A prospective observational study on prevention of contractures of upper limb following burn

Background: Over 1 lakh people are affected by burn every year in India and 20 thousands of them die per year. Post burn contracture is a common sequele occurring after burn. Upper limb contractures are also occurring more commonly because it is most mobile part of body and likely to be involved in burn. There are many studies on management of post burn contractures but literature about prevention of contracture is little, hence this study was conducted. The aim of this study was to recognise various preventive measures to prevent post burn contractures of upper extremity.Methods: This study was conducted in NSCBM Subharti Medical College and Hospital located in Meerut (North India) from October 2012 to October 2014 in Department of Surgery. It was a prospective observational study consisted of 80 cases who presented as acute burn of upper limb admitted in the hospital.Results: In our study early excision with skin grafting was done in 20 patients (25%) while delayed skin grafting was done in 25 patients (31%) while 35 patients (44%) were managed conservatively. In our study 20 patients reported back with a post burn contracture. The reason found was non-compliance to antideformity splint and physiotherapy.Conclusions: Early surgical management of deep burns, physiotherapy, anti-deformity position and proper splintage can significantly reduce the development of post burn contracture.

Bilateral Cavitary Lung Adenocarcinoma In A Young Lady: A Rare Case Report With Review Of Literature

A mucinous variant of bronchioloalveolar carcinoma is described as a rare variant of invasive adenocarcinoma and is characterized radiologically by consolidation, groundglass opacity, and nodules. Here, we report the case of a young lady with multiple cavitary disease presented with respiratory failure and mimicking as tuberculosis, pneumonia, vasculitis but initial laboratory investigations and bronchoscopy couldn’t clinch the diagnosis. Later on, CT-guided biopsy confirmed the diagnosis of mucinous bronchoalveolar carcinoma. Immunohistochemistry for TTF-1, EGFR, ALK, ROS mutation had been sent but the patient requested to discharge, have been put on EGFR inhibitor Gefitinib 250 mg once a day considering adenocarcinoma, female, Asian origin but couldn’t turn-up to review further details. The clinician should be aware of the cavitary presentation of adenocarcinoma of lung even in younger patients where the most common differential is tuberculosis

A rare mediastinal tumor-fat-forming solitary fibrous tumor

Solitary fibrous tumor is uncommon spindle cell mediastinal tumor arising mainly from pleural surface. Authors discuss a clinic-radiological features of Fat forming SFT which is rare variant of SFT in 70yrs old male patients. Initially we kept differential of Liposarcoma, Lymphoma on clinico-radiologically features but later after histopathology and Immunohistochemistery turns out to be Solitary fibrous tumor. Here accurate classification is important as SFT classified as intermediate type (rarely malignant), require wide surgical excision with close follow-up.

Postural & striatal deformities in Parkinson`s disease: Are these rare.

Parkinson`s disease (PD) is the most common neurodegenerative disease and is characterized by tremor, rigidity and akinesia. Diagnosis is clinical in the majority of the patients. Patients with PD may have stooped posture but some of them develop different types of postural and striatal deformities. Usually these deformities are more common in atypical parkinsonian disorders such as progressive supranuclear palsy and multisystem atrophy. But in many studies it has been highlighted that these may also be present in approximately one third of PD patients leading to severe disability. These include antecollis or dropped head, camptocormia, Pisa syndrome, scoliosis, striatal hands and striatal toes. The pathogenesis of these deformities is a complex combination of central and peripheral influences such as rigidity, dystonia and degenerative skeletal changes. Duration of parkinsonism symptoms is an important risk factor and in majority of the patients these deformities are seen in advanced statge of the disease. The patients with such symptoms may initially respond to dopaminergic medications but if not intervened they may become fixed and difficult to treat. Pain and restriction of movement are most common clinical manifestations and these may mimick symptoms of musculoskeletal disorders like rheumatoid arthritis. Early diagnosis is important as the patients may respond to adjustment in dopaminergic medications. Recent advances such as deep brain stimulation (DBS) and ultrasound guided botulinum toxin injection are helpful in management of these deformities in patients with PD.

Effect of ANXA2 gene single nucleotide polymorphism (SNP) on the development of osteonecrosis in Indian sickle cell patient: A PCR-RFLP approach.

Osteonecrosis is a serious complication in sickle cell patients. The common sites of the necrosis are femoral head, head of the humerus and acetabulam. Annexin A2 (ANXA2) protein mainly functions in bone formation and bone resorption. Alteration of ANXA2 gene may affect the manifestations of osteonecrosis in the patients. PCR-RFLP is a common applicable technique for the detection of known mutation/polymorphisms. Here we are presenting application of the PCR-RFLP technique for determination of the ANXA2 gene single nucleotide polymorphism frequency and their clinical association among Indian sickle cell patients. Five known SNPs of ANXA2 gene (rs7170178, rs73435133, rs73418020, rs72746635 and rs73418025) were determined using the HpyCH4V, DdeI, HpyCH4III and Sau 961 restriction enzyme respectively. Restriction enzyme DdeI was common for rs73435133 and rs72746635 SNP. Only the rs7170178 SNP was detected among patient and control and the other four SNPs were absent in the studied groups. The frequency of ANXA2 gene rs7170178 SNP (A/G, G/G) was comparatively higher in sickle cell patients than controls and it was clinically associated with sickle cell osteonecrosis. The P value of heterozygotes (A/G) and homozygotes (G/G) genotypes were <0.001 and 0.001 respectively, which were highly significant. This study established the application of PCR-RFLP in detection of ANXA2 SNPs in sickle cell patients.

Challenges in neurological practice in developing countries.

The burden of neurological illness is much higher in developing countries. Neurological disorders in these countries are mainly due to poverty and malnutrition. Spectrums of diseases are also different in comparison with developed countries. Lack of resources, ignorance, and overpopulation make it very difficult and challenging to tackle this problem. Majority of the patients are seen by general practitioners who have little knowledge about neurological illnesses. Most of the countries have very few or no neurologist. There is a greater need of taking neurological care at primary care level where majority of the patients struggle with epilepsy, stroke and neuroinfections.

Molecular characterization of hemoglobin D Punjab traits and clinical-hematological profile of the patients / Caracterização molecular dos traços de hemoglobina D Punjab e perfil clínico-hematológico dos pacientes

CONTEXT AND OBJECTIVE: Hemoglobin (Hb) D hemoglobinopathies are widespread diseases in northwestern India and usually present with mild hemolytic anemia and mild to moderate splenomegaly. The heterozygous form of Hb D is clinically silent, but coinheritance of Hb D with Hb S or beta-thalassemia produces clinically significant conditions like thalassemia intermedia of moderate severity. Under heterozygous conditions with coinheritance of alpha and beta-thalassemia, patients show a degree of clinical variability. Thus, our aim was to molecularly characterize the Hb D trait among individuals who were clinically symptomatic because of co-inheritance of alpha deletions or any beta-globin gene mutations. DESIGN AND SETTING: This was a cross-sectional study conducted in an autonomous tertiary-care hospital. METHODS: Complete blood count and red cell indices were measured using an automated cell analyzer. Quantitative assessment of hemoglobin Hb F, Hb A, Hb A2 and Hb D was performed by means of high performance liquid chromatography (HPLC). DNA extraction was done using the phenol-chloroform method. Molecular analyses on common alpha deletions and common beta mutations were done using the Gap polymerase chain reaction and Amplification Refractory Mutation System, respectively. RESULTS: We evaluated 30 patients and found clinical variation in the behavior of Hb D traits. In six patients, the Hb D traits were clinically symptomatic and behaved like those of thalassemia intermedia. Molecular characterization showed that three out of these six were IVS-1-5 positive. CONCLUSIONS: HPLC may not be the gold standard for diagnosing symptomatic Hb D Punjab traits. Hence, standard confirmation should include molecular studies.

CONTEXTO E OBJETIVO: Hemoglobinopatias da hemoglobina (Hb) D são doenças amplamente disseminadas no noroeste da Índia e geralmente se apresentam com anemia hemolítica leve e esplenomegalia leve a moderada. A forma heterozigótica de Hb D é clinicamente silenciosa, mas co-herança de Hb D com Hb S ou beta-talassemia produzem condições clinicamente significativas, como talassemia intermediária de gravidade moderada. Em condição heterozigótica com co-herança de alfa e beta-talassemia, pacientes mostram variabilidade clínica. Assim, nosso objetivo foi a caracterização molecular dos traços da Hb D em individuos clinicamente sintomáticos, devido à co-herança de deleções de alfa ou quaisquer mutações gênicas de beta-globina. TIPO DE ESTUDO E LOCAL: Estudo transversal; realizado em um hospital de cuidado terciário autônomo. MÉTODOS: Hemograma completo e índices de células vermelhas foram medidos pelo analisador automatizado de células. Avaliação quantitativa de hemoglobina Hb F, Hb A, Hb A2 e Hb D foi realizada por cromatografia líquida de alta eficiência. Extração de DNA foi feita pelo método de fenol-clorofórmio. Estudo molecular para deleções comuns de alfa e mutações comuns de beta foi feito por Gap-reação em cadeia da polimerase e amplificação refratária de mutação, respectivamente. RESULTADOS: Avaliamos 30 pacientes e verificamos variação clínica no comportamento dos traços da Hb D. Em seis pacientes, os traços da Hb D foram clinicamente sintomáticos e se comportavam como os de talassemia intermédia. A caracterização molecular mostrou que três desses seis pacientes eram IVS-1-5 positivos. CONCLUSÕES: HPLC pode não ser o padrão ouro para o diagnóstico de traços de Hb D Punjab sintomáticos. Assim, a confirmação padrão ouro deve incluir estudos moleculares.

Post-traumatic dissecting aneurysms of bilateral cervical carotid arteries with delayed complications.

Carotid dissection is an uncommon complication of trauma. They can present with immediate or delayed complications. We describe the case of a young patient with bilateral carotid dissections and acute infarcts. Brief review of literature and treatment options are discussed.

Congenital lung hernia.

We report a case of a congenital atraumatic lung hernia who underwent a successful operation.