The Functional Outcome Volar Barton Fracture Treated by Open Reduction and Internal Fixation with T Plate – A Prospective Study

Introduction: Barton's fracture is fracture-dislocation ofradiocarpal joint with the intra-articular fracture involvingthe volar or dorsal lip. These injuries are inherently unstabledemanding open reduction and internal fixation. We presentour experience with buttress plate fixation for volar Barton’sfracture with Ellis T-plate. Aims: To evaluate the functionaloutcome and complications in volar Barton’s fracture treatedby open reduction and internal fixation with T plate.Material and methods: This case series study wasconducted between January 2012 and November 2012 atDepartment of Orthopaedics, Government Medical CollegeThiruvananthapuram. The patients in the age group 18 -75years who were treated by ORIF for volar Barton fractureswere included in the study. During follow up, subjective andobjective assessments were done and the patient’s functionalstatus was evaluated with modified clinical scoring system ofGreen and O’Brien. The 32 patients involved were followedup for eleven months. The descriptive data were analysedusing ‘SPSS’ and conclusions were made based on it.Results: Wrist functions as assessed by Green and O’Brienscore showed 84.4% patients with excellent to good results.Five patients had either fair or poor outcome. None of thesevariables were found to have any significant effect on the finaloutcome.Conclusions: Ellis T plate is a simple and cheap implantwhich provides effective volar distal buttressing in treatmentof volar Barton fractures. Our study shows encouragingresults with good functional results. Also, there is a relativelyshort learning curve and the implant is cost effective.

Computer assisted learning vs. conventional teaching in experimental Pharmacology: perception of second year medical students

Background: The main pool of pharmacology practical teaching is formed by the use and demonstration of animal experiments. Animals have been used to demonstrate the effect of various drugs in experimental pharmacology classes, in the lab. The practical sessions in pharmacology training involving animal experiments are still taught by traditional teaching methods. Rapid development of information technology has led to newer trends in teaching and learning using Computer Assisted Learning (CAL). Keeping it in mind we decided to undertake this study to assess the perception of CAL in 2nd year MBBS students over conventional teaching in experimental pharmacology.Methods: This was an observational, questionnaire-based study. A total of hundred undergraduate MBBS (2nd year) students participated. Participants were first demonstrated an animal experiment by conventional teaching method followed by the same animal experiment demonstration on CAL. Students� feedback was recorded on a questionnaire and analyzed.Results: The mean age of the participants was 19.88�28 years. The study overall observed that 62% preferred CAL to conventional (38%). Majority of the participants� thought CAL (63%) helps to understand better over conventional (28%) and that CAL (63%) is time independent over conventional (28%). More than 85% felt that CAL was more explanatory and provided a better learning experience.Conclusions: Students preferred CAL to conventional teaching, in experimental pharmacology. It also provided insight on perception and experience of students towards CAL for experimental pharmacology. However, further studies are warranted to assess the knowledge, cognitive and psychomotor skills of students.

Psychological disorders and personality characteristics of with gastro-esophageal reflux disease.

Background: Gastro-esophageal reflux disease (GERD) can be traced back to disorders of the gastro-esophageal junction but several psychological factors interact to affect treatment outcomes. There is sparse literature from India regarding psychological co-morbidity and personality characteristics in patients with GERD. Aim and Objectives: To study the co-morbid psychological disorders and personality profiles in patients suffering from GERD. Methods: Two hundred patients with GERD-related symptoms were randomly screened for psychological disorders and personality characteristics using 30-item General Health Questionnaire (GHQ) and Sixteen Personality Factor Questionnaire (16PF) respectively. Patients who screened positive for presence of co-morbid psychological disorders were further interviewed using Structured Clinical Interview for DSM-IV Axis 1 Disorders (SCID-1) to find out the type of psychological disorder. Results: The prevalence of psychological co-morbidity in patients with GERD-related symptoms in our sample was found to be 40%. Major depressive disorder was the most common psychological disorder found co-morbid in these patients. Alcohol dependence was significantly observed in males; while in females, major depressive disorder and generalized anxiety disorder was more commonly seen. Regarding personality characteristics, a higher degree of neuroticism and risk-taking attitudes was found in patients of GERD with associated psychological co-morbidity Conclusions: This study suggests that the management of GERD may include psychological evaluations and possibly interventions in standard treatment protocols.

Association of OSTA index with bone mineral density (BMD) and its comparison with calcaneal quantitative ultrasound for the prediction of low BMD in peri-menopausal Indian women.

Background: Osteoporosis is characterized by low bone mineral density (BMD) and an increased risk of fractures with advancing age in postmenopausal women. BMD measurements with dual energy X-ray absorptiometry (DEXA) are costly and not widely available The Osteoporosis Self-Assessment Tool for Asians (OSTA) index is a simple tool based on age and body weight to predict low BMD and identify women at risk of osteoporosis. The objective was to study the association of OSTA index with BMD (T-score) and to validate OSTA index in comparison with calcaneal Quantitative Ultrasound (QUS) for the prediction of low BMD in peri-menopausal Indian women. Methods: This was a prospective, cross-sectional, descriptive study carried out in department of physiology of a tertiary care teaching hospital (Navi Mumbai). Seventy two peri-menopausal women between 40 to 55 years with no previous diagnosis of osteoporosis were included. Participants’ socio-demographic detail, anthropometric measurements, OSTA index and QUS-based BMD was recorded. Pearson’s correlation test was used. Sensitivity, specificity, positive and negative predictive value was calculated. Results: OSTA index did not correlate with BMD in the entire samples. On subgroup analysis, OSTA index significantly correlated in a positive direction with BMD (T-score) in women in the age group of 50-55 years. OSTA index had a sensitivity of 70 %, and specificity of 84.62 % at T-score cutoff value of < -1. Conclusions: OSTA index is a simple risk assessment tool that can be used to identify women with low BMD in the age group of 50-55 years.

Expanding horizons of anticoagulant therapy: Dabigatran etexilate a novel oral anticoagulant.

Thrombo-embolic disease is a major challenging clinical problem associated with significant mortality and morbidity. Anticoagulation with the existing heparin products and vitamin K antagonist (VKA) anticoagulants are still the mainstay of management. However, due to the risk of bleeding and well-documented drawbacks, the quest for a novel oral anticoagulant has led to the clinical development of dabigatran etexilate. Dabigatran etexilate is a direct thrombin (IIa) inhibitor which has recently been approved in India for prevention of venous thromboembolic events (VTE) in patients who have undergone major orthopaedic (total knee or hip replacement) surgery and for prevention of stroke, systemic embolism and reduction of vascular mortality in adult patients with atrial fibrillation. Thus dabigatran etexilate is a promising alternative to the current heparin products and VKAs in patients who require long-term oral anticoagulation.

Cytodiagnosis of salivary gland lesions.

Objectives: The purpose of the present study was to analyse the relative frequency and distribution of different salivary gland lesions,to evaluate the diagnostic accuracy and efficacy of FNAC in diagnosing these lesions and to correlate the FNAC finding with histopathological diagnosis wherever possible. Method : During the five year period of study ,hundred cases were studied .FNAC was done in eightyone cases and sixtynine cases were available for histopathological examination.Cyological and histological correlation was possible in fifty cases.For cytological examination smears were stained with Leishmann,H & E and PAP. Result : The results were analysed statistically by sensitivity,specificity ,positive and negative predictive values.In our study there was equal distribution of salivary gland lesion among both sexes.Maximium number of lesions were found in parotid followed by submandibular gland.The overall diagnostic accuracy of FNAC in diagnosing the malignant lesions was 90%. Conclusion: The diagnostic accuracy and low false positive and false negative diagnosis obtained in this study warrants FNAC to be utilized as first line diagnostic procedure in the evaluation of patients with suspected salivary gland lesions. Histopathological diagnosis however,still remains the gold standard.