Open reduction for neglected traumatic hip dislocation in children and adolescents

Background: Neglected traumatic dislocation of the hip is extremely rare in children, and the preferred treatment remains unclear. In this study we studied the role of open reduction in neglected traumatic hip dislocation in children and adolescents as a modality of treatment.Methods: Eight patients with a neglected, traumatic dislocation of the hip received in the emergency department of GMC, Jammu were managed by open reduction. Types of dislocations, associated lesions, treatment methods, complications, and clinical and radiological outcomes were reviewed in the study.Results: All patients presented with limp and pain. Six patients had minimal difficulty in squatting while two had marked difficulty. Leg lengths were within 2 cm in 7 of 8 cases at follow-up, and only 1 patient had a discrepancy greater than 2 cm.Conclusions: Open reduction is a satisfactory treatment for neglected hip dislocation. It restores joint stability, range of motion and limb length.

Effect of prenap coffee on daytime sleepiness in university students

Background: Daytime sleepiness impairs academic performance in college students. Napping is a counter to daytime sleepiness, but often causes sleep inertia on waking up. Caffeine absorption from beverages peaks 30 minutes after their ingestion presenting a window of opportunity to have a short nap such that the time of waking up is in synchrony with onset of action of caffeine; thereby abolishing post-nap inertia and achieving synergistic mitigation of fatigue.Objective of this study to assess effect of nap, coffee, ‘coffee and nap’ and ‘wakeful break without coffee’ on daytime sleepiness using Psychomotor Vigilance Tests (PVTs) and Karolinska Sleepiness Scale (KSS) score.Methods: After Institutional Review Board clearance, 10 subjects (aged 19-21 years) were selected using their Epworth Sleepiness Scale score (ESS >5) and called to the study site 8 times on different days to be exposed to these four conditions twice - only coffee (standardized), only nap (30min), coffee immediately followed by 30min nap, wakeful break (30min) without coffee or nap. Pre and post scores were recorded for electronic PVT (Reaction Time and Motor Responsiveness) and KSS for each attempt.Results: Test outcome was associated with intervention used (p=0.00001). ‘Nap only’ group was associated with deterioration in outcomes (p=0.00001), accounting for highest percentage (41%) of all deteriorated test outcomes. ‘Coffee only’ group was associated with improvement in test scores (p=0.00001), responsible for highest share (38.8%) of all improved test outcomes. ‘Nap only’ and ‘Coffee-nap’ group showed improvement in 11.67% and 21.67% of outcomes respectively. Conclusions: Pre-nap coffee is a proactive counter-measure to post nap sleep inertia.

Educational innovations/programmes for 1 Mbbs batch- 2012-13 under regional training centre, Smt.Nhl Municipal Medical College, Ahmedabad.

Context or Setting: The undergraduate MBBS curriculum needs revisions like active learning, exposure to newer teaching techniques, adding some new elements as suggested by MCI in its document Vision 2015. Need for innovation: Traditional teaching-learning process is perceived by students as boring and less relevant to their future goal. So we need to think of methods like integrated teaching and objective assessment methods like structured viva. Learners also need to have some hands on training for skills and active participation in important issues related to their careers. We tried to introduce some of these to First MBBS students. Description of innovation: Vertical And Horizontal Integration (Coordinated Program), Session On “Cardiopulmonary Resucitation”, Structured Viva, Session On “Time And Stress Management”, Programme Evaluation, Written Feedback Was Obtained From Students After Each Session. Lessons learnt : First MBBS students perceive innovative methods interesting and effective. They improve teaching-learning experience and hence should be encouraged.

A pilot study for diagnosis of genital Chlamydia trachomatis infections by polymerase chain reaction among symptomatic Indian women.

Background: Chlamydia trachomatis is the most common bacterial etiology of sexually transmitted infection. Aim : A pilot study was designed using PCR for amplification and detection of a specific 517 bp sequence of the common endogenous plasmid of C. trachomatis from clinical swab specimens obtained from symptomatic female patients attending STD clinics of AIIMS and Regional STD Teaching, Training & Research Center, Safdarjang Hospital, New Delhi. Methods: 97 patients were recruited in the study, and endocervical swabs were collected following standard procedures. The samples were analyzed by PCR and direct fluorescence antibody (DFA) for detection of C. trachomatis, and the sensitivity, specificity, PPV and NPV of PCR were calculated taking DFA as gold standard. Results: Out of 97 samples tested, 9 were positive for C. trachomatis by PCR. 1 PCR positive patient was negative by DFA although a total of 11 patients were positive by DFA. The sensitivity, specificity, PPV and NPV of PCR with reference to DFA was 72.73%, 98.84%, 88.89% and 96.59%, respectively. This PCR had high specificity and NPV for detection of C.trachomatis. Conclusions : In light of the introduction of enhanced syndromic approach, which involves the use of laboratory techniques (wherever possible) to confirm clinical diagnosis, a diagnostic PCR with high specificity and NPV is particularly valuable for determination of etiological diagnosis and hence contribute to judicious use of antimicrobials in the community.

Bilateral Asymmetrical Traumatic Hip Dislocation in an Adult.

Bilateral hip dislocation occurring as a result of trauma is a rare condition. Simultaneous anterior and posterior traumatic dislocation of both hips is even more unusual. A case is reported of bilateral asymmetrical traumatic hip dislocation in previously normal hips in a 20 year old adult male without an associated fracture of the pelvis or femur. An unusual mechanism for this injury is also described.

Evaluation of Results of Various Operative Method In The Management of Tibal Plateau Fracture In Adults.

A series of 25 patients of tibial condylar fractures treated with various operative methods have been reviewed after surgery. The study has 6 Type I, 6 Type II, 1 Type III, 5 Type IV, 3 Type V and 4 Type VI fractures. 16 patients were treated with open reduction and internal fixation with buttress plate, 3 patients with closed reduction and internal fixation with cannulated screws, 5 patients with open reduction with cannulated screws, 1 patient with closed reduction internal fixation with cannulated screw with external fixator.Out of 25 patients, 19 had excellent results, 4 had good results and 2 patients had a fair result. Two patients had superficial wound infection, two patients had screw irritation on medial end and 1 patient had malreduction.The surgical goals in treating these fractures are anatomic reduction, stable fracture fixation and early post operative rehabilitation.

Minimally Invasive Techniques in Distal Tibial Fractures.

A series of 20 patients of distal tibial fractures treated with minimally invasive techniques have been reviewed after surgery. The technique involves open reduction and internal fixation of the associated fibular fracture when present, followed by minimally plate osteosynthesis of the tibia utilizing precontoured tubular plates and percutaneously placed cortical screws. Out of 20 patients, 14 had excellent results, 4 had good results and 2 patient had a fair result. Two patients had superficial wound infection and one patient had palpable screw.This minimally invasive technique for treatment of distal tibial fractures proves to be a feasible and worthwhile method of stabilization while avoiding the severe complications associated with the more standard methods of internal or external fixation of those fractures.