STUDY OF SUPRACONDYLAR FEMUR FRACTURE MANAGED SURGICALLY USING LOCKING COMPRESSION PLATE.

Background- Fractures of distal femur are one of the most prevalent fractures encountered in high-velocity trauma which are associated with high morbidity and mortality if not managed well. The isolated fracture can itself lead to complications such as Acute Respiratory Distress and pulmonary embolism. This neccesitaties early stabilisation of the fractures. Open reduction and internal fixation (ORIF) with locking compression plate is the treatment of choice for closed fractures of the distal femur. Distal femur anatomic contoured locking compression plate (LCP) has shown to give one of the best results regarding recovery, fracture union, return to work and the functional outcome. We present our experience of management of distal femur fracture at our centre. Study Material and Methodsdone on 36 patients, (NEER'S Classification) age range of 18 to 70 years (irrespective of their sex), were subjected to fixation by locking compression plate after obtaining thorough written informed consent. The observational study was carried at our institute between June 2021 to June 2022 Patients of both gender who were skeletally mature are taken into the study. In 61.5% of patients up to 50 years old and in Results40% of patients older than 50 years, the functional evaluation of LCP using Neers criteria was excellent. There was no statistically significant (p>0.05) difference in patients' functional status according to their age group who had distal femur fractures, which were stabilise by LCP. For supracondylar femur fractures, locking compression plates is a safe technique that has a good functional outcome, early clinical and radiographic union, and few complications.

A Critical Review of Role of Medhya Dravyas (Nootropic Drugs) in Brain Fog with special reference to Covid- 19

Cognitive dysfunction after COVID-19 are hypoxia, microvascular injury, immunological dysregulation, chronic inflammation, patients with mild infections also report cognitive symptoms. A recognized symptom of long COVID is “Brain Fog”, characterized by fatigue, lack of ability to concentrate and can severely affect memory and cognition. Long-term side effects of COVID-19 is Brain fog which occurs irrespective of the severity of the infection. The Medhya Dravyas (Nootropic drugs) are beneficial to improve the power of retention, grasping, discrimination and recollection thus improving the Medha (Cognition). Present clinical study is an attempt to evaluate the nootropic effect of certain drugs in Brain Fog with special reference to Covid 19. Aim: To review medicinal plants showing Medhya Karma (Nootropic activity) on signs and symptoms correlated with brain fog in Covid 19 with Ayurveda as a natural and safe remedy. Material and Methods: Materials related to Covid 19, Brain fog, Neurological symptoms cognitive impairment, Medhya Dravyas (Nootropic drugs) have been collected from different journals, Ayurveda and Modern text, Authentic websites (PubMed, Google scholar, Scopus, etc.), Observation and Results: Plants reviewed showed nootropic action by Antioxidant, Acetylcholine esterase inhibition, NMDA antagonism, Dopaminergic, Anti-amyloidogenic, Inhibition of Tau aggregation and Neuroprotection. These properties helps in the management of cognitive impairment. Conclusion-Medhya Dravyas possess nootropic and rejuvenative properties. Plants shown maximum inhibitory activities against the factors causing brain Fog by Neuroprotection and memory enhancement. It reveals the strength of the Ayurveda system as well as potential in developing new drug for memory enhancement

Does dexmedetomidine combined with levobupivacaine in inferior alveolar nerve blocks among patients undergoing impacted third molar surgery control postoperative morbidity?

Background@#Postoperative analgesia (POA) is an important determinant of successful treatment. Dexmedetomidine (DEX) has recently gained attention as a promising adjuvant to local anesthetics (LA). The present study aimed to evaluate the efficacy and safety of levobupivacaine (LB) as an adjuvant during inferior alveolar nerve block (IANB) in the extraction of lower impacted third molars (LITM). @*Methods@#A prospective, randomized, placebo-controlled, triple-blind, parallel-arm, and clinical study was performed on 50 systemically healthy participants who required removal of an asymptomatic LITM. Using a 1:1 distribution, the participants were randomized into two groups (n = 25). Group L (control group) received 1.8 mL of 0.5% LB and 0.2 mL normal saline (placebo) and Group D (study group) received a blend of 1.8 mL of 0.5% LB and 0.2 mL (20 µg) DEX. The primary outcome variable was the duration of POA and hemodynamic stability, and the secondary variable was the total number of analgesics required postoperatively for up to 72 h. The participants were requested to record the time of rescue analgesic use and the total number of rescue analgesics taken. The area under the curve was plotted for the total number of analgesics administered. The pain was evaluated using the visual analog scale. Data analysis was performed using paired students and unpaired t-test, Mann–Whitney U test, Chi-square test, and receiver operating characteristic analysis. Statistical significance was set at P < 0.05. @*Results@#The latency, profoundness of anesthesia, and duration of POA were statistically significant (P < 0.05).The differences between mean pain scores at 6, 12, 24, 48, and 72 h were found to be significant (each P = 0.0001). Fewer analgesics were required by participants in group D (2.12 ± 0.33) than in L (4.04 ± 0.67), with a significant difference (P = 0.0001). @*Conclusion@#Perineurally administered LA with DEX is a safe, effective, and therapeutic approach for improving latency, providing profound POA, and reducing the need for postoperative analgesia.

Characterization of transcription factor genes related to cold tolerance in Brassica napus

Brassica napus is the third most important oilseed crop in the world; however, in Korea, it is greatly affected by cold stress, limiting seed growth and production. Plants have developed specific stress responses that are generally divided into three categories: cold-stress signaling, transcriptional/post-transcriptional regulation, and stress-response mechanisms. Large numbers of functional and regulatory proteins are involved in these processes when triggered by cold stress. Here, our objective was to investigate the different genetic factors involved in the cold-stress responses of B. napus. Consequently, we treated the Korean B. napus cultivar Naehan at the 4-week stage in cold chambers under different conditions, and RNA and cDNA were obtained. An in silico analysis included 80 cold-responsive genes downloaded from the National Center for Biotechnology Information (NCBI) database. Expression levels were assessed by reverse transcription polymerase chain reaction, and 14 cold-triggered genes were identified under cold-stress conditions. The most significant genes encoded zinc-finger proteins (33.7%), followed by MYB transcription factors (7.5%). In the future, we will select genes appropriate for improving the cold tolerance of B. napus.

Study of Expression of Indigenous Bt cry2AX1 Gene in T3 Progeny of Cotton and its Efficacy Against Helicoverpa armigera (Hubner)

Abstract Development of transgenic Bt crops with stable and high level of Bt protein expression over generations under different environmental conditions is critical for successful deployment at field level. In the present study, progenies of transgenic cotton Coker310 event, CH12 expressing novel cry2AX1 gene were evaluated in T3 generation for stable integration, expression and resistance against cotton bollworm, Helicoverpa armigera. The cry2AX1 gene showed stable inheritance and integration in the T3 progeny plants as revealed by PCR and Southern blot hybridization. The expression of Cry2AX1 protein on 90 days after sowing (DAS) was in the range of 1.055 to 1.5 µg/g of fresh leaf tissue except one plant which showed 0.806 µg/g of fresh leaf tissue and after 30 days (i.e., on 120 DAS) three plants recorded in between 0.69 to 0.82 µg/g and other plants are in range of 0.918 to 1.058 µg/g of fresh leaf tissue. Detached leaf bit bioassay in T3 progeny on 110 DAS recorded mortality of 73.33 to 93.33 per cent against H. armigera and severe growth retardation in surviving larvae. These results indicate that the expression of chimeric cry2AX1 is stable and exhibits insecticidal activity against H. armigera in T3 progeny of CH12 event of transgenic cotton.

Comparison of Glottic View and Haemodynamic Stress Response Associated with Laryngoscopy using the Macintosh, McCoy and Miller Blades in Adult Patients

Introduction: Laryngoscopy induces haemodynamic responsewhich has implications for patients with cardiovascularillnesses. We devised this study to compare the laryngoscopicview of the glottis obtained with the Macintosh, McCoy andMiller blades, and corresponding haemodynamic changes.Material and Methods: 105 ASA grade I and II patientsrandomly divided into three groups were intubated usingMacintosh, McCoy and Miller blade respectively. Cormackand Lehane grade of glottic view obtained, heart rate, systolicand diastolic blood pressure at baseline, immediately beforeinduction, following induction, and at 1, 3 and 10 minutesafter intubation were noted. Epi Info 7.2 was used forstatistical analysis. Chi square and ANOVA tests were appliedto compare haemodynamic parameters.Results: 18 patients (51.4%) were CL grade I and 17 (48.6%)were CL grade II in Macintosh, 24 (68.6%) were CL gradeI and 11 (31.4%) were CL II in McCoy and, 32 (91.4%)were CL I and 3 (8.6%) were CL II in Miller group. Risein heart rate following intubation was greatest with Millerblade, followed by Macintosh and least with McCoy, andwas statistically significant (P< 0.01). Rise in both, systolicand diastolic blood pressure following intubation was highestwith the Miller blade, followed by Macintosh and least withMcCoy, and the difference compared with baseline values wasstatistically significant (P<0.01).Conclusions: Miller blade provides best visualization of larynxbut McCoy blade produced least haemodynamic response,hence the latter is preferable when less haemodynamicresponse is desired.

Intra-Operative Hemodilution During Mitral Valve Replacement Surgery Using St Thomas Vs Del Nido Cardioplegia- A Single Centre Study.

Aim To assess the hemodilution during mitral valve surgery performed using St Thomas cardioplegia versus Del Nido cardioplegia. We also compared the volume of cardioplegia required, cross clamp time and cardiopulmonary bypass (CPB) time in each group. Methods and Materials Patients admitted between the period of January 2015 to June 2018 for mitral valve disease were included in this retrospective study. Patients were divided into two groups each comprising of 50 patients according to type of cardioplegia received during surgery. Results The hemodilution was much lesser in the patients who underwent mitral valve surgery using St Thomas cardioplegia (Haematocrit 26.3 ± 2.5%) as compared to those patients underwent the same surgery using del Nido Cardioplegia (Haematocrit 24.8 ± 2.2%). The volume of cardioplegia, cross clamp time and cardiopulmonary bypass time was less with del Nido cardioplegia as compared to St. Thomas cardioplegia (922.6 ± 95.4 vs 1854 ± 228.1 ml; 65.5 ± 8.2 vs 71.52 ± 8.8 minutes and 99.3 ± 13.1 vs 110.6 ± 14.6 minutes respectively). Conclusion The use of St Thomas Cardioplegia in patients during mitral valve replacement surgery has less hemodilution on CPB as compared to del Nido cardioplegia. But the patients who received del Nido cardioplegia has less requirement of number and volume of cardioplegia required during surgery with shorter cross clamp and CPB time

A retrospective epidemiological study of delay for updated Thai red cross intradermal anti-rabies vaccination schedule amongst animal bite cases attending ARV clinic at a tertiary care centre.

Background: Rabies is an acute viral disease, which causes encephalomyelitis in virtually all the warm blooded animals, including man. Almost 20000 deaths occur in India. The present study conducted with objective to analyze the delays and compliance for anti-rabies vaccination as per schedule and its some factors among the animal bite cases. Methods: Retrospective cross sectional record based study of cases attended Anti-Rabies Vaccination (ARV) clinic during the period of April 2012 to March 2013. The data extracted from records included socio-demographic variables, animal bite history treatment received and completion of ARV schedule. Data entered and analyzed using SPSS 21. Results: Total of 3548 animal bite cases attended the ARV clinic. Out of these cases, 18.2 %, 20.3% and 14.2% of cases not reported on scheduled date for 2nd, 3rd & 4th dose of ARV respectively. Only 34.3% of cases completed the schedule. Delay for receiving ARV among women, cases from rural area & class II animal bite was statistically significant. Conclusions: Counselling regarding follow up of ARV schedule at the time of first visit to the anti-rabies vaccine clinic must be strengthened to avoid poor compliance and delaying of schedule.

Management of Class II Malocclusion with Modification in Forsus Fatigue Resistance Device: A Case Report.

Management of class II malocclusion in adolescents by growth modulation is one of the most difficult and commonly encountered scenario in clinical orthodontics. Noncompliance has been a major concern for orthodontists. This case report describes the management of class II malocclusion in young adult with Forsus fatigue resistance device (3M Unitek, 2724 S., Peck Road, Monrovia, CA 91096; www.3Munitek.com), a fixed functional appliance, that is now most widely used for correction of Class II malocclusion. A common problem with this appliance is frequent debonding of mandibular canine brackets. The present article also describes a simple, chairside fabrication of acrylic button that will ensure prevention of debonding of brackets. This case report illustrates that functional appliances even today have a significant role in growth modulation that further minimizes the necessity of extraction of permanent teeth and orthognathic surgery.

Awareness of healthcare workers regarding Biomedical Waste Management (BMW) at Tertiary Care Government Hospital in Dhule (Maharashtra).

Background and objectives: Biomedical waste has been a growing concern due to increased awareness in public regarding HIV/AIDS, hepatitis B and exposure to other potential infectious diseases. Good BMW disposal practices lead to reduction in medical expenditure, unsightly scenes at various disposal bins and dumping sites. Improper biomedical waste management practices and indiscriminate disposal of hospital waste causes spread of illness leading to financial burden to society. The money saved by reduction in hospital acquired infections is much more than spent on control of hospital acquired infections. Therefore it is necessary to educate the staff, patients and community about the management of the infectious waste. The present study was designed to assess the awareness regarding biomedical waste in health care workers at a tertiary care Government hospital, Dhule (Maharashtra). Methods: Shri Bhausaheb Hire Government Medical College and Hospital is a 545 bedded tertiary care teaching Government hospital situated in rural area of Maharashtra at Dhule where per day approximately 90 Kg biomedical waste is generated .The present cross-sectional study was conducted during 1st August 2011 to 30th September 2011. Knowledge and practices about BMW was assessed among 153 health care workers (81 nursing staff, 35 laboratory technicians and 37 sweepers) handling BMW in the tertiary care Government hospital at Dhule. Results: It was found that only 70.6% of the health care workers were aware of biomedical waste management and 50.3 % had undergone training. 72.5 % of the health care workers were aware of 3 color coded bags used for collection of BMW. In the study only 41.8% of the workers were vaccinated against shepatitis B and 81.7% had received tetanus toxoid vaccine. Conclusion: For proper handling and disposal of BMW, all health care providers must undergo regular training in BMW management.

Transcriptome analysis of Anopheles stephensi embryo using expressed sequence tags.

Germ band retraction (GBR) stage is one of the important stages during insect development. It is associated with an extensive epithelial morphogenesis and may also be pivotal in generation of morphological diversity in insects. Despite its importance, only a handful of studies report the transcriptome repertoire of this stage in insects. Here, we report generation, annotation and analysis of ESTs from the embryonic stage (16–22 h post fertilization) of laboratoryreared Anopheles stephensi mosquitoes. A total of 1002 contigs were obtained upon clustering of 1140 high-quality ESTs, which demonstrates an astonishingly low transcript redundancy (12.1%). Putative functions were assigned only to 213 contigs (21%), comprising mainly of transcripts encoding protein synthesis machinery. Approximately 78% of the transcripts remain uncharacterized, illustrating a lack of sequence information about the genes expressed in the embryonic stages of mosquitoes. This study highlights several novel transcripts, which apart from insect development, may significantly contribute to the essential biological complexity underlying insect viability in adverse environments. Nonetheless, the generated sequence information from this work provides a comprehensive resource for genome annotation, microarray development, phylogenetic analysis and other molecular biology applications in entomology.

Strengthening of primary health care: Key to deliver inclusive health care.

Inequity and poverty are the root causes of ill health. Access to quality health services on an affordable and equitable basis in many parts of the country remains an unfulfilled aspiration. Disparity in health care is interpreted as compromise in 'Right to Life.' It is imperative to define 'essential health care,' which should be made available to all citizens to facilitate inclusivity in health care. The suggested methods for this include optimal utilization of public resources and increasing public spending on health care. Capacity building through training, especially training of paramedical personnel, is proposed as an essential ingredient, to reduce cost, especially in tertiary care. Another aspect which is considered very important is improvement in delivery system of health care. Increasing the role of 'family physician' in health care delivery system will improve preventive care and reduce cost of tertiary care. These observations underlie the relevance and role of Primary health care as a key to deliver inclusive health care. The advantages of a primary health care model for health service delivery are greater access to needed services; better quality of care; a greater focus on prevention; early management of health problems; and cumulative improvements in health and lower morbidity as a result of primary health care delivery.

Topical corticosteroid abuse on the face: A prospective, multicenter study of dermatology outpatients .

Background: Abuse of topical corticosteroids (TC), especially over the face, is prevalent worldwide, including in India. Data about the magnitude of this problem in our country is lacking. Aims: The aims of this study were to ascertain the demographics, magnitude and clinical features of TC misuse on the face in the dermatology outpatient department (OPD) attendees in order to raise awareness about this problem and to analyze its causes. Methods: This was a prospective multicenter questionnaire-based clinical study conducted at 12 dermatology centers nationwide. Patients with relevant facial dermatoses reporting to the investigator were asked about their current use of over-the-counter topical formulations and a structured questionnaire applied in case the same was confirmed to be TC. Results: A total of 2926 patients with facial dermatoses were screened, of which 433 (14.8%) were using TC. TC was used as a fairness/general purpose cream or aftershave in 126 (29%) and in 104 (24%) for acne. Steroid combinations were used by 258 (59.6%). Potent and super-potent TC were significantly (P = 0.05) more frequently used by the rural/suburban population. The younger age groups used more potent formulations. A non-physician recommendation for TC use was obtainable in 257 (59.3%) patients. Of these, 232 (90.3%) were for potent/super-potent steroids. Among 176 physician prescriptions, 78 (44.3%) were from non-dermatologists. All non-physician prescriptions and 146 (83%) physician prescriptions for TC were inappropriately refilled. Adverse effects were seen in 392 (90.5%) TC users. Acne/exacerbation of acne was the most common adverse effect. Conclusions: TC misuse in patients with facial dermatoses is quite common, and most of this use is unwarranted. Use as a fairness cream is the most common indication in this cohort. Limitations: This was an OPD-based study and, therefore, it may or may not accurately reflect the community data.

Acute and sub-acute toxicity of an insect pheromone, N-heneicosane and combination with insect growth regulator, diflubenzuron, for establishing no observed adverse effect level (NOAEL).

Aedes aegypti mosquito is one of the most notorious vectors of dangerous diseases like dengue hemorrhagic fever and chikangunya. One method of control of the vectors is by the use of semiochemicals or pheromones. The pheromone n-heneicosane (C21) has been proved to be effective in attracting the female Aedes aegypti to lay eggs in the treated water and the growth of the larva is controlled by insect growth regulator diflubenzuron (DB). This study was planned to assess the safety of C21 alone and the combination with DB. Acute toxicity tests were carried out using two doses, viz., 1600 and 3200 mg/kg and two routes of exposure oral and intra-peritoneal. Dermal toxicity test was carried out in both male and female rats at the dose of 3200 mg/kg. Primary skin irritation test was carried out in rabbits. Sub-acute (90 days) dermal toxicity studies in male and female rats at the dose of 1 and 2 mg/kg via the per-cutaneous route were also studied. Sub-acute (90 days) toxicity test through the oral route was carried out, at doses 125, 250 and 500 mg/kg in male and female rats. The calculated LD50 by ip route and dermal route was more than 5 g/kg in mouse and rats of both the sexes. In the primary skin irritation test no significant changes were noted. In the sub-acute toxicity studies even 500 mg/kg dose was not able to produce toxic response in rats when they were dosed daily for 90 days. The established no observed adverse effect level (NOAEL) was more than 500 mg/kg.

Pathogenesis and consequences of essential hypertension.

Essential hypertension is a global problem with fairly high morbidity and mortality. The pathological mechanisms in hypertension are many and involve sympathetic nervous system, renin-angiotensin-aldersterone system, nitric oxide and a host of vasoactive substances. The consequences of hypertension are related either to hypertension or to atherosclerotic process in the arteries.

Evaluation of efficacy of Dettol-H in hospital use.

A study was conducted at Safdarjang Hospital, New Delhi, to elucidate the bactericidal effect of a new disinfectant having benzalkonium chloride (40%) + disodium edetate (1.5%) and commercially available as Dettol-H, in comparison with that of a disinfectant already in-use in this hospital and having chlorhexidine gluconate (7.5%) + cetrimide (15%) + isopropyl alcohol (commercially available as Alpilon). The modified Capacity test of Kelsey-Sykes and In-use test of Kelsey-Maurer were carried out using control strains and random gram positive and gram negative bacterial isolates from clinical specimens. The two disinfectant solutions were analysed at three dilutions viz. weak, recommended and strong. From the study it could be inferred that both Dettol-H and Alpilon were equally effective in recommended and strong dilutions against the organisms tested. Weak dilutions were not effective in both and hence Dettol-H and Alpilon are effective only if used in prescribed concentrations.

Byssinosis in a Bombay textile mill.

BACKGROUND. Till a national campaign against dust-related lung diseases was launched by a voluntary agency in Ahmedabad in 1992, government records for the 150-year-old textile industry showed no cases of byssinosis--the disabling occupational disease caused by cotton dust. The worldwide incidence of byssinosis among workers in the dusty sections of textile mills is nearly 40%. We assessed the prevalence of byssinosis in a Bombay mill so that the Employees State Insurance Scheme would start conducting medical checks in all the 55 textile mills in Bombay and officially recognize the disease. METHODS. The study was conducted under the auspices of the Occupational Health and Safety Centre, a voluntary organization. Textile workers were called to a camp conducted over 3 nights and 3 days. We asked them to answer a questionnaire and tested their lung function using a Wright's ventilometer. The diagnosis of byssinosis was made if there was a feeling of chest tightness on exposure to cotton dust, and if the FEV1 was less than 60% of the expected result or the FEV1/FVC was less than 75%. RESULTS. Of the total 1075 workers in the mill only 273 came to the camp; 54 (30%) of the 179 individuals working in the dusty sections of the mill had byssinosis. In the non-dusty departments, 16 (17%) out of the 94 workers were affected. Among those working for less than 10 years in textile mills, 24% had byssinosis and among those working for more than 30 years, 45% had the disease. CONCLUSION. We found a prevalence of byssinosis among textile workers which is similar to that reported worldwide. The disease affected those who worked in both the dusty and non-dusty sections of the mill. There are an estimated 40,000 affected workers in Bombay and we suggest that the disease be recognized by the Employees State Insurance Scheme, and that the textile mill workers be compensated if they are affected by byssinosis.