Evaluation of the ocular surface in asymptomatic glaucoma patients on topical medications and following trabeculectomy - A cross-sectional study

Purpose: This present prospective, cross-sectional study aims to comprehensively evaluate the ocular surface in asymptomatic patients with diffuse blebs after trabeculectomy versus chronic anti?glaucoma medication use and compare it with the age?matched normal population. Methods: Objective clinical evaluation was done by tear film break?up time (TBUT) and Schirmer’s test (ST) in the three groups– trabeculectomy >6 months with a diffuse bleb (Wurzburg bleb classification score ?10), chronic anti?glaucoma medication (AGM >6 months) group, and normal population. In all groups, tear film osmolarity was checked with the TearLab® device (TearLab Corp., CA, USA), and subjective evaluation was performed by administering Ocular Surface Disease Index (OSDI) questionnaire. Patients already on chronic lubricants or any other drug for the treatment of dry eyes (viz. steroids, cyclosporin) or having symptoms suggestive of an abnormal ocular surface, who had undergone refractive or intraocular surgery, and contact lens users were excluded. Results: In total, 104 subjects/eyes were recruited over 6 weeks. Thirty?six eyes recruited in the trab group were compared with 33 eyes studied in the AGM group, and both these groups were compared to 35 normal eyes. When compared to normals, TBUT and ST were significantly lower (P = 0.003 and 0.014) and osmolarity and OSDI were statistically significantly higher (P = 0.007 and 0.003) in the AGM group, whereas only TBUT was statistically significantly different (P = 0.009) when the trab group was compared to normals. Also, when the trab group was compared to the AGM group, ST was found to be higher (P = 0.003) and osmolarity was lower (P = 0.034). Conclusion: To conclude, ocular surface is affected even in asymptomatic patients on AGM but near normalcy is possible following trabeculectomy when blebs are diffuse.

Association between non-high density lipoprotein-cholesterol fractions and presence of allostatic load among industrial workers

Objectives: Non-high density lipoprotein-cholesterol (non-HDL-C) fraction is the total cholesterol (TC) minus HDL-C. It is not a routinely reported component of lipid profile and is used in lipoprotein lowering therapy and prediction of coronary artery disease, target organ damage and atherosclerosis. Allostatic load (AL) is an imbalance between repetitive chronic exposure to stress and adaptive response. The present study investigates the association between non-HDL-C and its fractions (non-HDL-C/HDL-C, non-HDL-C/TC, non-HDL-C/ triglyceride [TG] and non-HDL-C/low-density lipoprotein-cholesterol [LDL-C]) and the presence of AL to determine, which fractions of non-HDL-C predict the diagnostic accuracy and optimal cut points. Materials and Methods: The study design is cross-sectional and data were collected from 169 male industrial workers. AL was measured using neuroendocrine (cortisol and dehydroepiandrosterone sulphate), cardiovascular (systolic blood pressure, diastolic blood pressure and heart rate), metabolic (TC, TG, HDL-C and LDL-C) and anthropometric (waist-hip ratio and body mass index) factors. The fractions of non-HDL-C/HDL-C, nonHDL-C/TC, non-HDL-C/TG and non-HDL-C/LDL-C were calculated using non-HDL-C, HDL-C, TC, TG and LDL-C values. Results: About 43.2% and 56.8% of workers had low and high AL, respectively. The non-HDL-C and its fractions such as non-HDL-C/HDL-C, non-HDL-C/TC and non-HDL-C/LDL-C were significantly increased in the high AL group. Stepwise regression analysis was used to examine the association between non-HDL-C fractions and AL. The fractions of non-HDL-C (? = 0.785, P = 0.001), non-HDL-C/TC (? = ?0.336, P = 0.001) and nonHDL-C/LDL-C (? = 0.295, P = 0.001) influenced AL by 38.6%. The AUC with 95% CI in the high AL group was as follows: non-HDL-C 0.766 (0.696–0.837, P = 0.001); non-HDL-C/HDL-C 0.638 (0.555–0.721, P = 0.002); nonHDL-C/TC 0.635 (0.552–0.712, P = 0.003) and non-HDL-C/LDL-C 0.520 (0.433–0.607, P = 0.657). Non-HDL-C and its fractions were more precisely predicted in the high AL category of workers than in the low AL category. Non-HDL-C predicted the most precisely, followed by non-HDL-C/HDL-C, non-HDL-C/TC, non-HDL-C/ LDL-C and non-HDL-C/TG. Conclusion: According to the present study, non-HDL-C and its fractions such as non-HDL-C/HDL-C, nonHDL-C/TC and non-HDL-C/LDL-C should be considered regular lipid profiles and could be used as biomarkers to reduce the risk of AL.

Impact of the novel coronavirus disease and lockdown on the packed red blood cells inventory management: An experience from a tertiary care oncology center in Western India

ABSTRACT Introduction The novel coronavirus disease has disrupted blood transfusion services worldwide. Despite blood transfusion services taking several precautionary measures to minimize the risks of COVID-19 during blood donations, donors became anxious regarding the risk of the COVID-19 infection during the donation and the blood transfusion services was facing the inevitable hazard of blood shortage. Methods The study was conducted at a tertiary care oncology hospital-based blood transfusion services and included analysis of blood donations, packed red blood cell units requirements, and packed red blood cell inventory in the pre lockdown and lockdown phase. New COVID-19 standard operating procedures with enhanced safety guidelines and donor confidence-building measures were implemented at the blood transfusion services. Results The total number of average monthly blood donations decreased in lockdown but the decrease was not statistically significant (238.5 vs. 197.8, P = 0.391). The requisitions for the packed red blood cell cross-matches (722.5 vs. 329.0, P = 0.001) and the packed red blood cell utilization (176.5 vs. 103.3, P = 0.028) for the hospital patients also decreased significantly due to the lockdown. In the lockdown phase, an expressive number of packed red blood cell units were outdated due to the unprecedented fall in the number of patients. In the post-lockdown phase, the packed red blood cell inventory was optimized with decreased outdating via a comprehensive approach. A special emphasis was given to the in-house donations. A second partial lockdown also decreased the blood donations. Conclusion Confidence-building in blood donors and the resolution of logistical issues were crucial for the efficient packed red blood cell inventory management in the lockdown. Implementation of COVID-19 preventive measures helped in the blood donor and blood transfusion services staff safety.

Synthesis, antibacterial, and antioxidant studies of 7-amino-3-(4-fluorobenzoyl)indolizine-1-carboxylate derivatives

In the present work, the quaternary salts of 4-aminopyridine, i.e., 4-amino-1-[2-(4-bromophenyl)-2-oxoethyl]pyridin-1-iumbromides were obtained by stirring 4-aminopyridine with phenacyl bromides in acetone at room temperature separately.These quaternary salts of 4-aminopyridine were treated with acetylenes (electron deficient), in the presence of anhydrouspossium carbonate in N,N-dimethylformamide solvent to get indolizine derivatives. The structures of newly synthesisedcompounds have been confirmed by spectroscopic techniques, such as liquid chromatography mass spectrometry,1H-NMR, and elemental analysis. Synthesized all compounds were screened for antibacterial and antioxidant activity.The compounds 2e, 2g, and 2j shows inhibition zone against bacteria and compounds 2a and 2f moderately active againstbacteria. All compounds 2a to 2j show 1,1-diphenyl-2-picrylhydrazide radical free radical scavenging activity, NitricOxide free radical scavenging activity, Reducing power scavenging activity, and Lipid peroxidation inhibition activity.

Influence of weather parameters on Aphis craccivora and Bean common mosaic virus disease incidence in Vigna unguiculata L. Walp

Aim: Many crop modelling and climate simulation studies have reported variability in pest and pathogen distribution as well as their interaction with host. These prediction encourages to revisit the pest and pathogen epidemological and distribution studies in light of changing climate. In line with above assumption, the present field study was carried out to study the population dynamics of cowpea aphid (Aphis craccivora) and its influence on BCMV disease incidence. Methodology: In this field experiment, A. craccivora population and BCMV disease incidence data were collected in different standard meteorological weeks of 2013-2014 and 2014-2015. Impact of weather parameters on A. craccivora and BCMV disease incidence was statistically analyzed. Results: The significant change in A. craccivora population and BCMV disease incidence was documented during the study. The maximum aphid population was observed during rabi season and less was observed in kharif and summer season. Whereas, incidence of BCMV was recorded maximum in rabi season. Correlation analysis affirmed, minimum temperature (Tmin) and rainfall had negative impact on A. craccivora whereas weather parameters had non-significant impact on BCMV disease incidence. The regression models developed from the present study explained 41.4 % to 78.8 % and 18.5 % to 46.1% variability (R2) of aphid population and BCMV incidence, respectively. Interpretation: The weather parameters had more impact on A. craccivora population than BCMV disease incidence and merely presence of maximum number of A. craccivora was not a deciding factor for outbreak of virus disease incidence.

Torsion of Appendix of Testis - Masquerading as Acute Epididymitis

A case of torsion of the appendix of testis is described in a 11 years old boy. He presented with sudden onset of severe pain in the left testis of 2 hour duration. Emergency exploration of the left testis revealed a torsion appendix of the left testis. The appendix of the testis was excised and the wound was closed. The patient made a smooth post-operative recovery

Medically Important Coagulase Negative Staphylococci

In recent years, coagulase negative Staphylococci(CONS) are increasingly recognized as one of the major causes of health care associated infections (HCAI). CONS infections are one of the major causes of morbidity and mortality in hospitalized patients. As CONS colonize various parts of the skin and mucous membranes, most of infections are en-dogenous in origin. However, they are also transmitted exogenously via various medical/ surgical procedures. The aim of present review article is to update and summarize the information available on medically important CONS with special reference to epidemiology, laboratory diagnosis and antibiotic resistance.

Antioxidant, anti-quorum sensing and anti-biofilm potential of ethanolic leaf extract of Phrynium capitatum and Dryptes indica

Objective: To investigate the antioxidant and anti-infective potential of Phrynium capitatum and Dryptes indica extract. Methods: The antioxidant potentials were determined by DPPH radical scavenging, reducing power, hydroxyl radical scavenging and total antioxidant assays. We further examined anti-quorum sensing activity and inhibition of synthesis of pathogenic factor of Chromobacterium violaceum and Pseudomonas aeruginosa PAO1. Bioactive compounds were determined using gas chromatography–mass spectrometry analysis. In silico analysis was conducted to determine the binding affinity of bioactive compounds of plant extracts for the quorum sensing regulatory receptor LasR. Results: DPPH assay showed that the ethanolic extract of Phrynium capitatum and Dryptes indica at 500 μg/mL showed (86.96 ± 4.07)％ and (74.83 ± 3.47)％ inhibition, respectively. Hydroxyl radical scavenging assay showed (73.17 ± 3.03)％ and (62.63 ± 4.59)％ activity, respectively. The ethanolic extract of Phrynium capitatum and Dryptes indica showed high level of attenuation of quorum sensing regulated pyocyanin production. Confocal laser scanning microscopic analysis revealed that the extracts had the potential to effectively inhibit biofilm formation of Pseudomonas aeruginosa. Molecular docking analysis showed a better binding affinity of bioactive compounds from the extracts for the structure of LasR protein of Pseudomonas aeruginosa. Conclusions: The ethanolic extracts of Phrynium capitatum and Dryptes indica possess antioxidant activity and the potential to inhibit the quorum sensing system and its regulatory virulence traits in Pseudomonas aeruginosa PAO1.

Antioxidant, anti-quorum sensing and anti-biofilm potential of ethanolic leaf extract of Phrynium capitatum and Dryptes indica

Objective: To investigate the antioxidant and anti-infective potential of Phrynium capitatum and Dryptes indica extract. Methods: The antioxidant potentials were determined by DPPH radical scavenging, reducing power, hydroxyl radical scavenging and total antioxidant assays. We further examined anti-quorum sensing activity and inhibition of synthesis of pathogenic factor of Chromobacterium violaceum and Pseudomonas aeruginosa PAO1. Bioactive compounds were determined using gas chromatography-mass spectrometry analysis. In silico analysis was conducted to determine the binding affinity of bioactive compounds of plant extracts for the quorum sensing regulatory receptor LasR. Results: DPPH assay showed that the ethanolic extract of Phrynium capitatum and Dryptes indica at 500 μg/mL showed (86.96 ± 4.07)% and (74.83 ± 3.47)% inhibition, respectively. Hydroxyl radical scavenging assay showed (73.17 ± 3.03)% and (62.63 ± 4.59)% activity, respectively. The ethanolic extract of Phrynium capitatum and Dryptes indica showed high level of attenuation of quorum sensing regulated pyocyanin production. Confocal laser scanning microscopic analysis revealed that the extracts had the potential to effectively inhibit biofilm formation of Pseudomonas aeruginosa. Molecular docking analysis showed a better binding affinity of bioactive compounds from the extracts for the structure of LasR protein of Pseudomonas aeruginosa. Conclusions: The ethanolic extracts of Phrynium capitatum and Dryptes indica possess antioxidant activity and the potential to inhibit the quorum sensing system and its regulatory irulence traits in Pseudomonas aeruginosa PAO1.

Effectiveness of topical green tea against multidrug-resistant Staphylococcus aureus in cases of primary pyoderma: An open controlled trial

Background: Antimicrobial activity of green tea against Staphylococcus aureus both in vitro and in vivo has been reported recently. Studies on clinical efficacy and safety of green tea as antibacterial agent against S. aureus in human cases are rare. Objectives: To evaluate the clinical effectiveness and safety of topical green tea on primary pyoderma caused by S. aureus. We also attempted to determine the minimum inhibitory concentration of green tea against S. aureus and methicillin-resistant S. aureus. Methods: Open label, prospective, placebo-controlled study included community-acquired primary pyoderma cases caused by S. aureus. Severity grading was done on a scale of 1–5. Green tea ointment 3% and placebo ointment were used. Cure was defined on the basis of negative culture and assessment of clinical improvement. Minimum inhibitory concentration was determined by agar dilution method. Data were analyzed using Statistical Package for Social Sciences (SPSS) software version 16. Results: Of the 372 patients, 250 received green tea and 122 received placebo. Multidrug-resistant S. aureus was isolated in 89.1% in green tea group and 81.1% in placebo group, respectively. Methicillin-resistant S. aureus was isolated in 24 patients. Cure was seen in 86% in green tea group and 6.6% in placebo group which was statistically very significant. The number of days for comprehensive cure in green tea group was 9.2 ± 6.4 days. All patients with methicillin-resistant S. aureus infection in the green tea group were cured. Minimum inhibitory concentration of green tea against S. aureus was 0.0265 ± 0.008 μg/ml and against methicillin-resistant S. aureus was 0.0205 ± 0.003 μg/ml. Limitations of the Study: Comparative trial was not conducted in the same patient with different lesions; children less than seven years were not considered as the school authorities did not permit for younger children to be included in the study and true randomization and blinding of investigators were not done. Conclusions: Green tea has a significant antibacterial effect against multidrug-resistant S. aureus. Minimum inhibitory concentration of green tea is established and is promising in methicillin-resistant S. aureus infections.

Biochemical Characterization and Antibiotic Susceptibility of Coagulase Negative Staphylococci Isolates from Exudates and Body Fluids

Coagulase negative Staphylococci (CoNS) are increasingly being recognized as significant nosocomial pathogens, partly due to the growing appreciation of this group of organisms as opportunistic pathogens or due to increase in the use of transient or permanent medical devices in seriously ill and immunocompromised patients. Aims and Objectives 1) Isolation of CoNS from exudates and body fluids. 2) Biochemical characterization of CoNS. 3) Antibiotic susceptibility pattern of CoNS. Method 180CoNS isolated from various exudates and body fluids such as pus, wound swabs, endotracheal secretions, sputum, branchialaspitate, and central lining tube were collected. All the CoNS isolates were processed in the Microbiology Laboratory and identified by colony morphology, gram staining, catalase, slide, tube coagulase test, anaerobic acid from mannitol, and deoxyribonuclease. Bacitracin (0.04 U) and furazolidone (100 μg) susceptibilities were done to exclude Micrococcus and Stomatococcus spp. The following biochemical tests were done for the speciation of the CoNS: urease test, phosphatase test, polymyxin B disc test, novobiocin disk test, ornithine decorboxylase test, mannitol to acid, Voges-Proskauertest, mannose fermentation, trehalose fermentation and antibiotic susceptibility testing. Result Out of 180 isolates, 78 are Staphylococcus epidermidis (43.3%), 63 are Staphylococcus hemolyticus (35%), 21 are Staphylococcus hominis (11.6%), and 18 are Staphylococcus lugdunensis (10.0%). Maximum number of CoNS were isolated from pus specimens (58.33%), followed by wound swabs (18.33%). A total of 164out of 180 strains were negative for both bound and free coagulase. A total of 60 strains were bound coagulase slow positive and free coagulase negative. S. epidermidis was the most frequent isolate and 68 S. epidermidis isolates were identified if ornithine decorboxylase was considered positive, while negative 10 S. epidermidis isolates required inclusion of trehalose and mannitol for speciation. Antibiotic susceptibility testing showed maximum resistance to penicillin (78.3) followed by chloramphenicol (41.6%). No resistance to vancomycin was seen. Conclusion: The study revealed S. epidermidis is the predominant CoNS from endotracheal secretions and also pus samples. S. hemolyticus was isolated from pus and central lining tubes, S. hominis and S. lugdunensis were isolated mainly from wound swabs. The present study suggests if coagulase-ve Staphylococci are repeatedly isolated from patients with infection they should be taken seriously and ABST done on these isolates for proper diagnosis and treatment especially in nosocomial infections.

Prevalence of Methicillin Resistant Staphylococcus aureus, Extended Spectrum of Lactamase Producing Escherichia coli and Klebsiella Spps Isolates from ICU Patients at Tertiary Care Hospital, Aurangabad

Background and Objectives The microbial surveillance of intensive care units (ICUs) for multidrug resistant bugs is required for management of ICU patients. The objectives of the study were to find out the prevalence and antimicrobial susceptibility pattern of methicillin-resistant Staphylococcus aureus (MRSA) and extended spectrum of beta lactamase (ESBLs) producing Escherichia coli and Klebsiella isolates in clinical samples from ICU patients. Methods A total of 464 clinical samples were received in the department of microbiology for culture and sensitivity from ICU patients and were processed as per standard protocol. Detection of MRSA and ESBLs was carried out by using CLSI guidelines. Results A total of 164 were positive for culture. A total of 196 isolates were isolated, among that 57 were S. aureus and 34 were E. coli, 51 were Klebsiella spp. and remaining 54 isolates were other gram negative and gram positive organisms. Out of 57 S. aureus, 23 (42.6%) were detected as MRSA. 41.2% of E. coli and 45.1% of Klebsiella spp. were ESBL producers. The antibiotic sensitivity rates were found higher in MRSA than MSSA and also same in non-ESBL-producing and ESBL-producing strains which were statistically significant (p-value). Conclusion The maximum ESBL producing isolates were Klebsiella. spp than E. coli. Vancomycin and linezolid remains a drug of choice for MRSA. For ESBL-producing E. coli and Klebsiella, carbapenems remain the drug of choice. Institutional antimicrobial surveillance and proper infection control practices are essential to prevent and control multidrug resistant bugs in ICUs and hospital.

Airway Diseases Education and Expertise (ADEX ) in Pediatrics: Adaptation for Clinical Practice in India.

Justification: Asthma and allergic rhinitis together are part of the concept of ‘one airway, one disease’ or ‘united airway disease’. The management of allergic airway diseases should address this united concept and manage the issue by educating the patients and their parents and health care providers, along with environmental control measures, pharmacotherapy and immunotherapy. Here, we present recommendations from the module of ‘Airway Diseases Education and Expertise’ (ADEX) that focused on allergic rhinitis, asthma and sleep disorder breathing as a single entity or Allergic Airway Disease. Process: A working committee was formed by the collaboration of Pediatric Allergy Association of India (PAAI) and Indian Academy of Pediatrics (IAP) Allergy and Applied Immunology chapter to develop a training module on united airway disease. Objectives: To increase awareness, understanding and acceptance of the concept of "United Airway disease" and to educate the primary health care providers for children and public health officials, in the management of united airway diseases. Recommendations: Recommendations for diagnosis, management and follow-up of Allergic airway disease are presented in this document. A better compliance by linking education of child, parent, grandparents and other health care providers, and scientific progress by collaboration between practitioners, academicians, researchers and pharmaceutical companies is suggested.

Angiographic Aspects of Myocardial Bridges.

Introduction: The segment of epicardial coronary artery that traverses intramurally through the myocardium and bridged by a bunch of cardiac muscle fibers is called tunneled artery or intramural artery. The band of cardiac muscle fibers passing over the tunneled artery segment is named as myocardial bridge. During angiography milking effect is observed during systole due to the external pressure of muscle fibers on the tunneled artery that leads to narrowing of vessel lumen and further ischemia. Materials & Methods: It is a prospective study performed from 2012- 2015 in cardiac centers available around Tirupati, Andhra Pradesh, South India. A total number of 2015 adult patients who underwent diagnostic coronary angiography were evaluated to detect myocardial bridges. With the informed consent the relevant data was collected from the patients and analyzed. Results: The prevalence of myocardial bridges was 3.17%. Among the 2015 patients 70.7% are males and 29.2% are females. Among 64 myocardial bridge positive cases 62.5% were male and 37.5% were female patients. Regarding coronary dominance 84% were right dominant and 14.4% were left dominant and 1.6% are balanced. The percentage incidence of myocardial bridging according to dominance was 3.01% for right dominant patients, 4.12% for left dominant patients and 3.1% for balanced dominant patients. In all the myocardial bridge positive cases they were located on the left anterior descending artery (LAD). According to diagnosis the patients with normal coronaries were 22.6%, patients with MILD CAD were 17.9%, patients with single vessel disease were 23.4%, patients with two vessel disease were 14.7% and the patients with triple vessel disease were 21.3%. The 64 myocardial bridging cases were grouped in to three groups according to their age. Incidence of double bridges was observed in 3 cases of which 66.7% males & 33.3% in females. Conclusion: These results shows that Andhra Pradesh population are with high angiographic incidence of myocardial bridges (MB’s), when compared with other population in India. We observed more lengthy bridges which may cause luminal reduction of coronary vessel and myocardial ischemia (MI), we also observed higher incidence of MB’s in male patients but systolic luminal reduction is more in female patients then in males. These observations suggest that the risk of MI will be more for the female patients with MB’s.

Tuberous sclerosis with giant renal angiomyolipoma and sclerotic skeletal lesions in a geriatric patient: role of imaging.

Tuberous sclerosis is a rare inherited neurocutaneous syndrome, which has multisystem involvement. We present a geriatric female patient with chronic abdominal pain who was diagnosed with giant renal angiomyolipoma (AML) and multiple sclerotic skeletal lesions. Radiological imaging played an important role in identifying these two features and diagnosing tuberous sclerosis in our case.

Design, architecture and application of nanorobotics in oncology.

Oncologists all over the globe, relentlessly research on methodologies for detection of cancer and precise localization of cancer therapeutics with minimal adverse effects on healthy tissues. Since the previous decade, the fast growing research in nanotechnology has shown promising possibilities for achieving this dream of every oncologist.Nanorobots (or nanobots) are typical devices ranging in size from 0.1 to 10 μm and constructed of nanoscale or molecular components. Robots will augment the surgeon’s motor performance, diagnostic capability and sensations with haptics and augmented reality. The article here aims in briefly describing the architecture of the nanorobots and their role in oncotherapy. Although, research into nanorobots is still in its preliminary stages, the promise of such technology is endless.

Bioremediation of Sewage Waste Waters by the Phototrophic Bacterial Consortium Isolated from Sewage Water.

Microbial based treatments are more economical, ecofriendly and sustainable alternative for waste treatment to existing chemical or physical treatment methods. The metabolic rate of microorganisms effect pH, BOD, COD, DO, concentration of suspended solids present in waste waters. Phototrophic consortium from sewage water was used in the present study to remediate sewage water. Treatment with bacteria caused a significant decrease in some of the parameters tested for waste water. Remediation of sewage water of Panagal by photosynthetic bacteria showed a 23% decrease in DO and 64% decrease in BOD was observed which was significant. COD and organic matter decreased to the extent of 32% and 75% respectively. Chloride levels (6%), bicarbonates (32%) and sulphates (19%) were also decreased. Remediation of sewage water of Prakasam bazaar by photosynthetic bacteria showed a decrease in DO by 22%. Chemical oxygen demand and Biological oxygen demand decreases were significant and were to the extent of 60% and 38% respectively. Bicarbonates (45%), chlorides (35%), sulphates (16%) and organic matter (28%) also decreased significantly.

Coexistence of carcinoma cheek with tuberculosis: a rarity.

Coexistence of tuberculosis and cheek malignancy is a rare phenomenon and it has never been reported to the best of our knowledge. Here, we present a case of carcinoma cheek with tuberculosis in a 50 year old male patient who was successfully managed by multimodality approach by combining anti-tubercular therapy with chemotherapy and radiotherapy.

A study of MIPO by locking compression plate fixation in the management of distal tibial metaphyseal fractures.

Background: Management of distal tibial metaphyseal fractures has been a difficult area because of the subcutaneous position of tibia. Exposure of implant has been a major problem in open reduction and fixation of these fractures. Minimally Invasive Plate Osteosynthesis (MIPO) is an established technique for fixation of fractures of the distal third tibia. Our study is aimed at management of intra-articular and extra-articular fractures of the distal third tibia by minimally invasive plate osteosynthesis technique by locking compression plate and follow them prospectively. Clinical and radiological outcomes were studied and clinical indications & efficacy of the procedure reviewed. Methods: From June 2012 to May 2014, 22 patients of closed distal tibial metaphyseal fractures were operated by MIPO technique with a distal tibial locking compression plate having 4.5/5 proximal and 3.5/4 distal screw holes. The follow up duration was for 2 years at our hospital. Results: The mean fracture healing time was 5.5 months (range 4-13months). We had 90% of union rate with good ankle movements and walking distance in 75% of the patients. Pos-operatively we had complications of, superficial infection occurred in 2 patients, implant failure in 1 patient leading to non-union and delayed union in 1-patient each. Conclusion: MIPO technique provides good, stable fixation of distal tibial metaphyseal fractures. Although slightly delayed bone healing, MIPO decreases the incidence of non- union and need for bone grafting. This technique should be used in distal tibia fractures where locked nailing cannot be done like fractures with small distal metaphyseal fragments, vertical splits, markedly comminuted fractures and in fractures with intra-articular extension.

The effect of magnesium sulfate as an adjuvant to 0.5% bupivacaine on motor and sensory supraclavicular brachial plexus blockade.

Background: Magnesium is a physiologic cation that blocks neuromuscular transmission and does not allow the nerve to be stimulated. This study investigates the effect of adding magnesium sulfate to 0.5% bupivacaine to extend the duration of sensory and motor blocks of the supraclavicular brachial plexus in orthopedic surgeries of the upper extremities. Methods: This controlled randomized double-blind study was performed on patients who were candidates for orthopedic surgery of the upper extremities. A total of 60 patients between 18 and 60 years with ASA Class 1 or 2 participated in the study. One Group M received 0.5% bupivacaine (1.5 mg/kg) with magnesium sulfate 20% (3 ml) as the case group, while the second Group P received 0.5% bupivacaine (1.5 mg/kg) with normal saline (3 ml) as a placebo to block the supraclavicular brachial plexus using nerve locator. The duration of the sensory and motor block of the supraclavicular brachial plexus was monitored and evaluated using the pinprick and modifi ed Bromage scale. Results: A total of 60 patients were included in the study with 30 patients having received 0.5% bupivacaine plus magnesium and the other 30 patients having received 0.5% bupivacaine plus normal saline. The mean sensory block duration in the case Group M was 249±9.36 and in control Group P was 160±5.62 (p<0.39). The mean motor block duration in the case Group M was 232±9.64 and in control Group P was 147±26.52 (both p<0.32). The mean onset of sensory block in case Group M was 15.5±2.16 and the onset block in control Group P was 12.73±1.18 (p<0.49; statistically not signifi cant). The mean onset of motor block in case Group M was 23.5±1.1 and the onset block in control Group P was 41±3 (p<0.53; statistically not signifi cant). Conclusions: The addition of magnesium sulfate to 0.5% bupivacaine increased the duration of motor and sensory supraclavicular brachial block in the upper extremities during surgeries when compared to the use of 0.5% bupivacaine alone, though statistically not signifi cant, but defi nitely in clinically signifi cant proportions.