Imaging in Covid-19 associated mucormycosis: a case series

Introduction: Mucormycosis is a very rare saprophy?c, opportunis?c fungal infec?on with high morbidity and mortality. With the Covid-19 pandemic, there is a sudden increase in the incidence of this disease due to causes not clearly known. Methods: Retrospec?ve clinic-radiological analysis of a series of seven microbiologically confirmed cases of Covid19 associated mucormycosis (CAM) treated at our ter?ary care center in 2021 was done. Results: All pa?ents were middle-aged with a mean age of 47 years. All pa?ents had poor glycemic control. Three pa?ents were on oxygen support and were given steroids during Covid-19 treatment. Symptoms were facial pain, swelling, headache, eyelid swelling, and nasal block. All pa?ents underwent contrast MRI to study the extent of ?ssue involvement. MRI helped in complete surgical debridement with minimal deformity. Conclusion: Judicious use of immunosuppressants and strict glycemic control vital during covid-19 treatment. Contrast MRI is the inves?ga?on of choice to iden?fy the extent of involvement in surgical planning.

Non-traumatic esophageal perforation: A case report on Boerhaave’s syndrome

Boerhaave’s syndrome is a potentially fatal condition characterized by spontaneous perforation of a previously healthy esophagus, due to severe vomiting or straining. It often presents with non-specific symptoms such as fever, pain, and vomiting and hence may go undiagnosed. The Makler’s triad, consisting of vomiting, chest pain, and subcutaneous emphysema, may be seen in only 50% of cases. Delayed diagnosis may result in complications such as sepsis, mediastinitis, pneumothorax, and multi-organ dysfunction. In general, patients presenting later than 48 h are conservatively managed with esophageal stenting. Surgical repair is usually reserved for those patients who present within 24 h, or are managed conservatively and develop complications. Mortality rises from 0% if treated within 24 h to about 29% if delayed more than 48 h. We present a case of Boerhaave’s syndrome in a 35-year-old male who presented with spontaneous respiratory distress and hemodynamic instability, about 36 h after the onset of vigorous vomiting. The case was managed initially with endoscopic insertion of a self-expanding metallic stent, followed later by surgical closure of the esophageal perforation. The patient, however, developed post-operative septic complications and died after a week

Historical and More Common Nongenetic Movement Disorders From Asia

Nongenetic movement disorders are common throughout the world. The movement disorders encountered may vary depending on the prevalence of certain disorders across various geographical regions. In this paper, we review historical and more common nongenetic movement disorders in Asia. The underlying causes of these movement disorders are diverse and include, among others, nutritional deficiencies, toxic and metabolic causes, and cultural Latah syndrome, contributed by geographical, economic, and cultural differences across Asia. The industrial revolution in Japan and Korea has led to diseases related to environmental toxin poisoning, such as Minamata disease and β-fluoroethyl acetate-associated cerebellar degeneration, respectively, while religious dietary restriction in the Indian subcontinent has led to infantile tremor syndrome related to vitamin B12 deficiency. In this review, we identify the salient features and key contributing factors in the development of these disorders.

Nine Hereditary Movement Disorders First Described in Asia: Their History and Evolution

Clinical case studies and reporting are important to the discovery of new disorders and the advancement of medical sciences. Both clinicians and basic scientists play equally important roles leading to treatment discoveries for both cures and symptoms. In the field of movement disorders, exceptional observation of patients from clinicians is imperative, not just for phenomenology but also for the variable occurrences of these disorders, along with other signs and symptoms, throughout the day and the disease course. The Movement Disorders in Asia Task Force (TF) was formed to help enhance and promote collaboration and research on movement disorders within the region. As a start, the TF has reviewed the original studies of the movement disorders that were preliminarily described in the region. These include nine disorders that were first described in Asia: Segawa disease, PARK-Parkin, X-linked dystonia-parkinsonism, dentatorubral-pallidoluysian atrophy, Woodhouse-Sakati syndrome, benign adult familial myoclonic epilepsy, Kufor-Rakeb disease, tremulous dystonia associated with mutation of the calmodulin-binding transcription activator 2 gene, and paroxysmal kinesigenic dyskinesia. We hope that the information provided will honor the original researchers and help us learn and understand how earlier neurologists and basic scientists together discovered new disorders and made advances in the field, which impact us all to this day.

Numbness Following Total Knee Arthroplasty: Role of Incision Length And Position -A Randomized Study

Background@#One of the symptoms annoying patients after total knee replacement (TKR) is numbness around the operative scar. Some studies have shown that altering the incision in terms of placement or length may decrease the incidence of numbness. It still remains unknown whether numbness affects patient-reported outcomes. @*Methods@#We conducted a randomized study to compare a short-length incision (n = 50) and a lateral exit incision (n = 50) with a standard midline TKR incision (n = 50) in terms of the incidence of numbness and its progress over 1 year of follow-up. Our secondary objective was to look at the involved zone, area of numbness, and secondary symptoms. We also looked at patient-reported outcome in terms of satisfaction in all groups using a visual analog scale and Forgotten Joint Score. @*Results@#At 3 months postoperatively, the incidence of numbness was least in the lateral exit group: 46.2% as compared to midline (62%) and short (58.3%), but the difference was not significant (p = 0.07). At 6 months, the short incision group had a significantly lower incidence (8%) of residual numbness as compared to 30% in the other two groups (p = 0.003). At 1 year, most patients recovered sensation loss and had similar function. @*Conclusions@#Placement or length of an incision did not significantly affect the incidence of numbness; however, the short incision led to early recovery of numbness. At 1 year of follow-up, most patients did not complain of loss of sensation and had similar functional outcome.

Choanal Polyps Originating from Unusual Sites: A Rural Tertiary Care Center Experience

Abstract Introduction Choanal polyps are benign lesions arising from the sinonasal mucosa, extending through the choana into the nasopharynx. Though polyps arising from the maxillary sinus and extending to the choana are common, polyps arising from the sphenoid sinus ostium, posterior part of middle turbinate, and inferior and middle meatus are quite uncommon. Objective To document the site of origin of choanal polyps arising from unusual sites; their clinical, radiological, and histopathological characteristics, as well as diagnostic challenges and management. Methods This retrospective, single-center study included 14 patients aged 16 to 75-years-old with choanal polyps. After obtaining informed consent, their clinical, radiological and surgical details and histopathology reports were reviewed. Patients were followed for at least 6 months after surgery. Results The predominant symptoms were unilateral nasal obstruction (n = 9), snoring, rhinorrhea, and epistaxis. Though anterior rhinoscopy was unremarkable, a mass could be visualized during posterior rhinoscopy in the nasopharynx in 11 patients, and a mass could be directly visualized in the oropharynx in 2 patients. After diagnostic by nasal endoscopy, these polyps were noted to arise from the posterior aspect of the middle meatus (n = 6), middle turbinate (n = 3), posterior septum (n = 3), sphenoid sinus ostium (n = 1), and inferior meatus (n = 1). All patients were managed surgically. The histopathological examination revealed inflammatory polyp (n = 12), actinomycosis (n = 1), and rhinosporidiosis (n = 1). Patients were followed up for 6 to 22 months. We observed no complications or recurrence. Conclusion Diagnostic nasal endoscopy should be performed in all patients presenting with nasal obstruction, to rule out choanal polyps arising from unusual sites. Complete polyp removal and appropriate treatment based on histopathology prevents recurrence.

LONG-TERM OUTCOMES FOLLOWING FREY'S PROCEDURE FOR CHRONIC PANCREATITIS – A TEN-YEARS OF SINGLE-CENTER EXPERIENCE FROM A TERTIARY CARE CENTER IN SOUTH INDIA

Background/Aim: Chronic pancreatitis (CP) is surgically treated in selected patient populations. Frey's procedure (FP) is the most commonly described procedure for CP with head mass. This study is being conducted to determine the long-term outcome and ef?cacy of FP in patients with CP in South India of various etiologies. Methods: This is a retrospective study of patients who underwent FP at our institution. Clinical features, perioperative ?ndings, and follow-up results were evaluated. A subgroup analysis of pain relief was performed between alcoholics and non-alcoholic groups and between patients receiving FP alone and FP with additional procedures. Of the 181 patients, alcohol was Results: the causative factor in 99 (54.69%), gallstones in 20 (11.04%), and idiopathic in 62 (34.25%). With a median follow-up of 43.49 months (range 12-72 months), 78 (43.09%) patients experienced complete pain relief. Due to persistent pain and the presence of preoperative diabetes mellitus (DM), pain relief in patients with postoperative complications was incomplete. New DM and exocrine dysfunction were reported in 25 years (13.81%) and 15 (8.28%) patients. Patients with a history of alcohol abuse, smoking, weight loss, and postoperative complications are associated with newly developed diabetes. FP is a Conclusion: safe surgical option for CP with acceptable perioperative complications and appropriate short-term and long-term pain management in properly selected patients. Continuous pain and preoperative DM were independent predictors of incomplete pain relief after FP. Symptoms associated with alcohol abuse, smoking, and weight loss were associated with the development of post-FP DM in the study population.

Implementation of Competency-based Medical Education in Forensic Medicine and Toxicology in Indian Medical Education — A Viewpoint on Challenges and Way Forward

The changing disease burden, living conditions and anticipations of end-users in health care have resulted in the decision of regulatory bodies in the Indian medical education system to shift the MBBS curriculum from Traditional to Competency-Based Medical Education (CBME).The efforts taken by the National Medical Commission (NMC) erstwhile Medical Council of India (MCI) to successful implementation of the herculean task of shifting curriculum are praiseworthy. MCI initiated a National Faculty Development Programme (FDP) in 2009 in all medical colleges under its ambit.MCI started with five regional centres, which now expanded to 22 centres, out of which 12 are regional centres, and 10 are advanced nodal centres. Nearly 44932 faculties were trained till December 2018. Despite all the advantages of CBME & the efforts taken up by governing bodies, there are many challenges. Some are common for all subjects, but few are unique or specific to a subject. This article views the possible challenges and the way forward for the successful implementation of CBME in Forensic Medicine and Toxicology.

Single Arm Clinical Study to Evaluate the Effect of Nasya in Meniere’s Disease followed by Concomitant Treatments

Meniere’s Disease is an ear disease specifically of inner ear. The clinical presentation includes vertigo which is episodic, sensorineural hearing loss which fluctuates, tinnitus and sensation of fullness of ear (aural fullness). Associated complaints includes headache, nausea, drop attacks (otolith crisis of Tumarkin). Meniere’s disease is relapsing in nature which greatly affects patient’s daily activities. The highest prevalent age group is 30-60 years of age. The main pathology occurs as the result of endolymphatic sac distension caused by excessive production or faulty absorption of endolymph or both. The cause is not known clearly. But few factors may contribute in the pathophysiology of Meniere’s disease like excessive retention of water and sodium, allergic reactions, vasomotor disorders, auto immune disorders like rheumatoid fever, middle ear infections etc. Acharya Sushruta has explained Karnarogas like Karnanaada, Karnakshweda, Badhirya which are nearer to Meniere’s disease when studied along with Bhrama. 22 subjects diagnosed with Meniere’s Disease fulfilling the inclusion criteria were selected for the study. Amapachana was done with Shunthi churna. Nasya with Bhringaraja taila followed by Karnapoorana with Bilva Taila and Sarivadi vati along with Dhanwayasa Kashaya and Satwavajaya chikitsa was given. Patient showed significant results in subjective and objective parameters.

Large right-sided pneumothorax with Takotsubo cardiomyopathy

Patients with left-sided pneumothorax presenting with electrocardiogram (ECG) changes resembling acute coronary syndrome (ACS) have been reported in the literature. Takotsubo cardiomyopathy (TCM) occurs predominantly in post-menopausal women with underlying intense emotional or physical stress. However, as this case report shows, it can complicate any acute illness leading to intense stress. We report a rare combination of ECG changes mimicking ACS in a man with a large right-sided pneumothorax and TCM.

Phyllode an Uncommon Tumor of the Breast - A Case Report

‘Phyllodes’ is a Greek word which means leaf- like. Phyllodes tumour, though appears well circumscribed, is characterized by irregular surface surface projections. These projections may be cut during surgical excision and predispose to recurrence. Phyllodes tumour shows a wide spectrum of activity varying from an almost benign condition to a locally aggressive, and sometime metastatic tumour. We report a 61 year old female patient presented with a lump on the left breast. Excision was done and histo pathology report revealed phyllode tumour.

Study of pattern & distribution of adverse drug reactions in acute coronary syndrome patients in a tertiary care hospital

Background & objectives: With the availability of a wide range of drugs to treat patients with acute coronary syndrome (ACS), adverse drug reactions (ADRs) have become inevitable in clinical practice. Thorough knowledge of such reactions is essential for the treating physician for optimal treatment and better outcomes. There are many scales to define, measure and assess the ADRs, but there is a dearth of data available on such drug reactions among ACS patients. Hence, this study attempted to analyze the pattern, causality, severity, predictability and preventability of ADRs in ACS patients. All the ADRs reported during the study period were analyzed for causality by the World Health Organization–Uppsala Monitoring Centre (WHO-UMC), Naranjo’s and Karch and Lasagna scales; severity by modified Hartwig and Siegel scale; predictability by Rawlins and Thompson criterion and preventability by Schumock and Thornton scale. Methods: A single-centre, record-based analysis for the occurrence of ADRs was done among ACS patients admitted to the department of Cardiology between January and October 2017. Demographic data, comorbid conditions, reported ADRs and ADR assessment details were noted from the hospital case records and ADR monitoring centre (AMC) records. The data were analyzed and presented in a descriptive manner using percentages, mean and standard deviation. The Pearson’s chi-squared test was used to ascertain the significance of the association between different groups. Results: Out of 324 patients under evaluation, 67 had developed one or more ADRs. There were 30 different types of ADRs reported, headache being the most common. Among the drugs, heparin was the most common factor, causing 27 per cent of ADRs. Definite causality of a suspected drug causing ADRs was seen in 11.9 (n=8), nine (n=6) and 7.5 (n=5) per cent cases as per WHO-UMC, Naranjo (Naranjo algorithm) and Karch and Lasagna scales, respectively. In the severity of ADRs, the most severe reactions according to the modified Hartwig-Siegel scale (level 4a in our study) were seen in 17.5 (n=12) per cent of patients, and the rest were either level 2 or 3 reactions. Nearly 92.5 (n=62) per cent of reactions were predictable according to the Rawlins and Thompson criterion. Application of the modified Schumock-Thornton scale showed that 22.4 per cent of ACS patients had preventable reactions, and the rest were not preventable.Interpretation & conclusions: The study results suggest that ADRs are relatively common among ACS patients. Most of these can be identified and assessed for causality, severity, predictability and preventability using various available scales. Diligent pharmacovigilance for identifying and assessing ADRs may help manage and mitigate morbidity associated with these in high-risk ACS patients.

Psychological impact of COVID-19 pandemic on adults: Time for a holistic approach

Background: COVID outbreak has escalated the burden of psychological distress and developing countries are struggling to manage cases and prevent deaths. To create a holistic approach its necessary to understand the psychological status during pandemic. Hence a study was conducted to evaluate psychological status of adults during COVID pandemic and to assess the relationship between psychological status and sociodemographic factors. Methods: Cross sectional study design and snow ball sampling technique was employed. The study was conducted on 647 adults using online based questionnaire distributed through the social media application and Email between April 2021 and june 2021. The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess depression and anxiety respectively along with Socio-demographic details and COVID-19 status. Results: 64.60% belonged to age group 18-24 years, 55.17% were females, 72% of them were unmarried and 61.8% were not working. Mean scores of PHQ-9 were 7.42�01 and GAD-7 was 5.78�23. There was a significant positive correlation between PHQ-9 and GAD-7 scores. 13.44% of participants reported severe depression category and 6.64% reported severe anxiety. Significant higher grades of severe depression and anxiety was found among Age <25 years and who studied up to graduate compared to their counter parts (p<0.05). Conclusion: Prevalence of anxiety and depression are high among general population during COVID pandemic. The psychological impact of COVID-19 on general population should be recognized as a public health priority by health care providers and policy makers who should urgently adopt strategies for a holistic approach in COVID pandemic.

Versatilidade da tela de 4-Polihidroxibutirato (PhasixTM) em cirurgia de parede abdominal / Versatility of poly-4-hydroxybutyrate (phasix™) mesh in abdominal wall surgery

ABSTRACT Background Poly-4-hydroxybutyrate (P4HB) is a naturally occurring polymer derived from transgenic E. coli bacteria with the longest degradation rate when compared to other available products. This polymer has been manufactured as a biosynthetic mesh to be used as reinforcement when repairing a variety of abdominal wall defects. Objective: We aim to describe our center initial experience with this mesh and discuss the possible indications that may benefit from the use of P4HB mesh. Methods: This is a descriptive retrospective study of patients who underwent abdominal wall repair with a P4HB mesh from October 2018 to December 2020 in a single, large volume, academic center. Results: A total of 51 patients (mean age 54.4 years, range 12-89) underwent abdominal wall reconstruction with a P4HB mesh between October 2018 and December 2020. The mean BMI was 30.5 (range 17.2-50.6). Twenty-three (45%) patients had a prior hernia repair at the site. We grouped patients into six different indications for the use of P4HB mesh in our cohort: clean-contaminated, contaminated or infected field (57%), patient refusal for permanent meshes (14%), those with high risk for post-operative infection (12%), visceral protection of second mesh (10%), recurrence with related chronic pain from mesh (6%), and children (2%). Median follow-up was 105 days (range 8-648). Two patients had hernia recurrence (4%) and 8 (16%) patients developed seroma. Conclusion: P4HB mesh is a safe and a viable alternative for complex hernias and high-risk patients with a low complication rate in the short-term.

RESUMO Contexto: 4-Polihidroxibutirato (P4HB) é um polímero natural derivado da E. coli transgênica que tem a mais longa taxa de degradação quando comparado a outros produtos. Este polímero é manufaturado como uma tela biossintética a ser usada como um reforço no reparo de uma variedade de defeitos de parede abdominal. Objetivo: O objetivo deste estudo é descrever nossa experiência inicial com esta tela e discutir suas possíveis indicações. Métodos: Estudo retrospectivo e descritivo com pacientes que foram submetidos a cirurgia de reconstrução de parede abdominal de outubro de 2018 a dezembro de 2020 em um grande centro acadêmico. Resultados: Cinquenta e um pacientes, média de 54,4 anos (12-89) foram submetidos a reconstrução da parede abdominal com tela de P4HB entre outubro de 2018 e dezembro de 2020. O índice de massa corpórea médio foi de 30,5 kg/m2(17,2-50,6). Vinte e três pacientes (45%) tinham cirurgia prévia de hérnia no mesmo local. Nós agrupamos pacientes em seis diferentes indicações para o uso da tela de P4HB: campo limpo-contaminado, contaminado, infectado (57%), recusa do paciente em telas permanentes (14%), pacientes com alto risco de infecção no pós-operatório (12%), proteção visceral de contato com outra tela (10%), recidiva da hérnia associada com dor crônica relacionada a tela anterior (6%) e pacientes pediátricos (2%). O seguimento mediano foi de 105 dias (8-648). Dois pacientes tiveram recidiva (4%) e 8 (16%) desenvolveram seroma. Conclusão: O uso da tela de P4HB se mostrou uma alternativa segura e viável com baixa taxa de complicações para estes pacientes no curto prazo.

Factors Influencing the Emergence of Self-Reliance in Primary Health Care using Traditional Medicine: A Scoping Review

Self-reliance is the responsible behavior and the ability of an individual to take care of one’s own health using local resources. A substantial proportion of the population use traditional medicine (TM) for primary health care (PHC) in low- and middle-income countries (LMIC). The underlying philosophy of the TM approach is self-reliance due to its emphasis on culture, traditions, customs, and local resources. Given the complexity and ambiguity of how self-reliance emerges, there is a need to have clarity in its understanding and the practice in relation to TM. Hence, we conducted this review to synthesize the factors determining the emergence of self-reliance in PHC using TM in resource-poor settings with a specific focus on LMICs. We searched PubMed, Google scholar, and the Social Science Research Network databases, and conducted reference tracking of selected articles. We included articles published between 2000 and 2020 May. Thematic analysis was done using QDA?miner Lite software version 2.1. We retained 29 papers for review and analysis. A conceptual framework was developed that located factors influencing the emergence of self?reliance. Self?reliance manifests through a socially constructed interaction between factors from the macro (policy and environment) to the micro context (community and household). Due to the lack of explanatory models, there is a substantial gap between understanding self-reliance and its application in health policy and practice. Achieving comprehensive PHC and universal health coverage requires policy provisions to create an enabling environment in health-care facilities, communities, and households that allows the emergence of self-reliance.

Placement of Oral Formulations of Brivaracetam in Various Patient Profiles: An Indian Perspective

Brivaracetam (BRV), an analog of levetiracetam (LEV), lowers seizure frequency through a unique mechanism. Although BRV is approved for focal epilepsy in patients aged >1 month (by the US Food and Drug Administration) or >16 years (in India), clinical studies have suggested its potential role in other indications such as generalized seizures, secondarily generalized tonic-clonic seizures, and drug-resistant focal epilepsy, and in certain special populations. Here, we discuss the potential role of BRV in different patient populations and present expert opinions for positioning the pre-existing and newly available oral formulations of BRV to aid both clinicians and diverse patient groupswith a simple and easy dosing and titration-based treatment, including safe and effective switching from LEV to BRV.

Effect of silver diamine fluoride, potassium iodide, and glutathione on micro-shear bond strength of glass ionomer cement to caries affected dentine

Background: Silver diamine fluoride (SDF, 38%) is an efficient topical fluoride used to arrest dental caries though it causes black staining of both teeth and restoration. The application of potassium iodide (KI) after SDF reduces the stain, but the color change is only temporary. An alternative method suggested is by mixing glutathione (GSH) with SDF, which preserves the silver ions of SDF within the solution. Hence, the purpose of this in vitro study was to evaluate the microshear bond strength (?SBS) of glass ionomer cement (GIC) to caries affected dentin (CAD) pretreated with SDF/KI/GSH. Materials and Methods: Thirty dentine slices of 2 mm thickness from human permanent upper premolars were demineralized using pH cycling method to mimic CAD. They were allocated to three groups of 10 each and treated with SDF, SDF-KI (SDF followed by KI), SDF + GSH (SDF mixed with GSH), respectively. Specimens were bonded with GICs. The ?SBS was assessed using a universal testing machine and the data obtained were analyzed using one-way ANOVA and Tukey's post hoc test. Results: The ?SBS (mean ± standard deviation) values for groups SDF, SDF-KI, and SDF + GSH were 4.81 ± 2.026, 5.78 ± 1.809, 8.18 ± 2.828 megapascal respectively. Group 3 showed significantly better bond strength compared to groups 1 and 2. In group 2, the addition of KI showed better bond strength when compared to group 1, but the difference was not statistically significant. Conclusion: Pretreatment of teeth with GSH along with SDF application showed significantly better bond strength of GIC to CAD compared to SDF and SDF-KI.

Does Risk Mitigation Reduce 90-Day Complications in Patients Undergoing Total Knee Arthroplasty?: A Cohort Study

Background@#With ever-increasing demand for total knee arthroplasty (TKA), most healthcare systems around the world are concerned about its socioeconomic burden. Most centers have universally adopted well-defined clinical care pathways to minimize adverse outcomes, maximize volume, and limit costs. However, there are no prospective comparative trials reporting benefits of these risk mitigation (RM) strategies. @*Methods@#This is a prospective cohort study comparing post-TKA 90-day complications between patients undergoing RM before surgery and those following a standard protocol (SP). In the RM group, we used a 20-point checklist to screen for modifiable risk factors and evaluate the need for optimizing non-modifiable comorbidities. Only when optimization goals were achieved, patients were offered TKA. @*Results@#TKA was performed in 811 patients in the SP group and in 829 in the RM group, 40% of which were simultaneous bilateral TKA. In both groups, hypertension was the most prevalent comorbidity (48%), followed by diabetes (20%). A total of 43 (5.3%) procedure-related complications were seen over the 90-day postoperative period in the SP group, which was significantly greater than 26 (3.1%) seen in the RM group (p = 0.039). The commonest complication was pulmonary thromboembolic, 6 in each group. Blood transfusion rate was higher in the SP group (6%) than in the RM group (< 1%). @*Conclusions@#Screening and RM can reduce 90-day complications in patients undergoing TKA.

Predicting the Anatomical Location of Neck of Femur Fractures in Osteoporotic Geriatric Indian Population

@#Introduction: Neck of femur fractures are quite common fractures in the elderly. Though a lot is spoken about the various modes of management of these fractures across different age groups, hardly any literary support mentioning their distribution, location and pattern can be found. In this study, we aim to find whether the Singh index, as a marker of osteoporosis on digital radiographs, can predict the location of neck of femur fractures in the elderly population. Materials and methods: We accessed 556 fractured hip radiographs in our institution over the past 5 years (2015- 2020) and correlated with the Singh index, as a marker of degree of osteoporosis, on pre-operative pelvis digital radiographs. Mid coronal CT cuts were also corroborated with the radiographic findings. A control group was set up and 361 radiographs were evaluated in the study group. Results: A total of 124 transcervical fractures (73%) were in Singh index 4, while 76 subcapital fractures (70%) were in Singh index 3. A total of 166 fractures (66%) were found in transcervical region in the age group of 60 to 80 years, while 80 fractures (74%) were in the subcapital region in patients above 80 years. Conclusion: We concluded that transcervical fractures were more common in patients with Singh index 4 (p<0.001) and subcapital more common in patients with Singh index 3(p<0.001). There was also a shift in location of the fractures from the transcervical region to the subcapital region with age above 80 years (p<0.001).

Cross clamping of the supraceliac aorta is effective for bleeding control in ruptured giant splenic artery pseudoaneurysm when proximal and distal control of the splenic artery is not possible: a case report / O clampeamento da aorta supracelíaca é eficaz no controle de sangramento em pseudoaneurisma gigante roto de artéria esplênica quando o controle proximal e distal da artéria esplênica não é possível - relato de caso

Abstract Splenic artery pseudoaneurysm is the most common of all the visceral artery pseudoaneurysms. Presentation is often variable and the condition demands immediate diagnosis and management because pseudoaneurysm rupture increases morbidity and mortality. It is associated with pancreatitis and other conditions like abdominal trauma, chronic pancreatitis, pseudocyst of the pancreas, liver transplantation, and, rarely, peptic ulcer disease. We present a case of a giant splenic artery pseudoaneurysm measuring 14x8 cm. Proximal and distal control of the vessels could not be achieved during the procedure because of local adhesions and inflammation and it was necessary to cross clamp the supraceliac aorta to control bleeding.

Resumo O pseudoaneurisma de artéria esplênica é o mais comum entre os pseudoaneurismas de artérias viscerais. A apresentação geralmente varia e requer diagnóstico e tratamento imediatos, pois a ruptura do pseudoaneurisma aumenta a morbimortalidade. Esse tipo de pseudoaneurisma está associado à pancreatite e a outras condições, como trauma abdominal, pancreatite crônica, pseudocisto de pâncreas, transplante de fígado e, raramente, úlcera péptica. Apresentamos um caso de pseudoaneurisma gigante de artéria esplênica, com tamanho de 14x8 cm. Durante o procedimento, não foi possível alcançar controle proximal e distal dos vasos devido a aderências locais e inflamação, sendo necessário o clampeamento da aorta supracelíaca para controle do sangramento.