Mid-term outcome of arthroscopic TightRope fixation of displaced lateral end clavicular fractures: Average follow-up of 6.1 years / 中华创伤杂志(英文版)

PURPOSE@#Various surgical modalities are available to treat Neer types 2 and 5 unstable fractures of lateral end clavicle but none of them are standardized. Arthroscopic fixation of the displaced lateral end clavicle fractures provides good short-term results but mid- to long-term outcomes are not available. The purpose of this study was to show the mid- to long-term radiological and functional outcomes of these fractures treated arthroscopically by a TightRope device, and to show the complications associated with this procedure.@*METHODS@#A retrospective study was conducted over 2 years from January 2014 to December 2015 with a minimum 5-year follow-up. Active patients aged 18-50 years with acute (less than 3 weeks) displaced fracture of lateral end of the clavicle, with a minimum 5-year follow-up were included in the study. Patients with associated fractures of the proximal humerus, glenoid, scapula and acromioclavicular joint injuries were excluded from the study along with open fractures and neurovascular injuries. The outcomes were assessed by objective (complications and radiographic examination) and subjective criteria (quick disabilities of the arm, shoulder and hand score, the Constant-Murley score and the visual pain analogue scale). The data were analyzed by SPSS version 21.0.@*RESULTS@#Totally, 42 patients were operated during the study period and 37 were available with a minimum 5-year follow-up. Thirty were male and 7 were female with a mean age of 29.5 years and a mean follow-up of 6.1 years. The mean quick disabilities of the arm, shoulder and hand score was 68.2 ± 4.6 preoperatively and 1.27 ± 2.32 at final follow-up (p < 0.001); the mean visual pain analogue scale score was 6.85 ± 2.2 preoperatively and 0.86 ± 1.60 at final follow-up (p < 0.001). The average Constant-Murley score was 93.38 ± 3.25 at the end of the follow-up. There were 2 fixation failures, with established non-union and 3 patients developed radiographic acromioclavicular joint arthritis.@*CONCLUSIONS@#Arthroscopic TightRope fixation of displaced lateral end clavicular fractures provides good radiological and functional outcomes at mid- to long-term follow-up. With the low complication rates and high patient satisfaction, this technique can be considered as a primary option in the surgical treatment of these fractures.

Problematic Mobile Phone Use Among Undergraduate Medical Students and Its Impact on Sleep Quality and Sleep Pattern

@#Introduction: Sleep deprivation is a concern in young adults and the use of mobile phone is very common in this population. This study aimed to measure and correlate the sleep quality, pattern of sleep and problematic mobile phone use in young medical students. Methods: A cross-sectional study was conducted using the Pittsburgh Sleep Quality Index (PSQI), Problematic Mobile Phone Use Scale (PMPUS) and Morningness-Eveningness Questionnaire (MEQ) among medical students in a Malaysian medical college. Correlation among the variables was done using bi-variate analysis followed by Pearson correlation coefficient and 2-tailed significance. A level for p ≤ 0.05 was considered as statistically significant. Results: We found significant positive correlation between poor sleep quality and total problematic mobile phone use as well as its sub dimensions, namely deprivation, adverse outcomes and control disorder. PSQI score showed significant negative correlation with different patterns of MEQ like moderate evening, late sleepers, moderate morning and early risers. Positive correlation of the PSQI with sub dimension of PMPUS reflects unhealthy dependency on mobile phone in this population. Conclusion: Our study revealed that the unhealthy use of mobile phone adversely affected sleep quality in the cohort of young medical students. It is thus important for medical schools to formulate policies and create educational programs vis-a-vis sleep health and to increase awareness regarding controlled mobile phone usage.

Post monsoon spatial distribution of uranium in water of Alaknanda and Ganges river

Uranium poses both chemical and radiological hazard to the living system. Drinking water from river is one of the major sources of uranium intake. Dissolution of minerals, washout from rain water, rock-water interaction, agricultural run off, and industrial disposals are some of the sources of uranium in river water system. Present study was aimed to determine the uranium in the water Alaknanda and Ganges rivers and its post-monsoon spatial distribution from Nandprayag to Haridwar. River water samples were collected during the post monsoon period in pre-washed polypropylene bottles from the designated locations at both of the rivers. Samples were filtered and analyzed by fluorimetric technique. The measurements showed the concentration of uranium in water of Alaknanda river varied from 3.05 micro g/l to 2.53 micro g/l along the downstream sampled locations with a mean value of 2.75 micro g/l, whereas in water of Ganges river the concentration varied in the range 1.70 micro g/l to 2.00 micro g/l with a mean value of 1.86 micro g/l. The average concentration of uranium was found significantly higher [2.75 micro g/l] in water of Alaknanda river than in Ganges river the average values [1.86 micro g/l] of. However, both the values were far lower than the permissible limits at the sampled locations. The values obtained in present studies were notably higher than that reported elsewhere which seems partly attributable to post monsoon contributing factors

Evaluation of preoperative Strepsils lozenges on incidence of postextubation cough and sore throat in smokers undergoing anesthesia with endotracheal intubation

Post-operative sore throat [POST] is an undesirable side effect of endotracheal intubation. Pharmacological and non-pharmacological measures have been utilized for minimizing the morbidity caused by POST. We have tested use of Strepsils lozenges in providing effi cacy for decreasing POST in smokers presenting for surgery under general anesthesia with endotracheal intubation. 100 patients, 20-65 years, American Society of Anesthesiologists [ASA] physical status I and II, either sex, history of smoking, posted for elective surgical procedure of more than 1 hour, requiring general anesthesia with endotracheal intubation were included and randomly divided into groups [n = 50] to receive Strepsils [Group A] and sugar candy [Group B]. The patients were assessed for cough, sore throat, and hoarseness of voice after extubation, 30 min, 12 hrs, and 24 hrs after extubation. At extubation no cough was seen in 39 [78%] patients [group A] compared to 23 [46%] patients [Group B], and mild cough in 22% [Group A] and 52% [Group B]. Incidence of sore throat at extubation was lower in group A compared to Group B [P = 0.04]. At other times of observations [30 min,12 hrs and 24 hrs] there was a significant decrease in incidence of sore throat in Group A compared to Group B [P = 0.000]. Hoarseness of voice was not observed in any patient in either group. Use of preoperative Strepsils lozenges decreases incidence of POST and maybe utilized as a simple and cost-effective measure for decreasing the symptoms of POST and increasing the satisfaction of patients.

Clinical vs. bispectral index-guided propofol induction of anesthesia: a comparative study

Clinically optimized focusing of drug administration to specific need of patient with bispectral index [BIS] monitoring results in reduced dose and faster recovery of consciousness. This study was planned with an aim to study and compare the conventional clinical end point or BIS on the requirement of dosage of propofol, hemodynamic effects, and BIS alterations following propofol induction. 70 patients, ASA I and II, 20-60 years undergoing elective surgical procedure under general anesthesia with endotracheal intubation were selected and divided into two groups. Group A received [inj.] fentanyl [2 micro g/kg], followed 3 min later by inj. propofol at the rate of 30 mg/kg/hr infusion till the loss of response to verbal command while group B received inj. fentanyl [2 micro g/kg], followed 3 min later by inj. propofol at the rate of 30 mg/kg/hr infusion. The end point of hypnosis was when the BIS value was sustained for 1 min at 48 +/- 2. The patients were intubated. Total induction dose of propofol was noted in each group. The value of BIS and hemodynamic parameters [heart rate, systolic/diastolic blood pressure] were noted at the time of loss of consciousness, at the time of intubation, and 1 min after intubation, thereafter every minute for first 10 min and thereafter every 10 min till end of surgery. Any involuntary muscle activity such as jerky movements, dystonic posturing, and opisthotonos were also recorded. The mean dose of propofol used in groups A and B were 1.85 +/- 0.48 mg/kg and 1.79 +/- 0.41 mg/kg, respectively. The dosage used in group B were less but not clinically significant [P=0.575]. On comparing the dosage of propofol in males among the groups there was a significantly lower dosage of propofol required in group B [2.06 +/- 0.45 mg/kg and 1.83 +/- 0.32 mg/kg, respectively, P=0.016]. This decrease however was not seen in female patients dosage being 1.65 +/- 0.44 mg/kg and 1.75 +/- 0.49 mg/kg, respectively [P=0.372]. The hemodynamic variables including heart rate, systolic/diastolic blood pressure and BIS were comparable within the group at induction, post-induction, and intubation. However, there was a significant increase in all the parameters at postintubation readings [P<0.001]. No significant difference in the induction dose of propofol was observed when assessed clinically [loss of verbal response] or by BIS monitoring. Traditional teaching to titrate the dose of propofol and depth of anesthesia during intubation by loss of verbal response is as good as BIS value monitoring

Long-term follow up of mesenchymal hamartoma of liver-single center study

Mesenchymal hamartoma of liver [MHL] is a rare liver tumor of childhood. About 200 cases have been reported till now. Most of the work on MHL is limited to case reports and there are not many long term follow-up studies. We present our 20 years of experience with this uncommon entity. This study aims to highlight clinical features, diagnosis and treatment of MHL. All patients with a diagnosis of MHL in last 20 years were included in this retrospective study. The patients were evaluated clinically, radiologically and pathologically. The total number of patients with a diagnosis of MHL was nine. Mean age of the patients was 19.89 +/- 2.75 months. Right lobe was involved in eight patients. The prominent clinical features were distension of abdomen and anorexia. Surgical options used were hepatic lobectomy, wedge resection and enucleation. Histopathology of the specimens showed cysts of variable size with normal hepatocytes, bile ducts and connective tissue stroma. Overall mortality was one [11.11%].: MHL is a benign tumor that can present with various clinical features. It should be differentiated carefully from other liver masses especially malignant ones. The diagnosis can be made with the help of radiology and histopathology. Adequate resection is curative in most of the cases and long-term follow up is satisfactory

Enzymatic quorum quenching increases antibiotic susceptibility of multidrug resistant pseudomonas aeruginosa

There is increasing emergence of multidrug resistant Pseudomonas aeruginosa [MDRPA] strains and drug resistance is positively-correlated with biofilm-forming ability. Since about 10% of P. aeruginosa genome is controlled by quorum sensing [QS], alteration in its antibiotic susceptibility by targeting QS was the focus of the present study. One day biofilms of PAO1 and three urinary tract infection MDRPA isolates [PA2, PA8 and PA18] were formed in 96-well microtiter plate. Biofilms were exposed to concentration gradient of ciprofloxacin and gentamicin to obtain Minimum Biofilm Eradication Concentration [MBEC] by direct enumeration method. Susceptibility of 24 h biofilms was evaluated by treatment with ciprofloxacin and gentamicin per se and in combination with lactonase. The effect was also examined on 72 h biofilms by Scanning Electron Microscopy. Lactonase treatment did not have any effect on growth of the selected strains but 73.42, 69.1, 77.34 and 72.5% reduction of biofilm was observed after lactonase [1 unit] treatment, respectively. Antibiotics in combination with lactonase [0.3 units] resulted in an increased susceptibility of the biofilm forms by > 3.3, 4, 5 and 1.5 folds of MBEC, for ciprofloxacin and > 6.67, 12.5, 6 and > 2.5 folds, for gentamicin respectively, which could be due to the disruption of biofilm by lactonase treatment as shown by scanning electron microscopy. Also there was significant reduction [p < 0.001] in virulence factor production by the strains. Lactonase treatment increased antibiotic susceptibility of the biofilms of MDRPA isolates underscoring the potential of quorum quenching in antimicrobial therapeutics

Intra and postoperative outcome of adding clonidine to bupivacaine in infraorbital nerve block for young children undergoing cleft lip surgery

To evaluate the efficacy of adding clonidine to bupivacaine in bilateral infraorbital nerve block for hemodynamic changes, requirement of opioids, volatile agent, and muscle relaxants intraoperatively and relief of pain postoperatively . Prospective, randomized, double-blind study. Fifty pediatric patients aged less than 24 months undergoing elective cleft lip repair were randomly allocated to two groups of 25 each. After tracheal intubation, group A received bilateral infraorbital nerve block with 1 ml solution of clonidine [1 micro g/kg] and bupivacaine 0.25%, and group B received 1 ml of 0.25% bupivacaine. Hemodynamic parameters, intraoperative requirement of volatile anesthetic agent, muscle relaxant, and analgesic were recorded. Pain was assessed postoperatively using the Face, Legs, Activity, Cry, Consolability scale till the first rescue drug was given. Two sample unpaired t-test and the correlation r test. The duration of analgesia from the time of administration of block in group A was 667.72 +/- 210.74 min compared to 558.48 +/- 150.28 min in group B [P<0.05]. Addition of clonidine as an adjunct to local anesthetic significantly decreased the requirement of other anesthetic drugs and significantly prolonged the duration of postoperative analgesia without any adverse effects

Comparison of intrathecal sufentanil and morphine in addition to bupivacaine for caesarean section under spinal anesthesia

Co-administration of small dose of opioids with bupivacaine for spinal analgesia is advocated because of synergistic action between local anaesthetics and opioids, leading to reduction in doses, intraoperative discomfort and postoperative analgesic requirement. We compared the effects of intrathecal sufentanil with intrathecal morphine, when added to bupivacaine for caesarean sections, Sixty ASA I and II parturients, undergoing caesarean section under spinal anaesthesia, were randomly allocated into three groups of 20 each to receive either injection [inj.] bupivacaine 12 mg [Group I], which was labelled as the control group; inj. bupavacaine 12mg + inj sufentanil lOmcg [Group II] or inj. bupavacaine 12 mg + morphine 0.2mg [Group III] in a double blind clinical trial. The parameters studied were the time of onset, sensory level of the block achieved, total duration of analgesia, any need of rescue analgesics, maternal side effects and foetal outcome. Mean duration of analgesia [hrs] was higher in group III as compared to group I and group II [15.9 +/- 0.96 VS. 1.95 +/- 0.55 and 5.83 +/- 0.39 respectively]; total duration of analgesia was significantly longer with the use of sufentanil and morphine as compared to control [5.83 +/- 0.39 and 15.91 +/- 0.96 vs. 1.95 +/- 0.55]. Onset of block was significantly faster with use of sufentanil in Group II [1.92+0.27] vs. Group I and II [4.64 +/- 0.28 and 4.50 +/- 0.22 respectively]. Analgesia was significantly better with the use of opioids compared to control as no additional analgesic were required in both groups. Side effects with insignificant difference noted were hypotension, nausea, and shivering. However, vomiting had a higher incidence in Group I [8[40%] vs. 1[5%] and 6[30%]]; and the incidence of pruritis and somnolence was higher [6[30%]] in Group II as compared to Group III [2[10%] and 1[5%] respectively]. No adverse effects on foetus were seen with use of opioids and comparable Apgar scores were noted. Addition of small doses of sufentanil or morphine to intrathecal bupivacaine is suitable for use in caesarean section, providing rapid onset and prolonged analgesia but with some side effects like pruritis and somnolence

Study of post dural puncture headache with 27g quincke and whitacre needles in obstetrics / non obstetrics patients

The proposed study was carried out in the department of Anaesthesiology, Intensive care and Pain management, Himalayan Institute of Medical Sciences. Swami Rama Nagar, Dehradun. A total of 120 patients of ASA I and II obstetric and non-obstetric undergoing elective/emergency surgery under subarachnoid block were included under the study. To evaluate the frequency of PDPH during spinal anaesthesia using 27 gauge Quincke vs 27G whitacre needle in obstetric/non obstetric patient. In our study patients were in the age group of 15-75 years. Most of the patients in our study belong to ASA Grade I. There was 2%, 1%, 4%and 3%hypotension in-group A, B, C,D respectively. There was 2%, 4% shivering in-group A,C respectively and 1% each in group B,D. In our study failed spinal with 27G Quincke needle was in one case [3.33%] in-group C where successful subarachnoid was performed with a thicken spinal needle 23G Quincke. There was no incidence of PDPH in-group A and D, while 1[2%] patient in-group B and 2[4%] in group C. All the three patients were for lower section caesarean section and were young and had undergone more than one attempt to perform spinal block. The headache severity was from mild to moderate and no epidural blood patch was applied

Cell and tissue culture of dracaena sanderiana sander cx mast a review

Dracaena sanderiana is a well known indoor ornamental plant. Few species of Dracaena possess some medicinal properties. Despite many uses, not enough attention has been paid to in vitro studies. In this present communication several aspects of cell and tissue culture of Dracaena sanderiana has been discussed and summarized

Comparative evaluation of intravenous propofol, thiopentone sodium and ketamine for short surgical procedures

The increasing popularity of outpatient surgery has prompted the search for new anaesthetic agent that can provide safe and effective anaesthesia with a rapid and smooth recovery We compared three induction agents, namely propofol, thiopentone sodium and ketamine to find the most suitable agent for this purpose. This prospective study was conducted at HIMS, Dehradun on 90 ASA I, II patients of either sex and in age group 16-65 years undergoing minor surgical procedures under general anaesthesia not requiring endotracheal intubation. The patients were randomly allocated into three groups of 30 patients to receive either inj propofol 2-2.5 mg/kg 1V [Group A], inj thiopentone 3-5 mg/kg IV [Group B], or inj ketamine 1-2 mg/kg IV [Group C]. It was noted that the induction time was shortest with Inj thiopentone and recovery was quickest with Propofol. Heart rate, SBP, DBP decreased with injection thiopentone and Propoiil being more in case of injection Propofol in comparison to injection to thiopentone. Inj Ketamine led to increase in all the parameters. Propofol is an ideal choice for short surgical procedures

Saraca indica leaf powder for decontamination of Pb: removal, recovery, adsorbent characterization and equilibrium modeling

The present study explores the effectiveness of Saraca indica leaf powder, a surplus low value agricultural waste, in removing Pb ions from aqueous solution. The influence of pH, biomass dosage, contact time, particle size and metal concentration on the removal process were investigated. Batch studies indicated that maximum biosorption capacity for Pb was 95.37% at the pH 6.5. The sorption process followed the first order rate kinetics. The adsorption equilibrium data fitted best to both Langmuir and Freundlich isotherms. Morphological changes observed in scanning electron micrographs of untreated and metal treated biomass confirmed the phenomenon of biosorption. Fourier transform infrared spectroscopy of native and exhausted leaf powder confirmed lead biomass interactions responsible for sorption. Acid regeneration was tried for several cycles with a view to recover the sorbed metal ion and also to restore the sorbent to its original state. The findings showed that Saraca indica leaf powder can easily be envisaged as a new, vibrant, low cost biosorbent for metal clean up operations

Effect of microbial contaminants on triphala drug efficacy during storage and enhancement of therapeutic spectrum of the drug in vitro

Present paper deals with the efficacy of Triphala churna extracts, extracted by using different processes viz. Chi-Pien Chen, Boiled [aq.], Alcoholic and Cold against five bacterial test organisms i.e. Salmonella typhi, Escherichia coli, Sarcina lutea, Bacillus megatcrium and Bacillus species by seeded agar diffusion method and its microflora during storage period of six months. Strength of the drug in terms of unit strength was also investigated. Positive correlation between concentration and efficacy of the drug was recorded in beginning. Maximum drug efficacy of the drug was found at 100% concentration followed by 75%, 50% and 25% respectively. Behaviour of drug efficacy of different types of extracts could not yield any definite pattern against all bacterial test organisms in relation to drug storage period. Maximum drug efficacy was found at zero day against S. typhi in case of Chi-Pien Chen and boiled extract while this value was recorded at two months storage period for some bacterial test organisms. A gradual declined trend of drug efficacy was noted in alcoholic and cold aqueous extracts with the duration of drug storage for all test organisms. A trend of regular enhancement of microbial flora during storage period was found. Negative correlation between drug efficacy and microbial load of the drug could be established

Chemical analysis of drinking water of villages of Sanganer, Tehsil, Jaipur District

Due to pressure of human activity, urbanization and industrialization, the groundwater sources are degraded gradually; therefore pure, safe, healthy and odorless drinking water is a matter of deep concern. There are many pollutants in groundwater due to seepage viz. organic and inorganic pollutants, heavy metals, pesticides, fluorides etc. In Rajasthan state, all 32 districts are affected with high fluoride concentration in groundwater and among these Jaipur ranks second. The drinking water samples were collected in clean polyethylene plastic containers from villages [Code No. 51-100] of Sanganer Tehsil of Jaipur District. The water samples were analysed for pH, Fluoride [F-], Electrical Conductivity [EC], Total Dissolved Solid [TDS], Calcium [Ca], Magnesium [Mg], Total Hardness [TH], Chloride [Cl-], Carbonate [CO3-2], Bicarbonate [HCO3-], Alkalinity, Sodium [Na+], Potassium [K+] and Nitrate [NO3-using standard techniques in laboratory [APHA, 1985]. The results revealed that most of the water samples were below or out of limited; according to the WHO standards [1996]. The fluoride concentration ranged from 0.4 to 5.4 ppm, where 42% samples showed fluoride less than permissible limit and 48% water samples were within optimum limit i.e. 1-1.5 ppm while 10% samples contained Fluoride higher than permissible limit. pH of all the samples were within limit [6 to 9.2], while EC of all the water samples were out of limit i.e. 300 micro mhos/cm. The alkalinity was greater than permissible limit [200 mg/l] in 98% villages and only 2% villages had below than optimum limit. The NO3- concentration was less than permissible limit [45 mg/l] in 64% villages whereas 26% samples showed higher concentration of NO3-. However only 10% samples contain optimum level of nitrate. Moreover Na concentration was greater than permissible [50 to 60 mg/l] limit in 98% water samples whereas K+ concentration was below the optimum [20 mg/l] level in all the samples studied. The results revealed that the quality of drinking water of Sanganer is very poor, which can be used for drinking and cooking only after prior treatment

Comparison of pharmacokinetics of two preparations of cyclosporine in end stage renal disease patients on maintenance haemodialysis

To compare the pharmacokinetics and tolerability of two preparations of cyclosporine. The bioavailability of two preparations of cyclosporine [Panimun Bioral, Panacea Biotec India and Sandimmun Neoral, Novartis Switzerland] was compared in 10 adult patients of ESRD on maintainence haemodialysis by enzyme multiplied immunoassay technique [EMIT] after 6.5 days of cyclosporine [5 mg/kg body weight/day in two divided doses] of either brand, with a clearance period of one week in between the two. Area under the curve [AUC], maximum whole blood concentration [Cmax], time to achieve Cmax [Tmax], half life [T1/2], constant of elimination [Kel] was calculated by computer software programme [PK Solutions]. The relative bioavialability of Panimun Bioral was 93%. The AUC [0-12] hours. Cmax Tmax, T1/2 and Kel was not statistically significantly different and side effects with both were minimal. The two preparation were bioequivalent

Studies on transition metal complexes of Schiff's Base derived from salicylaldehyde and 2-amino 4-phenyl oxazole

Recently a large number of work on heterocyclic transition metal complexes and their antifungal activity have been studied in this Laboratory and survey of literature revealed that no work has been done in the structural and fungicidal activity of transition metal complexes of Schiff's base derived from 2-amino 4-phenyl oxazole and salicylaldehyde. This note deals with the study of structural and fungicidal activity of transition metal complexes of Co [II], Cu [II], and Ni[II] with Schiff's base 2-amino-4-phenyl oxazole and salicylaldehyde. The newly synthesised complexes were also screened for their antifungal activity against different fungi viz; Phoma exiaua, Macrophomia phoseoli and Colletatrichum-capsici at 100, 50 and 20 ppm