Hemiarthroplasty in geriatric population with neck femur fracture: A retrospective study of 43 cases

Introduction: Hip fractures in the elderly have represented a major public health concern. Studies have shown that over 90% of the patients having these fractures are people of more than 50 years. These fractures have been classified according to their anatomical location into the neck of femur fracture, intertrochanteric fracture, and subtrochanteric fracture. The neck of femur fractures is associated with high mortality in the elderly compared to young adults. Surgical treatment is an established gold standard, with the option being osteosynthesis and hip replacement. Hemiarthroplasty is one of the gold-standard treatments chosen for the geriatric age group and has yielded universally acceptable results. Materials and Methods: The study evaluates the clinical, radiological, and functional outcomes of hip hemiarthroplasty in elderly with fracture neck of the femur Data of patients above 60 years who were operated on for fracture neck of the femur by bipolar hemiarthroplasty from May 2018 till December 2021were retrieved from the Medical Records Department of SCL Municipal General Hospital, affiliated to NHL Municipal medical college. The patients fitting the inclusion criteria were selected for the study. The sample size was calculated to be 43. Data were collected from the inpatient files, and then patients were asked to complete the questionnaire form during the final follow- up. All the patients were evaluated clinically and radiologically during the follow-up, and the functional outcome was assessed using the Harris Hip Score. Thirty-five patients had a domestic fall as the mode of injury. The lateral decubitus position of all patients was used during the operation that was performed using the Southern Moore approach. Forty patients received cemented femoral stems; the remaining three received press-fit ones. Results: The average age was calculated to be 71.86 years with the male-to-female ratio of 1: 1.15 with an average follow-up of 12.7 months. Eight patients had acetabular erosion at the end of 1 year. There was no femoral stem malalignment or aseptic loosening at the final follow-up. Nine patients had excellent Harris Hip scores, and five had fair scores. The remaining 29 patients had good Harris hip scores. Bipolar hemiarthroplasty has served us well in the study. Forty-one patients were able to get back to their preinjury functional level. Only one patient reported major pain in the hip at the final follow-up. In this study, there was no incidence of dislocation or revision surgeries. Conclusion: The present study modular bipolar hemiarthroplasty provides better pain relief with early mobilization and a good level of return to daily routine activities with minimal complications.

Prevalance Of Radiological Investigation In Low Back Pain - An Observational Study

Introduction: Lumbar spine pathology is major healthcare burden encountered in district and urban hospitals. Diagnostic imaging in these patients is not always indicated. Imaging is considered in those patients who show little or no improvement in their LBP after approximately six weeks of medical management with or without physical therapy, the current study was undertaken to assess the appropriateness of LBP imaging in primary care following the ACP guidelines. The inclusion criteria for the study were adult patients with persistent low back pain with orMethod: without radiculopathy post six weeks of medical management affecting their activity of daily living. And the exclusion criteria were spinal trauma , neurological impairment, bladder and bowel involvement, spinal malformations, history of malignancy presenting at the time of index visit. The study included total 115 patients. Out of 115 patients 87Result: [70%] patients showed abnormal finding on the radiographs. The most common abnormal finding was disco vertebral degeneration such as spondylosis (osteophyte formation) in 49.6%. Routine x-ray imaging in low backConclusion: pain patients is not always warranted. Moreover routine radiological imaging methods are not associated with meaningful clinical outcomes for the patients. Unnecessary imaging can lead to harmful radiation exposure of the patients and can further lead to additional medical expenditure and needless surgical intervention. Diagnostic radiological imaging should be used judicially.

Incisional Hernia: A Comprehensive Study on the Incidence and Management of Abdominal Incisional Hernia

Background and objectives: Incisional hernia is the one true iatrogenic hernia. The Incisional hernia occurs in less than 5-11% of patients subjected to abdominal operation. Incisional hernia usually starts within few months after surgery, as a result of failure of the lines of closure of the abdominal wall following laparotomy. If left unattended they tend to attain large size and cause discomfort to the patient. This study has been undertaken to assess the magnitude of this problem, various factors leading to development of this condition and the different modalities of treatment practiced in our set up. Methodology: The present study was conducted at the Department of General Surgery; AMC MET Medical college and Seth L. G. Hospital Ahmedabad, in which 60 patients of incisional hernia were treated during June 2018 to April 2020. Interpretation and Conclusion: Successful repair relies on knowledge of the dynamics of the abdominal wall, thorough technical execution, appropriate selection of synthetic or bioprosthetic material, and constitution of surgical team. Though laparoscopic repair has been demonstrated to be safe and a more resilient repair than open repair, open mesh repair remains a suitable alternative.

Liver Injury in Abdominal Trauma: Management and Association with Other Solid Abdominal Organ Injury

Background and objective : Blunt abdominal injury remains one of the commonest injuries. The solid organs, namely the Liver, Spleen & Kidney are the most commonly injured intra-abdominal organs. Non operative line of management is now considered the line of treatment for patients with intra-abdominal organ injury who are hemodynamically stable. In the case of polytraumatized patients with open or blunt abdominal trauma, the liver is the most frequently injured abdominal organ. Earlier, surgical treatment was the standard procedure globally for all kinds of trauma-related liver injuries. However, development of new interventional radiological techniques has changed the paradigm towards a non-surgical patient management. Methodology: An observational study of 50 patients with solid organ injuries of the abdomen following abdominal trauma admitted over a period from July 2018 up to August 2020 was carried out. Patient management either operative or conservative was decided on basis of hemodynamic status and they were divided in groups OP (Operated) and NOM (Non Operative Management). Interpretation and conclusion : In our study, majority of liver injury were treated conservatively. Splenic injury patients were mostly managed by operative intervention and renal injury patients were managed according to grading of organ injury.

Management Modalities of Choledocholithiasis: Endoscopic Retrograde Cholangiopancreatography Versus Open Common Bile Duct Exploration and Laparoscopic Cholecystectomy

Background and Objective : Common bile duct stone typically requires surgical intervention, which primarily involves open CBD exploration + Laparoscopic cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic CBD exploration. Open CBD exploration has multiple complications, high mortality rate and long recovery time. Methodology : A total of 50 cases presenting as choledocholithiasis between July 2018 to August 2020 were taken for study. 1st group of 20 patients underwent open cholecystectomy with open CBD exploration. 2nd group of 20 patients underwent ERCP followed by interval (6 weeks) laparoscopic cholecystectomy. Results : ERCP found to be better when compared with open CBD exploration in terms of less post-operative complications (5% in ERCP vs 20% in Open CBD exploration) and less mean duration of hospital stay(5 days in ERCP vs 8 days in Open CBD exploration). Interpretation and Conclusion : For management of CBD stone patient, gold standard treatment is ERCP followed by Laparoscopic Cholecystectomy. While in patients with incomplete clearance of CBD stone after ERCP, CBD exploration either laparoscopically or by open approach should be preferred. While in patients with CBD stone greater than 2 cm size, direct open CBD exploration is the preferred option380008

Evaluation of post partum intrauterine contraceptive device versus interval intrauterine contraceptive device insertion

Background: Family planning is important not only for population stabilization, but it has been increasingly recognized as central tool to improve maternal and neonatal health. Aim of current study was to compare interval and post partum intrauterine contraceptive device (IUCD) insertion in terms of effectiveness and safety.Methods: This was a prospective observational cohort study, done in the department of Obstetrics and Gynecology, GMERS Medical College, Sola, Ahmedabad, from August 2015 to April 2017 was taken for evaluation. 80 women in each group who were inserted IUCD after delivery and in the interval period were studied. Outcome was measured by expulsion rate, continuation rate, and incidence of dysfunctional uterine bleeding (DUB), Pelvic inflammatory disease (PID), failure rate and effect on puerperium.Results: Expulsion rate in PPIUCD group was 8.75% while in interval IUCD group it was 1.25%. Continuation rate following Postpartum intrauterine contraceptive device (PPIUCD) and interval IUCD insertion was 86.25% and 95% respectively. Incidence of bleeding per vaginum (menorrhagia) was 7.5% in PPIUCD group while 8.75% in interval IUCD group. There was one case 1.25% of PID in interval IUCD group while no case in PPIUCD was noted. Failure rate was nil in both the group. There was no effect on puerperium following PPIUCD insertion group during present study.Conclusions: PPIUCD is an effective and safe spacing method of contraception as compared to interval IUCD insertion. There is no statistically significant change in incidence of expulsion rate, continuation rate and other complications in both the group.

Prevalence of Dry Eye Disease in Western India

Introduction: Dry eye disease (DED), as defined by thedry eye work shop (DEWS II) guidelines, is a multifactorialdisease with various etiologies ranging from instability andhyperosmolarity of the tear film, inflammation and damageof the ocular surface and neurosensory abnormalities. Studywas done with the purpose to report the prevalence of dry eyedisease (DED) in western India.Material and Methods: This was a cross sectional studyconducted from April 2018 to March 2019. Patients fromoutpatient department > 18 years of age were selected basedon systematic random sampling. The ocular surface diseaseindex (OSDI) questionnaire was explained to the patientsand asked to fill-up and the total OSDI score was calculated.Based on the OSDI scoring, DED prevalence was calculated.Demographic details of the patients were noted and comparedbetween all patients and those with DED.Results: Of the 578 patients included in the study, 198patients (34.26%) had DED. Of those, 95 (47.98%) patientshad mild DED, 63 (31.82%) had moderate DED and 40(20.20%) had severe DED. The mean age of patients withDED was 50.63±18.69 years. Females (54.04%) were morecommonly affected compared to males (45.96%). There wassignificant difference in mean age among the total patientsand DED patients (P= 0.03). The gender ratio was notsignificantly different among total patients and DED patients(P=0.17).Conclusion: The hospital-based prevalence of DED inwestern India is 34.26%. The disease is more common inelderly females.

Comparison of Nepafenac Plus Steroid Versus Steroid Alone for Control of Ocular Inflammation after Phacoemulsification

Introduction: Cataract is the most common surgicalprocedure. Study was done to compare the effect of nepafenac0.1% plus prednisolone 1% vs prednisolone 1% alone incontrolling ocular inflammation after phacoemulsificationMaterial and Methods: A total of 140 patients wererandomized to receive prednisolone 1% (group I) vsnepafenac plus prednisolone 1% (group II) after uneventfulphacoemulsification. Patients were examined on first day,one week and one month for vision, slit lamp evaluation foranterior segment inflammation and cystoid macular edema.Results: Average visual acuity was 6/9 in both groups.Anterior segment inflammation was significantly less in groupII on first post operative day. On later visits, there was nosignificant difference in inflammation in both groups. CMEwas not seen in any group.Conclusion: This study suggests that addition of nepafenac0.1% to prednisolone 1% significantly reduces the intraocularinflammation after phacoemulsification in the earlypostoperative period.

Laparoscopic repair of perforated peptic ulcer: Our experience.

Laparoscopy is an important milestone in the history of surgery. Almost all abdominal surgeries can now be approached laparoscopically. Laparoscopic perforated duodenal ulcer (DU) repair has been shown to be feasible. However, whether its superior to open repair is yet to be established and has not become the standard of care. Laparoscopy offers better visualization and early recovery.

Laparoscopic appendicectomy surgery using spinal anesthesia.

Laparoscopic abdominal surgery is conventionally done under general anesthesia. Spinal anesthesia is usually preferred in patients where general anesthesia is contraindicated. We have presented here our experience using spinal anethesia as the first choice for laproscopic surgery for ever 2 years with the contention that it is good alternative to genral anesthesia.

Design and evaluation of famotidine mucoadhesive nanoparticles for aspirin induced ulcer treatment

The present study was performed to design and evaluate the famotidine loaded mucoadhesive nanosuspension for aspirin induced ulcer. A 3-factor, 3-level Box-Behnken design was applied to study the effects of amount of the beads (X1), PVPK-30(X2) and Tween-80 (X3) on the particle size (Y1), and cumulative percentage drug released after 1h (Y2). The optimization was performed using the desirability function and contour plots. The scanning electron microscopy (SEM) showed the nanoparticles as spherical in shape. The differential scanning calorimetry (DSC) analysis indicated that there was substantial crystallinity change in the nanoparticle compared with the pure drug. Ex-vivo mucoadhesion study showed that famotidine mucoadhesive nanoparticles possessed higher mucoadhesion than the famotidine nanoparticles. The in vivo studies on aspirin-induced rats indicated the lowering in ulcer index for famotidine mucoadhesive nanoparticles was 0.46+0.011, which was significantly better than the effect of traditional famotidine suspension (0.66+0.035). Famotidine mucoadhesive nanosuspension could be prepared using the media milling technique and allowing significant reduction in ulcer index compared to famotidine suspension.

Profile of fatal two wheeler accidental cases in Ahmedabad.

Background and objective: In these days of fast life every person wants to save his/her time. But unfortunately some becomes victim of accidents. Objective of this study is to analyze age, sex and time distribution, area of accidents, type of rider and protection used in deceased in two wheeler road traffic accidents. Methodology: The present study was conducted in the department of Forensic Medicine, B.J. Medical College, Ahmedabad. The study included 100 cases of fatal two wheeler accidents occurred during the time between January 2011 to June 2011. Results: in the two wheeler accidental deaths most commonly involved age group is 31-40, males are predominant, more in urban area, drivers are more affected, occur more in evening time and non protected are more affected. Conclusion: it can be concluded that careful driving should be done at the evening time, and Helmet/protection must be used and everyone must follow the traffic rules.

Analysis of homicidal deaths in and around Bastar region of Chhattisgarh.

FREEDOM FROM VIOLENCE, not necessarily proportional with development in some basic capabilities like nutrition, longevity and literacy which positively related to economic growth. So, dealing with violence in society is intrinsically a matter of public interest. In present study 79 cases of homicidal deaths due to different mechanical injuries was studied in two year period from 1/1/2009 to 31/12/2010. The incidence of homicidal death was 9.13% during this period. Males affected more in comparison to females. Majority of cases were fall in 21-40 yrs. of age comprising 50 cases (63.28%).Injuries by blunt weapons commonly observed in 30 cases (37.97%) which followed by injuries by sharp weapons 19 cases (24.05%). Totally 329 sharp injuries observed in comparison to 152 blunt injuries. Incidences were prevalent at dense forest area 26 cases (32.91%), in married persons 55 cases (69.62%), in between 6 pm to 12 midnight 24 cases (30.37%) and revenge was main motive 23 cases (29.11%).

Profile of organophosphorus poisoning at Maharani Hospital, Jagdalpur, Chhattisgarh: A three years study.

A number of Organophosphorus compounds have been introduced in Indian market as agricultural insecticides, being effective against wide range of insects and pests. But a number of these compounds have proved to be more toxic to humans than its utility as insecticides, pesticides or fungicides. This study aims to evaluate the certain factors which are very significant in relation to outcome of Organophosphorus compound poisoning like age, sex, SE status, marital status, reason of committing suicide, etc. and attempt to know its prevalence in society and try to plan for future preventive strategy. The study was carried out on 288 cases of Organophosphorus compound poisoning which come to Maharani Hospital, Jagdalpur, (C.G) from 01/01/2007 to 31/12/2009. M: F ratio was 1.3: 1.0. Majority of the cases were in age group of 21-30 yrs includes 128 cases (44.44%). Higher proportion of cases from lower class of society 141 cases (48.95%), from rural area 237 cases (82.29%), due to lack of education in affected community. Suicidal intent to consume the compound was the commonest - 250 cases (86.80%). Recovery rate was highest amongst those who consume less than 10 ml of poison – 120 cases (41.66%).

Study of road traffic accidental deaths (RTA) in and around Bastar Region of Chhattisgarh.

To analyze the magnitude of head injury in fatal RTA cases, present study was conducted in the department of Forensic Medicine Toxicology, Govt. Medical College, Jagdalpur (Chhattisgarh) in 2009 calendar year. The present study was undertaken on 105 victims of RTA who died due to head injuries, which autopsied at GMC, Jagdalpur (C.G). Most of the accidents occurred in the afternoon hours (12: 01 - 18:00). There was a clear male dominance (88.57%). The most affected age was middle age (21-40 yrs) & most commonly affected age group is 21-30 yrs. Vehicular occupants were commonly affected (63.80%) & amongst them two wheeler occupants most commonly involved. Fissure fracture of the skull was commonest (45.71%) & parietal region of head was mostly involved region of the head (27.61%). Among the intracranial hemorrhages, subdural hemorrhage (SDH) was commonest (31.42%). In relation duration of survival time 59.04% of victims died within 24 hrs of fatal accident.