis found in 10 patients. Two patients had thrombocytopenia while 4 had deranged renal parameters at the time of admission. Urine culture showed Escherichia coli in 8 patients and Klebsiella in two patients. Four patients required percutaneous drainage. Interval nephrectomy was done in one patient due to non-functioning kidney.Conclusions: Majority of patients diagnosed as emphysematous pyelonephritis were managed conservatively due to diagnosed at an early stage. Percutaneous drainage is successfully utilized in patients with more advanced disease.

A study of waist circumference and waist-hip ratio as markers of type 2 diabetes mellitus in an urban population of district Bareilly

Background: Type 2 diabetes mellitus belongs to a group of diseases labelled as lifestyle diseases and is on the rise in Asians especially Indians. Hence finding bio-markers is important to warn people and create awareness. Aim of the present study is to estimate waist-hip ratio, waist circumference in type 2 diabetic patients with respect to gender. Methods: A cross-sectional, community based study was conducted from February 2014 to February 2015 among adults in the age group of 30 year and above residing in area covered under UHTC of Bareilly City. A simple random sampling technique was adopted to achieve the desired sample size. 640 is the sample size came out to be by applying 3.8 4𝑃𝑄/d2 formula. Subject’s waist circumference, waist-hip ratio was measured in study samples. House to house survey was done for collecting data. Data tabulated and subjected to statistical analysis. Results: Prevalence of DM and IFG was more in those who were having high waist circumference and the association was also found to be statistically significant. The association was also found statistically significant between male high waist hip ratio and Diabetes Mellitus but no association was seen between female’s high waist-hip ratio and Diabetes Mellitus.Conclusions: High waist circumference can be a screening procedure for DM individuals in both sexes, but the same scenario we haven’t seen in high waist hip ratio among females and prevalence of DM. Appropriate waist circumference and waist-to-hip ratio values are complex because they are likely influenced by gender and other factors.

Comparative Study of Levobupivacaine with Butorphanol and Ropivacaine with Butorphanol in Supraclavicular Brachial Plexus Block

Ropivacaine and levobupivacaine are less cardiovascular and central nervous system toxic, being an alternative to bupivacaine. Butorphanol, an opioid significantly prolongs the duration of the local anaesthetics. Methods: A comparative, Prospective, Randomized, Clinical study was conducted in 60 patients of either sex of ASA I,II ,with age group 18-60 years undergoing upper limb orthopaedic surgeries under USG guided Supraclavicular Brachial Plexus block. Patients were randomly allocated to Group L: 30ml 0.5% Levobupivacaine+600 mcg Butorphanol. Group R: 30ml 0.5% Ropivacaine with 600mcg Butorphanol. Block characteristics were compared as a primary outcome. The data were analyzed with Student-t test. Results: Heart rate, Mean BP, Onset and duration of sensory and motor blockade, Post-op VAS score(every 1 hour for 16hours) were compared intraoperative as well as in the postoperative period. Demographic and hemodynamic data were comparable. All hemodynamic parameters compared were insignificant (P>0.5%).The onset of sensory and motor was significantly earlier in GROUP L (P =0.0048, P=0.002) compared to GROUP R. The duration of sensory and motor block was significantly higher in GROUP L (P=0.00073, P=0.00021). Group R required rescue analgesic earlier than Group L. Conclusion: Though both are long acting and safer than bupivacaine, Levobupivacaine is better than ropivacaine in terms of early onset of sensory-motor blockade and prolonged duration of sensory-motor blockade. Butorphanol augments the efficacy of local anesthetics without any untoward side effects.

A Comparison of Audio and Audio-Visual Distraction Techniques in Managing Dental Anxiety in Pediatric Patients: A Clinical Study

Background: Pain and fear of pain makes dental treatmentvery difficult for clinician as well as patients. Minimizing fearand anxiety can help to treat patients more comfortably.Various techniques like audio distraction, audio visualdistraction are used to minimize anxiety.Aim: To compare audio and audio-visual distractiontechniques in managing dental anxiety.Methods: 100 children visiting the Department of Dentistry,UPUMS, Saifai for routine dental care were examined. Theselected 100 children were randomly allocated to 2 groups.Group 1: audio distraction and Group 2: audiovisual group.Results: Venham’s anxiety scale was found to be lower inaudiovisual distraction group, although the difference was notfound to be statistically significant during all the visits.Relatively less increase in pulp rate was also observed in audiovisual distraction group in current study.Conclusion: Audiovisual distraction technique can bepreferred over audio distraction in paediatric patients

OsNAC-like transcription factor involved in regulating seed-storage protein content at different stages of grain filling in rice under aerobic conditions

In this study, we show that NAC-like transcription factor (TF) has 90% sequence similarity with cDNA of the OsNac5 gene present in the NCBI database. Phylogenetic analysis of the NAC gene family was performed with inclusion of the highly diverse C-terminal sequences. We report that this gene is also found to be orthologous to Glycine max NAC8, NAC2, Triticum aestivum NAC6 and paralogous to OsNAC6. mRNA was purified from five recombinant inbred lines (RILs) and parents of rice at three different stages of grain filling under aerobic conditions, with grain protein content (GPC) spanning from 4 to 14%. TheNAC-like TF encoding a protein was found to be upregulated at the S2 stage in the leaf (3.9-fold) and panicle (1.84-fold) of parent HPR14 and in five RILs (1.9 to 4.51-fold in leaves and 0.47 to 3.2-fold in panicles). Expression analysis of the NAC-like TF encoding a protein for the rice gene was found to be upregulated at the S2 stage in the leaf and panicle of parental line HPR14 and RILs with high protein content.

Musculoskeletal "don't touch" lesions: pictorial essay / Lesões musculoesqueléticas do tipo "não toque": ensaio iconográfico

Abstract Focal bone lesions are not uncommon findings in the daily practice of radiology. Therefore, it is essential to differentiate between lesions with aggressive, malignant potential that require action and those that have no clinical significance, many of which are variants or benign lesions, sometimes self-limited and related to reactive processes. In some cases, a diagnostic error can have catastrophic results. For example, a biopsy performed in a patient with myositis ossificans can lead to an incorrect diagnosis of sarcomatous lesions and consequently to mutilating surgical procedures. The present study reviews the main radiological aspects of the lesions that are most commonly seen in daily practice and have the potential to be confused with aggressive, malignant bone processes. We also illustrate these entities by presenting cases seen at our institution.

Resumo O achado de lesões ósseas focais não é incomum no dia-a-dia do radiologista. É, portanto, imprescindível saber discernir as lesões com potencial maligno agressivo, que requerem ação, das desprovidas de significado clínico, muitas destas sendo variantes da normalidade ou processos reativos benignos, às vezes, autolimitados. Em alguns casos, a confusão diagnóstica pode ter resultados catastróficos, como a realização de biópsia em casos de miosite ossificante, que pode levar ao diagnóstico incorreto de lesões de origem sarcomatosa e a cirurgias mutilantes. O presente estudo faz uma revisão dos principais aspectos radiológicos das lesões que mais comumente são vistas no dia-a-dia e que possuem potencial para causar confusão com processos ósseos malignos e agressivos. Ilustramos, ainda, essas lesões, apresentando casos do nosso serviço.

Snakebite: A Study on Clinical Presentation, Treatment and Public Awareness

Introduction: Since ancient times, snakes have beenworshipped, feared, or loathed in South Asia. It is surprisingthat, snake bite poisoning is seldom mentioned as a priority forhealth research in a developing country like India. Keeping inview the above facts present study is conducted amongpatients of snake bites in and around Rewa, public awarenessof first-aid measures and clinical profile of the snake bitepatients.Material and Methods: The present study was carried outamong 160 patients of snake bites poisonous andnonpoisonous, admitted in Serious Patient Ward in Departmentof Medicine over a period of 26 months. All the patients ofpoisonous bites were observed for complications and managedaccordingly. Outcome was noted in the form of whether patientsurvived or died due to snake bite.Results: Ghabrahat (96.77%) and local pain (51.61%) werethe chief presenting complaints and tenderness (32.25%),redness (17.74%) at the local site were the main local findings,in non-poisonous group. In the poisonous group difficulty inopening of eyes (83.33%), difficulty in swallowing (77.78%),and difficulty in speaking (66.67%) were the main presentingcomplaints. Signs of envenomation in decreasing order werebilateral ptosis. (91.6%), bulbar palsy (72.85%), generalizedparesis (55.56%), drowsiness (44.44%) and varying degree ofrespiratory paralysis (25%) the main local effects in poisonousgroup tenderness (44.44 %), bleeding (22.2 %), redness(33.3%), oedema (27.7%). Of the total 36 cases, 30 (83.33%)survived and 6 (16.67%) died due to complications.Conclusion: It can be concluded from the study that generalpublic needs to be educated about pattern of behaviour ofsnakes, care while moving in night specially in fields, not tosleep on floors, importance of first aid specially use oftourniquet and immobilization of bitten parts not to waste timein seeking remedies from Ojhas etc and above all shift theaffected person at the earliest to nearest medical centre wherespecific therapy for dealing with such victims is available. Allthese measures will go a long way in saving many ofunfortunate victims of snake bite.

A study on health profile of manjha makers in district Bareilly

Background: Bareilly is famous for its manjha all over the world. More than 20,000 workers are engaged in the making the Manjha in Bareilly which is an important unorganized sector in western Uttar Pradesh. Objective was to study health profile of manjha makers in district Bareilly.Methods: The workers engaged in making manjha were randomly approached in the selected areas and interviewed using a semi open ended questionnaire. Responses were marked based on duration and severity of symptoms.Results: The mean age of study participants was 31±9.9 years. The mean age of starting manjha making was 15.3±6.7 years. 51 (47.2%) study participants were having wounds and cuts in hands and fingers.Conclusions: Manjha makers are in direct contact with inhalable glass dust (silica dust) and chemical colors which can reach the circulation through cuts and wounds. The higher prevalence of musculoskeletal and respiratory symptoms as well as other symptoms like cut wounds in hands and possible absorption of dyes through cuts underlines the need of a larger study to know the factors causing these symptoms and ways to prevent the suffering of manjha makers.

Integrating bilingual musculoskeletal imaging education into radiology and diagnostic imaging residency programs / Método de integração do ensino bilíngue da imagem musculoesquelética na residência de radiologia e diagnóstico por imagem

Abstract Objective: To analyze the perception of the relevance of introducing bilingual (Portuguese-English) musculoskeletal imaging education into radiology and diagnostic imaging residency programs, describing the method used. Materials and Methods: To evaluate the relevance of incorporating the bilingual study of musculoskeletal imaging into medical residency programs, we administered a questionnaire, consisting of several multiple-choice questions and one subjective question, to 21 radiology residents at a private tertiary hospital. The residents completed the questionnaire voluntarily and anonymously. Results: Integrating English teaching into radiology training was considered important by 95.2% of the residents. Approximately 90% of residents believe that the method applied at their institution is suitable for learning. Conclusion: The introduction of the English language into the teaching of musculoskeletal imaging in the radiology residency program was perceived positively by the residents, and the preceptors effectively supported those activities.

Resumo Objetivo: Analisar a percepção de relevância da introdução do ensino bilíngue (português-inglês) da imagem musculoesquelética na residência e aperfeiçoamento médico em radiologia e diagnóstico por imagem, descrevendo o método utilizado. Materiais e Métodos: Um questionário, composto por perguntas de múltipla escolha e uma pergunta subjetiva, foi aplicado a 21 residentes e aperfeiçoandos de radiologia e diagnóstico por imagem de um hospital terciário privado, que responderam de forma voluntária e anônima, com a finalidade de avaliar a relevância da incorporação do estudo bilíngue da imagem musculoesquelética na residência médica. Resultados: A integração entre ensino da radiologia e da língua inglesa foi considerada importante por 95,2% dos residentes e aperfeiçoandos. Cerca de 90% dos residentes e aperfeiçoandos acreditam que o método aplicado na instituição é adequado para a aprendizagem. Conclusão: A introdução da língua inglesa no ensino da imagem musculoesquelética na residência médica de radiologia foi avaliada de forma positiva pelos médicos residentes, tendo os preceptores apoiado de forma efetiva as atividades.

Study of Incidence of Helicobacter pylori Infection in Patients of Peptic Ulcer Perforation

Background: Peptic ulcer disease (PUD) is a common disorder that affects millions of individuals each year. PUD has a major impact on our health-care system by accounting for roughly 10% of medical costs for gastrointestinal diseases. Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs are the predominant causes of PUD overall, PU mortality and hospitalization rates have declined for the past two decades, but complications such as PU perforation and bleeding remain a substantial health-care problem. Materials and Methods: A prospective 1-year study conducted in 116 cases of peptic perforation admitted in surgical wards of Sanjay Gandhi Memorial Hospital, Rewa, M.P., during the study period June 2016–May 2017. All patients suspected of peptic perforation were admitted to surgery ward and underwent emergency exploratory laparotomy. Post-operatively, H. pylori serological test to detect IgG antibody was done with patients’ blood serum. Their findings were recorded in a pro forma and master chart. The information obtained was tabulated and analyzed. Results: The incidence of H. pylori infection in our study was found to be 31.03%, i.e., 36 cases of 116 cases. Conclusion: Tobacco chewing, smoking, alcohol, inadvertent use of analgesics, and H. pylori infection are the most common predisposing factors for PUD, and patients’ inability to get proper and complete treatment is responsible for peptic perforation. Early hospitalization and urgent surgical intervention can significantly reduce the post operative morbidity and mortality in peptic ulcer perforation patients. Post-operative H. pylori eradication therapy and follow-up endoscopic facilities in patients found positive for H. pylori can reduce recurrence rates and subsequently the burden of this disease

Unusual Presentation of a Penetrating Aortic Arch Injury

A 27-year-old man was admitted with a penetrating injury at the mid-manubrium. Computed tomographic (CT) angiography showed a filling defect in the aortic arch. This was evaluated as a sign of injury and the patient underwent an emergency operation. No active bleeding or clot was found in the mediastinum during the operation. The laceration point was between the innominate and the left carotid artery posteriorly. The injury was approached using hypothermic circulatory arrest. Aortotomy and exploration showed a 2-cm-long full-thickness aortic injury with an overlying clot. A filling defect on angiography as a sign of a penetrating arch injury has never been reported previously, but was the main pathological finding on CT angiography in our case. The aorta is a high-pressure system and injuries to it should be treated aggressively.

Truview PCDTM Video Laryngoscope versus McCOY Laryngoscope for Tracheal Intubation: A Comparative Study.

Background: McCoy laryngoscope and video laryngoscopes are being increasingly used and have a definitive advantage over conventional laryngoscopes in management of potentially difficult airways. The aim of our study was to compare relative effectiveness of McCoy laryngoscope and True view PCDTM video laryngoscope in patients undergoing oral tracheal intubation. Methods: Fifty patients of American Society of Anaesthesiologists (ASA) grade I and II, aged 20 – 50 years, posted for elective surgery under general anaesthesia were randomly allocated into Group T (Truview group, n=25) and Group M (McCoy group, n=25). The two groups were compared for demographic data, intubation difficulty score (IDS), Cormack-Lehane (CL) grade, POGO score, time to intubation, number of intubation attempts and haemodynamic parameters. Results: The demographic data and ASA status was comparable in both the groups. Group T had a significantly less IDS score as compared to Group M (p < 0.001). Seventeen patients in Group T and 8 patients in Group M had IDS = 0. The CL grade and POGO scores were better in Group T than in Group M. Intubation was successful in the first attempt in 94% patients in Group T and 88% patients in Group M. There was a transient increase in HR and NIBP after intubation in both the groups which returned back to the baseline within 5 minutes. No incidence of hypoxia and airway trauma was noted in the two groups.Conclusion: Truview PCDTM video laryngoscope resulted in better glottic visualization with lower IDS than McCoy laryngoscope in patients undergoing oral tracheal intubation.

Assessment of nutritional status among adolescents: a hospital based cross sectional study.

Background: Adolescence, a period of transition between childhood and adulthood, occupies a crucial position in the life of human beings. The primary causes of under nutrition in India are its large population, socio-economic differences and inadequate access to health facilities. Nutritional assessments among adolescents are important as they are the future parents and constitute a potentially susceptible group. Studies on the assessment of nutritional status of adolescents are less in number and a National database has not yet been developed. Methods: The present hospital based cross sectional study was conducted in year 2013 among 344 rural adolescents of 10-19 years age (166 boys and 178 girls) attending the outpatient department at rural health training centre (RHTC) Dhaura Tanda, district Bareilly, Uttar Pradesh, belonging to the Muslim and Hindu caste communities. The nutritional status was assessed in terms of under nutrition (weight-for-age below 3rd percentile), stunting (Height-for-age below 3rd percentile) and thinness (BMI-for-age below 5th percentile). Diseases were accepted as such as diagnosed by pediatrician, skin specialist and medical officer. Results: The prevalence of underweight, stunting and thinness were found to be 32.8%, 19.5% and 26.7% respectively. The maximum prevalence of malnutrition was observed among early adolescents (28%-47%) and the most common morbidities were URTI (38.6%), diarrhea (16.8%), carbuncle / furuncle (16%) and scabies (9.30%). Conclusion: The study concluded that the most common morbidities among adolescents were related to nutrition and personal hygiene. Regular health programmes should focus to educate and promote health among adolescent.