A Comparative Study Of Modified Tension Brand Wiring And Cannulated Cancellous Screw Fixation In Management Of Transverse Fractures Of Patella.

Abstracts: Background This study compares the results of two commonly used methods of internal fixation for transverse fracture of patella namely modified tension band wiring (TBW) and cannulated cancellous screw fixation. Methodology: The study consists of 20 cases treated at BRIMS hospital , Bidar with modified tension band wiring with K-wires and cannulated cancellous screws with a follow up of 1 year. Out of 20 cases, Group A consists of 10 patients treated for tension band wiring and Group B of 10 cases treated for cannulated cancellous screws. Results: Union was achieved in all 20 cases. Group A treated 9 out of 10 had excellent to good results with knee flexion more than 120° and Group B, had 8 out of 10 with excellent to good results with knee flexion more than 120°. In all the 20 cases Quadriceps wasting was severe but less in Group A. Discussion: Although the modified tension band technique (eg. tension band supplemented by longitudinal Krischner wires) has long been the mainstay for fixation of transverse fractures of patella. It has shortcomings, such as bad reduction, loosening of implants, and skin irritation. It was found that modified tension band wiring showed better results than cannulated cancellous screws as stability of implants is better in transverse fracture patella and post operative rehabilitation is faster. Conclusion The modified tension band wiring is better than that of Cannulated cancellous screw transverse fractures of patella probably because of good stability of implant and easier postoperative rehabilitation. [

A Retrospective Study In The Management Of Inter Trochanteric Fracture By DHS Fixation In Boyd And Graffin Type I & II Fractures.

Abstracts: Background: Hip fractures are devastating injuries that most commonly affect the elderly and have a tremendous impact on both the health care system and society. It is now accepted universally that internal fixation is the best method of treatment of intracapsular fracture as it allows early stabilization and patient mobility.1 Methodology: This study consists of 20 cases of intertrochanteric fracture treated with dynamic hip screw and plate. Results: In our study most of the fractures were Boyd and Griffin type II fracture with 14 patients (70%) and type I were 6 patients (30%). In the study trochanteric fracture was common in old age group and were treated with Dynamic Hip screw, because of its sliding mechanism which gives compression at the fracture site. Discussion: The average time of consolidation of fracture in our study was 20 weeks. It was 9 months in conservative method with deformity as seen by Frew.2 So, dynamic hip screw is a better implant for the treatment of trochanteric fracture. This is because of sliding screw, which gives compression at the fracture site. Due to its sliding mechanism, the fracture union rate and movement at hip joint were good in most of our cases. Due to its sliding mechanism the fracture union rate and movement at the joint were good in most of the cases. Conclusion: DHS is a good modality of treatment for internal fixation of intertrochanteric fractures Boyd and Graffin’s type I & II. However good medial cortical opposition either by close reduction or open reduction with/without medial displacement of distal femoral fragment is mandatory for good result.

Evaluation of fluid intake and its relationship between preterm delivery in pregnant women / Шинэ санаа Шинэ нээлт

BACKGROUNDAccording to WHO statistics of 2013, daily 371,124[1] births, annually 135.5 million [1] births occur worldwide which tends to increase in the following years. In Mongolia, studies that evaluaterelationship between fluid intakes of pregnant women and preterm delivery risk have not been conducted so far to our knowledge. Thus, we aimed to determine this relationship by evaluating first and second trimester fluid intakesof pregnant women in Mongolia.METHODS35 and above years old pregnant women of 24-32 gestational weeks have been included in the study where body measurements and fluid intake were collected via questionnaireand examination.RESULTSWhen we studied the relationship between average fluid intake and preterm delivery risk, having inadequate fluid intake in the first trimester increased the risk of preterm delivery by 5.98 (CI95% 0.89-40.08, p<0.01) fold whereas having inadequate fluid intake in the second trimester increased the risk of preterm delivery by 4.03 (CI 95% 1.06-15.21, p<0.01) foldrespectively.CONCLUSIONSOur results show that low fluid intake in first and second gestational trimesters results in increased risk of preterm delivery significantly in Mongolia.

Clinical experience with BIAsp 30: Results from the Philippine cohort of the global a1chieve study

OBJECTIVE: To evaluate the safety, effectiveness and health-related quality of life (HRQoL) parameters of A1chieve study participants in the Philippine cohort, who were treated with BIAsp 30.METHODOLOGY: A1chieve is a non-interventional, six-month, observational study of 66,726 people with type 2 diabetes mellitus (T2DM), including both insulin users and non-insulin users, started on insulin detemir, insulin aspart, or BIAsp 30 in 28 countries across four continents. The present study evaluates the safety, effectiveness and HRQoL in 1,252 subjects from the Philippine cohort of the A1chieve study who were treated with BIAsp 30.RESULTS: At baseline, the mean age, duration of diabetes and mean BMI were found to be 55.5±11.7 years, 7.2 ± 5.6 years and 25.4 ± 5.3 kg/m2, respectively. Seventy-eight percent (78%) of subjects were insulin naïve and 22% were prior insulin users. At baseline, glycemic control was poor (HbA1c = 9.9%) in the entire cohort. Overall there was a 2.7% reduction in mean HbA1c and 44.2% subjects achieved the HbA1c target of CONCLUSION: BIAsp 30 is safe and efficacious for initiating and intensifying insulin therapy for Filipino T2DM patients.

Analysis of association of TaqI VDR gene polymorphism with the chronic periodontitis in Dravidian ethnicity.

AIM: The aim of this study is to analyze the association of TaqI vitamin D receptor (VDR) gene polymorphism with the chronic periodontitis (CP) in Dravidian ethnicity. MATERIALS AND METHODS: A total of 120 subjects were recruited for this study, which included 60 CP and 60 healthy controls. TaqI VDR gene polymorphism was analyzed using specific primers and amplified by polymerase chain reaction (PCR) and visualized under 2% agarose gel. RESULTS: Our study results showed that Tt and tt genotype had a higher frequency of occurrence in CP compared with controls. Similarly, t allele was found to be associated with CP. CONCLUSION: Our study concludes that TaqI VDR gene polymorphism is associated with CP in Dravidian ethnicity.

Phase II Study of Docetaxel with Radiation Therapy for Post Prostatectomy Rising PSA.

Aims: To determine the tolerability of adding docetaxel to radiation therapy in patients with a rising PSA post prostatectomy for prostate cancer. Study design: Phase II study of the combination of docetaxel and radiation therapy. Place and duration of study: University and Veterans Association Hospital from 2007- 2009. Methodology: Patients eligible to receive “salvage” radiation therapy were enrolled in a prospective study to receive concomitant weekly docetaxel (20 mg/m2) and then 4 cycles of full dose (75 mg/m2) docetaxel. Results: All 19 patients were able to complete the concomitant therapy, with just one patient not receiving all 7 cycles of weekly chemotherapy (missing one). Sixteen of 19 completed all four cycles, 2 completed 3 cycles and 1 completed 1 cycle of full dose docetaxel. During combined treatment, there were 3 transient grade 3 toxicities (diarrhea, hemoglobin decline, and hyperglycemia). There was no grade 4 toxicity. During full dose docetaxel, 3 patients suffered a grade 3 decline in WBC count and 2 went on to grade 4. Other single incidents of grade 3 toxicity were anxiety, fatigue, hyperglycemia, diarrhea, febrile neutropenia, port infection and abscess. All the toxicities were transient. By the end of treatment, 89% had a decline in PSA. Conclusion: This is the first report of combined docetaxel and radiation in the post prostatectomy setting. Patients tolerated the combined treatment very well. Toxicities of the full dose docetaxel are consistent with what’s reported in the literature and appear tolerable.

Synthesis of novel Naphthalene COX inhibitors for anti-inflammatory activity.

Inflammation forms the part of various diseased conditions. To treat inflammation variety of anti inflammatory agents are synthesized, they showed undesirable side effects. In order to avoid these side effects, nonsteroidal anti-inflammatory drugs were developed. Research is a continuous and never ending process; efforts are being made to improve the present drug profile such that present side effects can be eliminated. Syntheses of number of naphthalene derivatives with pyrazole moiety were completed. The present classification records for numerous naphthalene derivatives (naproxen and nabumetone) and also many anti-inflammatory drugs containing diaryl heterocycle(celecoxib,rofecoxib) are available as reference, therefore some new non-vicinal 3,5 diaryl heterocycles,in which naphthalene as one of aryl ring and pyrazole as central scaffold was prepared and evaluated for anti-inflammatory activity. The purity of all compounds has been examined by the TLC and structure is confirmed by different analytical techniques like IR, Mass spectroscopy and NMR. Further, the synthesized drugs were evaluated for in vivo anti inflammatory activity by carrageenan induced rat paw edema test using Indomethacin as a standard drug. In conclusion, we have found that two compounds showed equipotent activity while other two showed slightly more anti-inflammatory activity respectively.

Psychosocial profile of women who have undergone sterilization: a cross sectional study

Background Though sterilization is a popular method of contraception, there are some concerns about the psychologicalsequelae including regret after the procedure. Such regret may result in lifelong personal distress.Aims To study the psychological status in terms of depression & anxiety in women who have undergone femalesterilization and to know whether these changes affect the quality of life.Methods This is a cross sectional questionnaire based study of women of reproductive age group. Various instrumentsassessing anxiety, depression and quality of life have been administered. The data is statistically analyzed.Results The mean anxiety and depression scores were low in these subjects. Similarly the quality of life was good in alldomains. However the subjects experienced sexual problems like anxiety about sex (3.3%), decreased libido (10%)and decreased frequency of coitus (31%), whereas the menstrual symptoms were not affected significantlyConclusions The findings indicate that literacy rate, self motivation, knowledge of procedure and constant availabilityof medical services have impact on outcome of the procedure.

Study of psychological morbidity & coping mechanisms in family members of persons with mental illnesses

Background: The psychological morbidity of family members of mentally ill is generally overlooked. This studyfocuses on the psychological morbidity in family members.Aim : To study psychological morbidity and coping mechanisms used by the family members of mentally ill admittedin psychiatric hospital.Methods: A sample of 45 family members of mentally ill admitted in The Institute of Mental Health, Hyderabad wastaken. Severity of illness in patients and psychological morbidity and coping mechanisms used by the family memberswere assessed.Results : There is no significant psychological morbidity among the family membersConclusions Acceptance is the most common coping mechanism used by family members of persons with mental illness.

Aeroallergens in clinical practice of allergy in India- ARIA Asia Pacific Workshop report.

Allergic diseases such as bronchial asthma, allergic rhinitis and atopic dermatitis are dramatically increasing all over the world including developing countries like India. Today, more than 30% of the population is known to suffer from one or other allergic ailment. Major causative agents implicated are pollen grains, fungal spores, dust mites, insect debris, animal epithelia, etc. Several aerobiological studies have been conducted in different parts of the country to ascertain aerial concentration and seasonality of pollen grains and fungi. Recently, an "All India Coordinated Project on Aeroallergens and Human Health" was undertaken by us to discover the quantitative and qualitative prevalence of aerosols at 18 different centers in the country. Allergenically important airborne pollen identified by clinico-immunologic evaluation are Alnus, Amaranthus, Argemone, Brassica, Cannabis, Cassia, Cedrus, Chenopodium, Cocos, Holoptelia, Mallotus, Morus, Parthenium, Prosopis juliflora, Quercus, Ricinus communis, and grasses such as Cenchrus, Cynodon, Imperata, Pennisetum etc. Cross-reactivity of the IgE antibodies is a common phenomenon among various pollen allergens. Ricinus communis pollen a commonly growing weed/shrub in India, cross-reacts with latex (Hevea brasiliensis), Mercurialis annua and also with seeds of Ricinus communis--all belonging to family Euphorbiaceae but geographically distantly located. Areca catechu cross-reacts with other members of Arecaceae such as Phoenix sylvestris, Cocos nucifera and Borassus flabelifer while pollen of Holoptelia integrifolia from India cross reacts with pollen of Parietaria judaica from Mediterranean Europe, both of which are members of family Urticaceae. Several reports on pollen and fruit syndrome have been analyzed. Experiments conducted by us revealed that pollutants (NO2 and SO2) not only affect pollen morphology but also changes its allergenic potency.

O que é um alergista? / What is an allergist?

Introdução: O alergista é o médico que concluiu com êxito um período de treinamento especializado em alergia e imunologia e um período de treinamento em medicina interna e/ou pediatria. Os alergistas também são imunologistas clínicos especializados, devido à base imunológica das doenças que diagnosticam e tratam. Na maioria dos países, o período aprovado de formação na especialidade em alergia e imunologia é de dois a três anos de treinamento intenso e específico. Dependendo dos sistemas de credenciamento nacionais, a conclusão desse treinamento será reconhecida por um certificado de treinamento especializado em alergia, em alergia e imunologia ou em alergia e imunologia clínica, outorgado por uma comissão diretiva. Em alguns países, isso acompanha a conclusão bem-sucedida de um exame de qualificação e, em outros, as competências apresentadas por um supervisor de treinamento. Os alergistas totalmente treinados fazem uma importante contribuição para o delineamento dos sistemas de atendimento local e proporcionam o atendimento necessário aos pacientes com doenças alérgicas. Os alergistas agem como defensores do paciente, e apóiam e questionam o caso para melhorar a educação dos médicos de atendimento primário e secundário, assim como de outros profissionais de saúde que também atendem pacientes alérgicos. Os alergistas devem estar disponíveis para fazer o atendimento dos casos mais complicados, que estão além do campo de ação de médicos de atendimento primário e secundário e de outros profissionais de saúde com bom treinamento. As principais características que definem um alergista são a apreciação da importância dos desencadeantes externos que causam a doença e o conhecimento de como identificar e tratar essas doenças, juntamente com a experiência nas terapias imunológicas e fármacos apropriados. Essa conduta no diagnóstico e na terapia é um valor essencial do especialista em alergia, e destaca o alergista entre muitos especialistas cujas bases de pacientes podem sobrepor-se com a especialidade...

Requisitos para treinamento médico em alergia: competências clínicas essenciais para o tratamento de pacientes com doenças alérgicas ou imunológicas: declaração da posição provisória da word allergy organization (WAO) / Requirements for physician training in allergy: key clinical competencies appropriate for the care of patients with allergic or immunologic diseases: a provisional position statement of the world allergy organization

Introdução: As doenças alérgicas têm prevalência extraordinária em todo o mundo, e a incidência de alergia é crescente em to¬dos os lugares!-7. Como os processos alérgicos e imunol¬gicos sobrepõem todos os sistemas orgânicos, nem sempre a alergia é ensinada nas escolas de medicina como uma disciplina separada. Realmente, a falta de reconhecimento da especialidade e da necessidade de ensinar as doenças alérgicas e imunológicas resulta no fato de a alergia não ser incluída em certos currículos de medicinas. Com a estimativa de que 22 pt por cento da população global tem doenças alérgicas e imunológicas, está na hora de reconhecer e fortalecer a educação em alergia e imunologias. A World Aflergy Organization, uma aliança de 74 sociedades nacionais e regionais de alergia, criou este documento consensual para estabelecer diretrizes educacionais que aplicadas mundialmente, para identificar e corrigir as deficiências do treinamento em alergia e para definir metas de treinamento apropriadas. Ao criar este consenso, é reconhecido que cada país tem seus próprios princípios e metas de educação médica nos níveis de graduação e pós-graduação. Este documento define o que um médico deve saber para tratar pacientes alérgicos.

'Rescue' radiofrequency ablation for atrial tachycardia presenting as cardiomyopathy in pregnancy.

A young primiparous lady presented with drug-refractory atrial tachycardia which had led to cardiomyopathy. Three attempts with electrical cardioversion were also unsuccessful. She was rescued by radiofrequency ablation.

A study of clinical efficacy of sildenafil in patients with primary pulmonary hypertension.

BACKGROUND: Primary pulmonary hypertension is a disorder with limited treatment options and poor outcome. Sildenafil, a pulmonary vasodilator, is likely to be beneficial in primary pulmonary hypertension. We studied the clinical efficacy of sildenafil in patients with primary pulmonary hypertension. METHODS AND RESULTS: A registry of patients with primary pulmonary hypertension has been maintained in our hospital since January 1999. Of a total of 60 patients. 29 (M:16, F:13) consented to try sildenafiL. New York Heart Association functional class, six-minute walk test and Doppler echocardiographic evaluation of pulmonary artery pressure was done before and after treatment with sildenafil. Sildenafil was initiated at a dose of 25 mg thrice a day and increased up to 100 mg thrice a day as tolerated. There was a significant improvement in the functional class. The six-minute walked distance increased from 297.07+/-130.69 m at baseline to 427.68+/-85.35 m after 3 months of sildenafil therapy (p<0.0003). The mean of the pulmonary artery systolic pressure before starting sildenaffil was 109.26+/-24.15 mmHg (mean+/-SD) and it decreased to 95.15+/-24.64 mmHg (p<0.008). While 19 of the 31 historical controls in whom sildenafil was not given died during follow-up (11-44 months), only 1 of the 29 patients given sildenafil died (in an accident) during follow-up (5-20 months). CONCLUSIONS: Sildenafil, a pulmonary vasodilator, has a beneficial effect in patients with primary pulmonary hypertension in improving the functional class, six-minute walked distance and in decreasing the pulmonary artery pressures.

A case-control study of plasma homocysteine levels in South Indians with and without coronary artery disease.

BACKGROUND: An increased level of plasma homocysteine is being recognized as a new risk factor for coronary artery disease. Since there are not enough data about its importance in Indians with coronary artery disease, we aimed to assess the significance of plasma homocysteine as a coronary risk factor in South Indian patients. METHODS AND RESULTS: In a case-control study, fasting plasma homocysteine levels were estimated in 565 subjects, of whom 221 were cases and 344 were controls. Of the 221 clinically defined cases, 112 underwent coronary angiography while 107 of the 344 controls had angiographically proven normal coronary arteries. Ninety healthy volunteers from the community were also included as controls. Fluorescent polarization immunosorbent assay was used to measure plasma homocysteine levels. In 12 patients, this method was compared to high pressure liquid chromatography and was found to give comparable results. The mean plasma homocysteine level was 18.30 +/- 10.08 micromol/L in clinically defined cases and 18.04 +/- 10.69 micromol/L in controls. Similarly, in angiographicallyproven coronary arterydisease patients, the mean plasma homocysteine levelwas 18.49 +/- 10.04 micromol/L and in individuals with angiographically normal coronary arteries, it was 19.16 +/- 11.38 micromol/L. CONCLUSIONS: There is no statistically significant difference in plasma homocysteine levels between controls and cases with coronary artery disease. The mean plasma homocysteine levels in controls as assessed by fluorescent polarization immunosorbent assay in the present study population are higher as compared to other published reports.

Drug treatment of portal hypertension.

Despite advances in endoscopic management, variceal bleeding is still associated with a significant mortality. In recent years, several therapeutic agents have been shown to lower the portal pressure and reduce variceal bleeding. In patients presenting with acute variceal bleeding, the drug of choice is somatostatin; it is as effective as endoscopic treatment and is virtually free of side-effects. The second-line drug therapy in acute variceal bleeding is a combination of vasopressin and nitroglycerine. Every patient with a history of variceal bleeding is at an increased risk of rebleeding and should receive some form of preventive therapy. In these patients, non-selective beta-blockers and endoscopic treatment are equally effective and either modality can be used. Since each episode of variceal bleeding carries a 30%-50% risk of death, cirrhotics who have never experienced variceal bleeding but are at high risk to develop this complication (high portal pressure, variceal grade III and IV, and presence of red wale markings over the varices) should be identified and treated. Beta-blockers are the treatment of choice and should be continued for the rest of the patient's life. Isosorbide-5-mononitrate is also useful in lowering the portal pressure and may be combined with beta-blockers in those who do not respond to the use of beta-blockers alone. However, isosorbide-5-mononitrate should not be given alone for a long duration because of its adverse haemodynamic effects. Additional measures which are useful in decreasing the risk of variceal bleeding are good control of ascites, especially with spironolactone and a low salt diet, and early recognition and treatment of bacterial infections.

Current status of transjugular intrahepatic portosystemic shunt (TIPS).

TIPS is the creation of an intrahepatic shunt between the portal and hepatic veins. The primary indications for TIPS are unresponsive acute variceal bleeding; bleeding from gastric varices, ectopic varices and portal gastropathy; and variceal bleeding in patients awaiting liver transplantation. Preliminary reports suggest that TIPS may be useful in other conditions such as resistant ascites, cirrhotic hydrothrorax and hepatorenal syndrome. TIPS has also been successfully placed in a proportion of patients with Budd-Chiari syndrome and portal vein thrombosis. The immediate post-procedure complication rate is low, considering the serious underlying illness of patients undergoing TIPS. However, the main concern in the long-term is stent stenosis or occlusion. Within one year, nearly 50% of patients develop stent dysfunction and a significant proportion of these patients suffer from recurrent variceal bleeding. At present, no clear solution has been found to this problem. It is hoped that stents made of material which is less thrombogenic and which provokes a less exuberant host tissue response may become available. Until then, TIPS should be reserved for complications which are unresponsive to standard therapy and in patients where surgery is considered hazardous.

Endoscopic treatment of bile duct stones: is stone extraction necessary after endoscopic sphincterotomy?

BACKGROUND: The current treatment for stones in the biliary tree is endoscopic sphincterotomy (ES) followed by stone extraction with the help of balloon catheters or metal baskets. Stone extraction techniques are often associated with complications. Moreover, the balloon catheters break easily which aids to the cost of the procedure. The present study was designed to examine the effectiveness of endoscopic sphincterotomy (ES) alone in allowing spontaneous expulsion of bile duct stones and to determine the circumstances which warrant stone extraction. METHODS: Endoscopic retrograde cholangio-pancreatography (ERCP) was attempted in 68 patients with stones in the common bile duct. The stone size was determined by ultrasound, cholangiography in post cholecystectomy patients with a T-tube or by ERCP. Patients with stone size of 15 mm or less in diameter were treated with ES alone without stone extraction. Patients were discharged from the hospital within 24 hrs and returned for reassessment every week or earlier, if symptomatic, until complete clearance of stones was demonstrated. RESULTS: Endoscopic sphincterotomy was successfully performed in 63 (93%) patients, the procedure was abandoned in the remaining 5 patients for technical reasons. Spontaneous clearance of stones was observed in 55 (87%) patients, usually without any accompanying pain (47.85%). Persistent stones were seen in 8 (13%) patients; extension of the ES resulted in spontaneous stone expulsion in 6 of these patients. Thus, 61 (97%) of the 63 patients with stones of 10 mm or less in size cleared the stones spontaneously and all 8 patients who failed the initial ES, had stones > 10 mm in size. COMMENT: The present study shows that all small stones (< 10 mm) and most of those < 15 mm are expelled spontaneously after an adequate ES. These finding if substantiated by larger studies will reduce considerably the cost of the procedure as well as the morbidity associated with mechanical stone extraction.