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Abstract Introduction Squamous cell carcinoma (SCC) of the maxillary alveolus is a relatively rare disease. There is lack of data on this subsite as compared with other sites. The factors that affect survival in cases of maxillary alveolar SCC are tumor stage, local and cervical metastases, histological grading, and the margin status. Objectives To evaluate the overall survival (OS), the disease free survival (DFS), and the complex interaction and effects of margin status, histological differentiation, habits (such as smoking and the use of smokeless tobacco products), and cervical and distant metastases based on clinicopathological data. Methods We examined the electronic database at our hospital from 2003 to 2017. We included all cases with a histopathological diagnosis of SCC of the maxillary alveolus. Tumors originating primarily from the maxillary alveolus were included, while those originating from adjacent subsites, like the hard palate, the buccal mucosa or the maxillary sinus were excluded. We also excluded all the patients who were not operated on with a curative intent. Results More than half of the patients had stage-IV tumors at the time of presentation, while only one fourth of them had nodal metastasis. The rate of recurrence increased in cases of primary tumors in advanced stages and the degree of histological differentiation. The 2-year and 5-year OS rates were of 54.5% (18 patients) and 30.3% (10 patients) respectively. Conclusion Primary tumors in advanced stages, histological grade, and presence of nodal metastasis are poor prognostic markers in terms of long-term survival.
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Puberty is a pivotal biological process that completes sexual maturation to achieve full reproductive capability. It is a major transformational period of life, whose timing is strongly affected by genetic makeup of the individual, along with various internal and external factors. Although the exact mechanism for initiation of the cascade of molecular events that culminate in puberty is not yet known, the process of pubertal onset involves interaction of numerous complex signaling pathways of hypothalamo-pituitary-testicular (HPT) axis. We developed a classification of the mechanisms involved in male puberty that allowed placing many genes into physiological context. These include (i) hypothalamic development during embryogenesis, (ii) synaptogenesis where gonadotropin releasing hormone (GnRH) neurons form neuronal connections with suprahypothalamic neurons, (iii) maintenance of neuron homeostasis, (iv) regulation of synthesis and secretion of GnRH, (v) appropriate receptors/proteins on neurons governing GnRH production and release, (vi) signaling molecules activated by the receptors, (vii) the synthesis and release of GnRH, (viii) the production and release of gonadotropins, (ix) testicular development, (x) synthesis and release of steroid hormones from testes, and (xi)the action of steroid hormones in downstream effector tissues. Defects in components of this system during embryonic development, childhood/adolescence, or adulthood may disrupt/nullify puberty, leading to long-term male infertility and/or hypogonadism. This review provides a list of 598 genes involved in the development of HPT axis and classified according to this schema. Furthermore, this review identifies a subset of 75 genes for which genetic mutations are reported to delay or disrupt male puberty.
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Adolescent , Male , Humans , Adult , Child , Gonadotropin-Releasing Hormone , Gonadotropins/metabolism , Hypogonadism , Testis/metabolism , Puberty/physiology , Sexual MaturationABSTRACT
Objectives@#Users share valuable information through online smoking cessation communities (OSCCs), which help people maintain and improve smoking cessation behavior. Although OSCC utilization is common among smokers, limitations exist in identifying the smoking status of OSCC users (“quit” vs. “not quit”). Thus, the current study implicitly analyzed user-generated content (UGC) to identify individual users’ smoking status through advanced computational methods and real data from an OSCC. @*Methods@#Secondary data analysis was conducted using data from 3,833 users of BcomeAnEX.org. Domain experts reviewed posts and comments to determine the authors’ smoking status when they wrote them. Seven types of feature sets were extracted from UGC (textual, Doc2Vec, social influence, domain-specific, author-based, and thread-based features, as well as adjacent posts). @*Results@#Introducing novel features boosted smoking status recognition (quit vs. not quit) by 9.3% relative to the use of text-only post features. Furthermore, advanced computational methods outperformed baseline algorithms across all models and increased the smoking status prediction performance by up to 12%. @*Conclusions@#The results of this study suggest that the current research method provides a valuable platform for researchers involved in online cessation interventions and furnishes a framework for on-going machine learning applications. The results may help practitioners design a sustainable real-time intervention via personalized post recommendations in OSCCs. A major limitation is that only users’ smoking status was detected. Future research might involve programming machine learning classification methods to identify abstinence duration using larger datasets.
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Objectives@#Users share valuable information through online smoking cessation communities (OSCCs), which help people maintain and improve smoking cessation behavior. Although OSCC utilization is common among smokers, limitations exist in identifying the smoking status of OSCC users (“quit” vs. “not quit”). Thus, the current study implicitly analyzed user-generated content (UGC) to identify individual users’ smoking status through advanced computational methods and real data from an OSCC. @*Methods@#Secondary data analysis was conducted using data from 3,833 users of BcomeAnEX.org. Domain experts reviewed posts and comments to determine the authors’ smoking status when they wrote them. Seven types of feature sets were extracted from UGC (textual, Doc2Vec, social influence, domain-specific, author-based, and thread-based features, as well as adjacent posts). @*Results@#Introducing novel features boosted smoking status recognition (quit vs. not quit) by 9.3% relative to the use of text-only post features. Furthermore, advanced computational methods outperformed baseline algorithms across all models and increased the smoking status prediction performance by up to 12%. @*Conclusions@#The results of this study suggest that the current research method provides a valuable platform for researchers involved in online cessation interventions and furnishes a framework for on-going machine learning applications. The results may help practitioners design a sustainable real-time intervention via personalized post recommendations in OSCCs. A major limitation is that only users’ smoking status was detected. Future research might involve programming machine learning classification methods to identify abstinence duration using larger datasets.
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Purpose@#The treatment of acutely obstructing colorectal cancers is still a matter of debate. The prevailing opinion is that an immediate resection should be performed whenever possible. This study sought to determine whether immediate resection is safe and oncologically valid. @*Methods@#We completed a retrospective 2-center cohort study using the medical records of patients admitted for acutely obstructing colorectal cancer under the care of the Colorectal Team, Noble’s Hospital, Isle of Man, and the Emergency Surgery Unit, Umberto I University Hospital, Rome, from March 2013 to May 2017. The primary endpoints were 90-day mortality and morbidity, reoperation rate, and length of stay. The secondary endpoints were status of margins, number of lymph nodes retrieved, and the rate of adequate nodal harvest. @*Results@#Sixty-three patients were retrospectively enrolled in the study. Mortality was associated with age > 80 years and Dukes B tumors. The length of hospital stay was shorter in patients who had their resection less than 24 hours from their admission, in those who had laparoscopic resection and in those with distal tumors. The number of lymph nodes retrieved and rate of R0 resections were similar to those reported in elective colorectal surgery and were greater in laparoscopic resections and in patients operated on within 24 hours, respectively. @*Conclusion@#Immediate resection is a safe and reliable option in patients with acutely obstructing colorectal cancer.
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@#Goat Warble Fly Infestation (GWFI) is also known as subcutaneous myiasis caused by Przhevalskiana silenus (Diptera: Oestridae). It is widely distributed in tropical and sub-tropical areas of the world. In goats, WFI is usually detected through conventional procedure which underestimated the infestation. The current study was designed to determine the serodiagonsis of GWFI (through IDEXX Hypodermosis serum antibody test) and also aimed to investigate its seroepizootiological profile in Pothwar region, Pakistan from 2013-14. The results showed that average seropositivity (ELISA kit) of GWFI was 18.5% whereas, it was 11% by using conventional procedure (Palpation method) depicting a significant difference (p<0.05). Higher seropositivity (30.8%) was observed in Jhelum district as compared to e Attock district (6%). The L1 larvae were found in September, while nodules start appearing in October to December and last until the end of February. The month wise peaks of optical density (OD) was higher in December which gradually decrease along with the end of winter season. The prevalence of GWFI revealed no significant difference among three host breeds (Jattal, Beetal and Tedy). According to the results, high infestation rate (28%) was observed in young animals of age group < 1 year as compared to old animals (> 2 years). Topographically, hilly areas (33%) provide favourable climatic conditions for the propagating of larval stages. Sex difference showed no significant difference. The seroprevalence varied significantly with respect to age, month, districts and topographical location. The current study proved that serologic diagnosis (commercial ELISA kit) as more sensitive and accurate for timely diagnosis of GWFI than traditional method. The information on the epizootiology of P. silenus in goats of Pothwar region would help in devising effective control strategies.
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Background: Excessive daytime sleepiness is a key symptom in patients with sleep- breathing disorders (SBD) and represents a new major public health issue due to its repercussions. The ESS is a simple and validated method, which measures the probability of falling asleep in a variety of situations. Aims and objectives is to study the accuracy of the Epworth Sleepiness Scale (ESS) questionnaire in the identification of Obstructive Sleep Apnoea (OSA) in patients with symptoms of sleep disordered breathing in a tertiary care centre.Methods: This present study was conducted in the Department of Respiratory medicine, New Medical College, Kota on 70 adult patients who presented with symptoms of Sleep Disordered Breathing and underwent Type 2 Polysomnography after answering Epworth sleepiness score in Hindi Language.Results: Epworth sleepiness scale has predicted excessive day time sleepiness in 60% of study subjects with ESS score more than 10 taken as cut off. Mean value for ESS in the study was 10.78. 35.71% of the patients had severe OSA diagnosed by polysomnography and 30% patients had moderate OSA. Mild OSA was detected in 7.14% patients. Sensitivity of the ESS score >10 in diagnosing OSA was found to be 72.5%. Specificity of the scale was 73.6%.There was significant correlation between ESS score and diagnosis of OSA (p value <0.001).Conclusions: The study concludes that ESS has got good relevance in predicting OSA in patients with sleep disordered breathing.
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Background: The treatment modality use in early pleural empyema mainly depends on the antimicrobial therapy along with thoracocentesis. In case of complicated empyema this modality does not work and lung not fully expand, until removal of adhesions. The main purpose of the current study is to analyze the experience of management of complicated parapneumonic effusion and empyema thoracic through rigid medical thoracoscopy under local anaesthesia. Aim and objective is to study the role of medical thoracoscopy in the management of empyema thoracic and parapneumonic effusion at tertiary health centre.Methods: This is a descriptive case series study in which 49 patients were recruited, who have clinically and radiologically show empyema thoracic, from department of Respiratory medicine, GMC, Kota, Rajasthan. All patients underwent medical thoracoscopy under local anesthesia. Written Informed consent was taken from the study participants. Ethical approval was obtained from Ethical Review Committee of the hospital. Patients who have HIV and Hbsag positive, those with multiple organ failure and bleeding disorders were excluded.Results: Total 49 patients, out of them 41(84%) were male and 8(16%) were female with mean age 45 years (range 18 to 70 years). Final evolution through chest x-ray revealed complete resolution or successful thoracoscopy done in 37 case of fibrinopurulent (92.50%) and 5 cases of organizing empyema (55.56%). overall success rate 85.71%. Total 7 cases (3 case of fibrinopurulent and 4 cases of organizing empyema) refer to higher center for decortications.Conclusions: Medical Thoracoscopy under local anaesthesia is a safe procedure, efficient and cost-effective intervention for early management of complicated empyema, particularly in early stage of empyema (fibro purulent).
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Background: Lung cancer is most common cause of cancer related death in men and women world wise responsible for over 1 million death annually. Lung cancer is leading cause of cancer death in united states and worldwide. Lung cancer is the most common neoplasm contributing more frequent among males causing cancer related mortality in both sexes. Objective of this study was to radiological presentation in bronchogenic carcinoma along with prevalence of pulmonary TB in a tertiary center.Methods: Total of 100 patients with histologically proven lung cancer, from July 2018 to June 2019 at a tertiary center Kota Rajasthan. Data of participants regarding demographics, history of smoking habit, clinical presentation, histopathological type, radiographic findings on chest radiograph, ultrasonography, computed tomography (CT) scan, Statistical analysis was performed using descriptive statistics of the collected data.Results: Most common age group of bronchogenic carcinomas was seen between 60-69 years of age (37%) with male predominance (82%). smoking history present in about (80%) patients. Most common radiological presentation was a mass lesion present in 91% patients (n=91) followed by unilateral hilar prominence present in 44% of patients (n=44). Other common finding includes mediastinal widening (38%), collapse (26%). pleural effusion (22%), metastasis (22%), cavitation (13%), consolidation (12%), bony erosion (11%), pneumothorax (5%), and pancost tumor (4%). prevalence of pulmonary TB in bronchogenic carcinoma is 9% and this is due to high burden of pulmonary TB in India.Conclusions: In this study adenocarcinoma was found to be most common type of lung cancer. Smoking is most common risk factor. Pulmonary TB coexistence with bronchogenic carcinoma was more common. The local immunity is deteriorated in cancer cases.
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The aim of present work was to investigate blends of Eudragit® NE 30D with Aquacoat® ECD using different ratios to eliminate curing effect associated with individual polymers. Propranolol HCl 10% w/w was layered onto sugar cores using 5% w/w HPMC as a binder. Drug-layered-cores were coated either with pure or blends of Aquacoat® ECD: Eudragit® NE 30D in a fluidized bed coater to obtain 20% w/w coating level. Talc 35% w/w was used as anti-tacking agent. The pellets were characterized for in vitro dissolution studies, morphology, water uptake-weight loss, osmolality and adhesion of coating after curing at 60 °C or 60 °C/75% RH for 24 h. The findings revealed that Aquacoat® ECD coated pellets showed curing effect due to further gradual coalescence of polymeric particles which resulted into better film formation upon curing. In contrast, the curing effect of Eudragit® NE 30D coated pellets was caused by decrease in adhesion of coatings after curing which provided entirely different swelling behavior of uncured (localized swelling) and cured (uniform swelling) pellets. The undesired curing effect of individual polymers was eliminated by using their blends in appropriate ratio.
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Polymers/analysis , /classification , Calorimetry, Differential Scanning/methods , Drug Delivery Systems/adverse effectsABSTRACT
Objectives: The purpose of the study is to investigate p16 protein expression and promoter methylation of p16 gene and their association with molecular subtypes based on parameter such as estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Materials and Methods: A total of 114 breast cancer tissue biopsies were collected for methylation-specific polymerase chain reaction (MSP) and immunohistochemical (IHC) analysis. Results: Seven tissue microarrays were constructed. p16 protein expression was studied in 114 cases, of which 35/114 (30.7%) cases showed strong expression and the majority of them had ER-positive tumor (57.6%), and it was statistically significant (P < 0.0074). Similarly, p16 expression was reduced in the majority of PR-negative tumors (83.9%) and the association was statistically significant (P = 0.0026). p16 methylation was studied in 114 cases and was positive in 71.0% cases. Conclusion: High p16 protein expression was associated with ER-positive, PR-negative, and HER2-negative tumors which is associated with poor prognosis. p16 protein expression may be used as a prognostic indicator to predict treatment response to hormonal therapy.
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Background/objectives: The aim of our study was to review the safety and effectiveness of Endoscopist-directed nurse-administered propofol sedation (EDNAPS) during GIT endoscopic procedures, occurrence of major and minor adverse events followed by propofol sedation, level of patient satisfaction and possible choice of propofol as sedative agent in their future endoscopic procedures in Pakistani population. Materials and methods: Prospective data were collected from patients receiving diagnostic AGD, colonoscopy or ERCP. Subjects who stopped the emergency procedure or both EGD and colonoscopy were excluded on the same date. Other exclusions include over 20 years of age, pregnancy, the American society of associate psychologists (ASA) Class III or IV, overweight (body weight>100kg), or drugs or its components or components (Soybean or egg) allergies included. Result: In our study a total of 929 patients comprising 520 males (56%) and 409 females (44%) with mean age of 46.19 ± 15.3years, mean MBI 24.27 ± 2.7. Age-specific propofol dosage was similar across gender except for age group 60 years and above where higher mean propofol dosage was required for females as compared to males for EGD and Colonoscopy (82.8 ± 32.2 vs. 63.5 ± 29.8; p-value 0.005; 81.1 ± 26.1 vs. 75.3 ± 25.0; p-value 0.03). The required examination was completed in all cases. There was no major adverse event. Majority of the patients rated the procedure satisfactory and agreed to undergo same sedative for next time. Conclusion: Endoscopist-directed nurse-administered propofol sedation (EDNAPS) during GIT endoscopic procedures is safe and effective in selected patients.
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Genetic diversity of thirty mulberry accessions was determined by using the eleven different phenotypic characters. The study was conducted in field areas of Azad Jammu and Kashmir. The main objective of this study was to find out the diversity in morphological characters of Mulberry accessions found in Azad Jammu and Kashmir and Pakistan. The results showed that there is a significant difference in quantitative parameters among the thirty accessions (p≤0.001). The cluster analysis showed that the data is divided into two main groups at near 80 dissimilarity level. This study suggests that the Morus germplasm is quite diverse.
Se determinoÌ la diversidad geneÌtica de treinta accesiones de mora utilizando once caracteres fenotiÌpicos diferentes. El estudio se realizoÌ en aÌreas de campo de Azad Jammu y Cachemira. El objetivo principal de este estudio fue conocer la diversidad en los caracteres morfoloÌgicos de lss accesiones de mora encontrados en Azad Jammu, Cachemira y PakistaÌn. Los resultados mostraron que hay una diferencia significativa en los paraÌmetros cuantitativos entre las treinta accesiones de mora (p≤0.001). El anaÌlisis de conglomerados mostroÌ que los datos se dividen en dos grupos principales a un nivel de disimilitud cercano a 80. Este estudio sugiere que el germoplasma de Morus es muy diverso.
Subject(s)
Genetic Variation , Morus/anatomy & histology , Pakistan , Cluster Analysis , Principal Component AnalysisABSTRACT
Abstract Flatulence and fullness of stomach is one of the most common problem associated with chickpea primary due to presence of some oligosaccharides and phenols. In this investigation Desi and Kabuli varieties were compared for these oligosaccharides and phenolic compounds. Furthermore, the effect of different processing and cooking methods such as soaking, cooking and germination in the reduction of these antiphysiological factors were are also studies. Maximum tannic acid (0.90 ± 0.20%) was observed in Parbat and C-44 while minimum (0.60 ± 0.04%) in Karak-2. Stachyose contents ranged between 1.10 ± 0.05 (Karak-3) to 1.42 ± 0.02% (Parbat) while raffinose was 0.63 ± 0.05(Karak-3) to 0.81 ± 0.02% (Dasht). The highest tannic acid content was reduced up to 50% in C-44 by cooking of 72 hours germinated seeds. Stachyose and raffinose contents were completely removed after 72 hours germination. Present studies revealed that cooking after germination is the most effective method to reduce the anti-nutritional factors of chickpea. Individually, soaking and cooking also contributed to the loss of the same factors but to a lesser extent.
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Adhatoda vasica and Calotropis procera species were investigated as a resource for new diverse pharmacological agents including B complex, individual total phenolic compounds and antioxidants for curing and treatments of many infectious diseases in human through advanced analytical methods. These plants are abundant in Khyber Pukhtoon Khawa, Pakistan as well as in all over the world and famous for their unique medicinal importance. These herbaceous species are so far used for animals curing while current exploration of these species showed that these species are a precious resource of various compounds which can be employed in the formation of different drugs. The results showed that the leaf and flower extracts of Adhatoda vasica and leaf extract of Calotropis procera contained higher contents of bioactive compounds. The chemical analysis of the samples resulted in higher values of total phenolic compounds [71.32mg GAE/g], total antioxidants [651% DPPH inhibition], the enzyme catalase [4716Mug/g], ash content [16.72%] and pH values in the Calotropis procera, whereas the total carotenoids [1987mg/100g], the enzymes, superoxide dismutase [4566Mug/g] and peroxidase [1322Mug/g] were higher in leaves of Adhatoda vasica. The flower extract of the Adhatoda vasica was rich in the flavonoids [0.87mg/100g] and organic matter [89.99%] as compared to Calotropis procera. The obtained data for each parameter was interpreted by applying Complete Randomized Design [CRD] along with factorial arrangements. The mean comparison was performed using LSD test at 5% probability level. The presence of these phytochemicals may lead to the conclusion that these herbal plants have the potential for formation of new drugs and can be used as herbal medicine for treatment of different cancer and viral diseases. These compounds are also useful in the treatment of the tumor
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Vaginal vault evisceration is a rare condition seen in postmenopausal women who have previously undergone hysterectomy, causing disruption of the vaginal vault and resulting in extrusion of intraperitoneal content. We report a case of a woman who presented with spontaneous rupture of the vaginal vault and prolapse of small bowel loop two years after abdominal hysterectomy. The rent in the vaginal vault was repaired via vaginal route after the repositioning of the bowel. Vaginal evisceration remains a rare but potentially serious condition that requires emergency surgical intervention
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Background: In liver cirrhosis anemia occurs in up to 75 percent of the patients and blood transfusion is the mainstay of treatment of anemia. Red cell alloimmunization is a common problem encountered in multi-transfused patient. Alloimmunization can make further blood transfusion troublesome as extensive matching of donor is required to provide antigen free blood to the recipient for which alloantibodies are formed. Antibodies to foreign red cell antigens in patient's blood results in delay of transfusion because of complex pre-transfusion tests and difficulty in finding compatible red blood cell unit. Moreover, they can also cause delayed hemolytic blood transfusion reaction
Objectives: 1] To determine frequency of red blood cell alloantibodies in multi-transfused liver cirrhosis patient. 2] To determine the specific type of most common alloantibodies in multi-transfused liver cirrhosis patient
Study design: Cross-sectional study
Place of study: Pathology department of King Edward Medical University with sampling from four hospitals located in Lahore, Pakistan: Mayo Hospital, Jinnah Hospital, Services Hospital and Sir Ganga Ram Hospital
Period of study: January 2016 to March 2016
Methodology: To establish alloimmunization rate in multi-transfused liver cirrhosis patient, cross-sectional study was designed. Sample size of 90 liver cirrhosis patients of all age groups and both genders who had been transfused at least 5 times were taken with the exclusion criteria of known alloantibodies or autoimmune diseases. Patients were screened for alloantibodies using tube IAT and if found positive specific type of antibody was determined using extended red cell panel
Results: 90 patients were screened for alloantibodies of which 3 patients were positive for alloantibodies giving alloimmunization rate of 3.3 percent in multi-transfused liver cirrhosis patient. All three patients had antibodies of different specificities. First patient had anti-D, second patient had anti- Le[b] belonging to Lewis blood group system and third patient had Anti-Jk[a] belonging to Kidd blood group system
Conclusions: This study was conducted to explore the frequency of alloimmunization in multi-transfused liver cirrhosis patients. Due to cross-sectional study design, incidence of formation of new antibodies as well as loss of antibodies over time could not be determined. Therefore, to establish red blood cell alloimmunization rate in cirrhotic patient, a large-scale prospective study should be done in which LISS IAT or enzyme treated cell should be used and antibody detection tests should be done at defined time intervals after blood transfusion. It is suggested that antibody screening test should be done twice. Once shortly after blood transfusion [may be after one month] to detect fast appearing new antibodies or anamnestic response of undetectable antibodies. Secondly after longer interval to detect slow evolving antibodies
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The present study was undertaken to find out the safety levels of fenbendazole in common peafowl. This bird, raised on aviaries and zoos, can be severely parasitized with Ascaridia galli [enteric worms] and Syngamus trachea [gapeworm] along with other parasitic worms. Fenbendazole is a highly effective benzimidazole-class anthelmintic in animals. The objective of this work was to provide target animal safety data in young peafowl and to demonstrate reproductive safety in adult birds. During the experimental study, diets containing fenbendazole at 0, 100, 200 and 300 ppm were fed for 21 days [three times the normal treatment duration]. Data for feed consumption, feed conversion rate, and body weights were recorded for each bird in each group. Drug concentrations in different tissues of birds were determined to correlate concentrations with clinical observations, clinical pathology, and histologic findings. There were no morbidities or mortalities after study day 21. Additionally, there were no statistically significant treatment-related differences among above mentioned parameters. Analysis of fenbendazole concentrations in kidney, liver, leg/thigh, and breast muscle and skin with associated fat revealed that, even at the highest dose level used and with no feed withdrawal, fenbendazole concentrations were relatively low in these tissues. These findings indicate that fenbendazole has a relatively wide margin of safety in young peafowl and that the proposed dose of 100 ppm in the feed for 7 consecutive days is well within the margin of safety. In the reproductive safety study, five breeder peafowl farms fed fendbendazole at 100ppm for 7 days and collected data on hatching percentage of peahen eggs before and after treatment. Reproductive performance in peahen was not adversely affected
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Objective: To document the clinical presentation of neglected DDH and evaluate the outcome of triple procedure
Methods: It was a descriptive case series study, conducted at the Department of Orthopedic Surgery, National Institute of Rehabilitation Medicine [NIRM], Islamabad over a period of 8-years. It included children aged >1 and <9 years who underwent the triple procedure of open reduction, femoral shortening and Salter's osteotomy. Clinical evaluation was performed using McKay's criteria. Tonnis classification and Severin's scoring system were employed for the radiological evaluation
Results: There were 193 children with 213 DDH affected hips. The mean age was 3.31+/-1.6 years. The preoperative severity of the femoral head dislocation per Tonnis classification was Grade-I in 7.98%[n=17], Grade-II in 48.35%[n=103] and Grade-III in 43.66% [n=93] hips. The postoperative MacKay criteria was 'Good' to 'Excellent' in 193[90.61%] hips. The postoperative Severin's class was I in 113[53%] hips, II in 48[22.53%] hips, III in 43[20.18%] and IV in 9[4.22%] hips. The preoperative acetabular index ranged from 39 degree to 51 degree with a mean of 43.91+/-3.69 degree. The mean postoperative AI was 18.42+/-2.99 degree. The postoperative centre edge angle ranged from 21 degree to 26 degree with a mean 23.18 +/-1.35 degree
Conclusions: The single stage triple procedure offers the surgical remedy of choice with favourable results for managing neglected and late diagnosed DDH among children aged 1-8 years
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Unintentional foreign body ingestion is common among children. Normally, these ingested foreign bodies pass spontaneously and the rest can be removed endoscopically; only few ingested foreign bodies lead to complications and need surgical intervention. We are reporting a case of accidental nail ingestion in a 10-year-old child which led to a sealed perforation of duodenum. Operative management included primary duodenal repair after removal of nail. Post operative recovery was smooth and oral was started on day 5. We recommend that all ingested sharp and large foreign bodies should be removed endoscopically, if not passed spontaneously