Bryant's Traction for Neonatal Femur Fracture Occurred During Birth.

Femoral shaft fracture is an uncommon birth trauma. Bryant's Traction followed by spica cast is an acceptable method of treatment of femoral shaft fracture 0-18 month's age group. Here we treated 30 cases of neonatal femur fracture during birth with only Bryant's Traction of both legs for 3 weeks in hospital. We retrospectively reviewed all neonatal femur fractures occurred during birth admitted in FMCH during a two and half years period. All patients were followed up monthly for 3 months and 6 monthly for 2 years. All fractures healed satisfactorily clinically and radiographically and with no residual deformity, limb length discrepancy or functional impairment. Parents were highly satisfied with the method and its result. It is very simple method and could be safely carried out.

The malaria severity score: A method for severity assessment and risk prediction of hospital mortality for falciparum malaria in adults.

Back ground: There is paucity of research to quantify the severity and to predict the mortality risk of severe falciparum malaria even if it affects multiple organ systems during the course of the disease. Therefore, the aim of the present study is to develop a severity score for assessment of disease severity and risk prediction in adult patients of severe falciparum malaria on the first day of hospitalisation. Methods: A cohort of 2598 patients of falciparum malaria were enrolled in this study of which 2089 patients were included as developmental sample and 509 patients as validation sample. Physiological variables were analyzed for defining and assessment of severity of organ dysfunction (OD). The severity level and corresponding severity score for each organ dysfunction were determined by logistic regression analysis that took both the relative severity among the organ systems and the degree of severity within an organ system into account. Risk of mortality has been calculated for each score. Results: Physiological variables defined dysfunction in 7 organ systems with 3 levels of severity (I to III). Neurologic and renal dysfunction had 3 levels of severity. Hematologic, cardiovascular, and respiratory dysfunction had 2 levels of severity where as hepatic and metabolic dysfunction had 1 level of severity. 1,3, and 5 points were assigned to level I,II, and III severity of organ dysfunction respectively. Malaria without any abnormal physiological variables had been considered as no organ failure and assigned 0 score. The cumulative scores in a patient is known as malaria severity score (MSS) that ranged from 0 to 21. Risk of mortality had been calculated for each score. Conclusion: This prospective study provides an objective tool for assessing severity levels for organ dysfunction and prediction of risk of mortality in severe falciparum malaria which can be used for treatment and research. It has been observed that no two patients of falciparum malaria are same in severity. The severity varies over time and malaria can affect single or multiple organs with different levels of severity which can be quantified as level I, II, and III. Neurologic and renal dysfunction were the most severe with level III severity, followed by haematologic, cardiovascular, and respiratory dysfunction with level-II severity, as well as hepatic and metabolic dysfunction the least severe with level-I severity. Patient of malaria can be stratified as low, intermediate, and high risk depending on the MSS. With the help of MSS daily risk estimates and recovery time of OD can be determined. ©

Juvenile T waves (a study of 100 normal subjects).

"Juvenile pattern" of T wave inversion in the precordial leads of electrocardiogram was studied in 100 normal healthy Indians of 0 to 70 years of age in both sexes. Incidence of such pattern was observed in 25 subjects upto 19 years of age. Persons of weight/height ratio less than 30% had higher incidence of juvenile T waves. Maximum incidence (48%) of juvenile T waves was observed in the annual income group of Rs. 15000/-. Exercise ECC showed slight flattening of the inverted T waves in V1 to V3 leads in eight subjects only.