Cemented Calcar Replacement versus Long Stem Cemented Hemiarthroplasty in Unstable Intertrochanteric Fractures in Octogenarians / Substituição do calcar cimentado versus hemiartroplastia de haste longa cimentada em fraturas intertrocantéricas instáveis em octogenários

Abstract Objective The aim of the present study was to compare functional results after Cemented Calcar replacement vis-a-vis Long stem Cemented hemiarthroplasty in patients aged more than 80 years with unstable intertrochanteric fractures. Methods The present prospective, randomized trial included 140 patients with AO/OTA type 31-A2, A3 intertrochanteric femur fracture, randomized into 2 treatment groups and followed-up for a minimum of 2 years. Sixty-seven patients in group A were treated with a cemented calcar replacing prosthesis, and 65 patients in group B were treated with a cemented long stem femoral stem prosthesis. The primary end points were hip functions at 2 years. The secondary end points were the complications encountered, mortality, surgical time, reoperation, blood loss, and activities of daily living. Results There were no major differences between the groups in terms of hip function, quality of life (health related), reoperation, mortality, and blood loss. However, the function in hip joint and activities of daily living deteriorated in both groups in comparison with prefracture levels. Conclusion In octogenarians with an unstable intertrochanteric fracture, cemented calcar replacing prosthesis has similar clinical results in comparison with long stem cemented hemiarthroplasty. Hemiarthroplasty with either implant is a good option in this subset of patients. Level of evidence: I

Resumo Objetivo O objetivo do presente estudo foi comparar os resultados funcionais após a substituição do Calcar cimentado em comparação com a hemiartroplastia cimentada de haste longa em pacientes com mais de 80 anos com fratura intertrocantérica instável. Métodos O presente estudo prospectivo e randomizado incluiu 140 pacientes com fratura de fêmur intertrocantérica, conforme classificação AO/OTA tipo 31-A2, A3, randomizados em 2 grupos de tratamento e acompanhados por um período mínimo de 2 anos. Sessenta e sete pacientes do grupo A foram tratados com uma prótese de substituição do calcar cimentada e 65 pacientes do grupo B foram tratados com uma prótese femoral de haste longa cimentada. Os desfechos primários foram as funções do quadril em 2 anos. Os eventos secundários foram as complicações encontradas, a mortalidade, o tempo cirúrgico, segunda cirurgia, perda de sangue e as atividades do cotidiano. Resultados Não houve grandes diferenças entre os grupos em termos de função do quadril, qualidade de vida (relacionada à saúde), segunda cirurgia, mortalidade e perda de sangue. No entanto, a função da articulação do quadril e as atividades da vida diária se deterioraram em ambos os grupos em comparação com os níveis pré-fratura. Conclusão Nos octogenários com fratura intertrocantérica instável, a prótese de substituição do calcar cimentada apresentou resultados clínicos semelhantes em comparação com a hemiartroplastia de haste longa cimentada. A hemiartroplastia comqualquer umdos implantes é uma boa opção nesse subgrupo de pacientes. Nível de evidência: I

A prospective randomized study to compare dexmedetomidine and dexamethasone as an adjunct to bupivacaine in transversus abdominis plane block for post-operative analgesia in caesarean delivery

Background: Caesarean section is most frequently performed surgery worldwide. Patients experience moderate to severe pain in the first 48 hours post-operatively. Aim of this study was to evaluate the efficacy of dexmedetomidine and dexamethasone as an adjunct to bupivacaine in ultrasound guided TAP block for postoperative analgesia in patients of caesarean section.Methods: A total 120 ASA I and II patients undergoing elective and emergency caesarean section under subarachnoid block were randomly divided into three groups B, BDM, BDX to receive bupivacaine alone or dexmedetomidine or dexamethasone as an adjunct to bupivacaine in ultrasound guided TAP block. Postoperatively, the patients were evaluated for pain level at rest and on movement with a 10 cm visual analog scale (VAS) pain score (0 = no pain and 10 = worst pain), time to demand of first analgesic request, number of analgesic requirements, nausea or vomiting, sedation and patient satisfaction at 0 hours and at 2, 4, 6, 12, 18, and 24 hours.Results: VAS score was significantly higher in group B in comparison to BDM and BDX, and higher in BDX in comparison to group BDM. Mean duration of analgesia was significantly higher in group BDM in comparison to group B and BDX. Total number of rescue analgesic demands were significantly lower in group BDM in comparison to group B and BDX. Sedation score and satisfaction score was higher in group BDM as compared to group B and BDX.Conclusions: Addition of dexmedetomidine and dexamethasone as an adjunct to bupivacaine reduces postoperative pain, prolongs analgesia, decreases demand for additional analgesics and provides better maternal satisfaction as compared to plain bupivacaine group in TAP block in patients undergoing caesarean section under subarachnoid block. Among dexmedetomidine and dexamethasone, dexmedetomidine had prolonged analgesia as compared to dexamethasone group.

Comparison of Canal Transportation and Centric Ability of HyFlex CM and Wave One File System

The success of root canal therapy requires effective cleaning and shaping of canals. The present study was conducted to compare canal transportation and centric ability of CM and WO file system. Methods: The present study was conducted on 40 recently extracted mandibular premolars of both genders. The teeth were randomly divided into 2 groups. In group I, teeth were prepared using HyFlex CM files up to 25/0.4 and in group II, teeth were prepared using WO files up to 25/0.8.The amount of canal transportation was evaluated by measuring the shortest distance from the edge of uninstrumented canal to the periphery of the root (mesial and distal) and then comparing this with the same measurements obtained from the instrumented images. The mean centering ratio indicates the ability of the instrument to stay centered in the canal. Results: Canal transportation was small in group I as compared to group II at 3mm, 9mm and 12 mm. The difference was significant (P< 0.05). The mean centric ratio in group I was 0.394 at 3 mm, 0.311 at 9 mm and 0.459 at 12 mm. In group II, it was 0.514 at 3 mm, 0.501 at 9 mm and 0.782 at 12 mm. The difference was significant (P< 0.05). Conclusion: Canal preparation with HyFlex CM file system showed lesser transportation and better centering ability than WO file system.

Papillary carcinoma of lingual thyroid with cervical nodal metastases and absence of an orthotopic thyroid gland: a case report and review of literature

Lingual thyroid is a rare developmental abnormality characterized by the failure of the thyroid gland, or remnants, to descend from anywhere along its embryologic path of origin at the foramen caecum to its normal eutopic pretracheal position. The reported prevalence of lingual thyroid is 1 in 100,000, and it is more common in females, with a female to male ratio ranging from 3:1 to 7:1. Carcinoma of the lingual thyroid is even more unusual with less than 1% of lingual thyroids undergoing malignant transformation. Only 40 cases have been reported in the world literature. Herein, we present an uncommon case of papillary carcinoma of lingual thyroid with bilateral cervical nodal metastases in an elderly female with the absence of an orthotopic thyroid gland. Ours is an unusual case report analyzing the diagnostic and therapeutic issues, surgical management strategies and treatment outcomes related to this rare disease entity

Total pancreatic lipomatosis: An unusual entity

Total pancreatic lipomatosis is an unusual entity of pathologic significance and speculative origin. It refers to complete replacement of pancreatic parenchyma by fat cells. Fat replacement may vary from mild fatty infiltration to massive replacement of the pancreas by adipose tissue, resulting in malabsorption syndrome due to pancreatic insufficiency. We present the case of a 60-year-old elderly woman with atypical abdominal complaints, diabetes mellitus, weight loss and steatorrhea. Abdominal computed tomograms were diagnostic of pancreatic lipomatosis. Magnetic resonance [MR] imaging verified this impression. The patient improved clinically after an 8-week trial of high-dose oral pancreatic enzyme replacement therapy. There is a marked reduction of steatorrhea and weight gain. This case report focuses on pathophysiology, diagnosis and treatment guidelines of pancreatic lipomatosis

Cell surface proteins play an important role in probiotic activities of Lactobacillus reuteri

BACKGROUND: Eight Lactobacillus reuteri strains, previously isolated from breast-fed human infant feces, were selected to assess the potential contribution of their surface proteins in probiotic activity. These strains were treated with 5 M LiCl to remove their surface proteins, and their tolerance to simulated stomach-duodenum passage, cell surface characteristics, auto aggregation, adhesion, and inhibition of pathogen adhesion to Caco-2 cells were compared with untreated strains. RESULTS: The survival rates, auto aggregation, and adhesion abilities of the LiCl-treated L. Reuteri strains decreased significantly (p< 0.05) compared to that of the untreated cells. The inhibition ability of selected L. reuteri strains, untreated or LiCl treated, against adherence of Escherichia coli 25922 and Salmonella typh iNCDC113 to Caco-2 was evaluated in vitro with L. reuteri ATCC55730 strain as a positive control. Among the selected eight strains of L.reuteri, LR6 showed maximum inhibition against the E. Coli ATCC25922 and S. typhiNCDC113. After treatment with 5 M LiCl to remove surface protein, the inhibition activities of the lactobacilli against pathogens decreased significantly (p< 0.05). Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) analysis indicated thatLR6 strains had several bands with molecular weight ranging from 10 to 100 KDa, and their characterization and functions need to be confirmed. CONCLUSIONS: The results revealed that the cell surface proteins of L. reuteri play an important role in their survivability, adhesion, and competitive exclusion of pathogen to epithelial cells.

Comparison of speed of inhalational induction in children with and without congenital heart disease.

Background: Conduct of stable inhalational anesthetic induction in children with congenital heart disease (CHD) presents special challenges. It requires in‑depth understanding of the effect of congenital shunt lesions on the uptake, delivery, and equilibration of anesthetic drugs. Intracardiac shunts can alter the induction time and if delivery of anesthetic agent is not carefully titrated, can lead to overdosing and undesirable myocardial depression. Aims: To study the effect of congenital shunt lesions on the speed of inhalational induction and also the impact of inhalational induction on hemodynamics in the presence of congenital shunt lesions. Setting: Tertiary care hospital. Design: A prospective, single‑center clinical study. Materials and Methods: Ninety‑three pediatric patients undergoing elective surgery were segregated into three equal groups, namely, Group 1: no CHD, Group 2: acyanotic CHD, and Group 3: cyanotic CHD. General anesthesia was induced with 8% sevoflurane in 6 L/min air‑oxygen. The time to induction was noted at loss of eyelash reflex and decrease in bispectral index (BIS) value below 60. End‑tidal sevoflurane concentration, minimum alveolar concentration, and BIS were recorded at 15 s intervals for the 1st min followed by 30 s interval for another 1 min during induction. Hemodynamic data were recorded before and after induction. Results: Patients in Group 3 had significantly prolonged induction time (99 ± 12.3 s; P < 0.001), almost twice that of the patients in other two groups (51 ± 11.3 s in Group 1 and 53 ± 12.0 s in Group 2). Hypotension occurred after induction in Group 1. No other adverse hemodynamic perturbations were observed. Conclusion: The time to inhalational induction of anesthesia is significantly prolonged in patients with right‑to‑left shunt, compared to patients without CHD or those with left‑to‑right shunt, in whom it is similar. Sevoflurane is safe and maintains stable hemodynamics in the presence of CHD.

Growth, photosynthetic activity and oxidative stress in wheat (Triticum aestivum) after exposure of lead to soil.

The present study was conducted to assess quantitative information about lead (Pb) contamination in soil on the growth and physiology of wheat. Solutions with three different concentrations of Pb as [Pb(NO3)2 at 500, 1000 and 2500 >M] were incorporated into the soil to achieve Pb-stressed conditions in comparison to unstressed, water treated, control variant. Wheat growth measured in terms of root length, shoot length and dry weight exhibited a significant decline with increasing Pb concentrations in the soil. Root and shoot length and seedling weight declined in the range of ~23–51, ~17–44, and ~21–44% in response to 500 to 2500 >M Pb. In addition, there was a significant reduction in the levels of photosynthetic pigments-chlorophyll a (16-66%) and b (10-24%) and total chlorophyll content (by 14-39%) in plants growing in Pb-contaminated soil. It indicated a negative effect on photosynthetic activity in wheat and was confirmed by reduced photochemical efficiency of PSII (Fv/Fm) in the range of ~ 3-37% in response to 500 to 2500 >M Pb. The reduction in wheat growth in Pb-contaminated soil was accompanied by induction of oxidative stress as indicated by enhanced lipid peroxidation in terms of malondialdehyde (MDA) content (by 18-40%) and hydrogen peroxide (H2O2) content (by 34-123%) and alterations in the activity of enzymes, superoxide dismutases (SOD) and guaiacol peroxidases (GPX) in wheat roots. The study concludes that Pb in soil inhibits growth and phototsynthetic activity in wheat through induction of oxidative stress.

Phytotoxic effect of 2-benzoxazolinone (BOA) against some vegetable crops.

Benzoxazolin-2(3H)-one (BOA) is a well known allelochemical that is being explored for its herbicidal activity. However, not much is known about its effect on crop plants. The present study investigated the effect of BOA on germination and early growth of four vegetable crops viz. Pisum sativum L., Raphanus sativus L., Brassica oleracea L. var. botrytis and Brassica oleracea L. var. capitata. At 1000 <M, germination of P. sativum, R. sativus and B. oleracea var. botrytis was reduced by more than 50%, whereas that of B. oleracea var. capitata was completely suppressed. Further, BOA reduced the root and shoot length of the test plants by ~ 40-82% and ~55-85%, respectively. In general, the effect was more pronounced on the root (~82% in B. oleracea var. botrytis) than on the shoot growth (~73% B. oleracea var. botrytis). 2- Benzoxazolinone significantly enhanced the contents of proteins (by 6-28%) and carbohydrates (by 61- 189%) in B. oleracea var. capitata and decreased the activities of related enzymes like proteases (by 13- 36%), a-amylases (19-60%) and b-amylase (25-70%). The observed decline in the activities of hydrolytic enzymes amylases suggest that BOA interferes with the vital metabolic processes in the germinating seedlings leading to growth reduction. The study reveals that BOA interferes with the germination and early seedling growth of vegetable crops and induces biochemical alterations.

simple clinical score "TOPRS" to predict outcome in pediatric emergency department in a teaching hospital in India

To develop a simple clinical scoring system for severity of illness to help prioritize care and predict outcome in emergency department. Prospective hospital based observational study. Out of a total of 874 children who attended emergency department in one year, 777 were included in the study. Data was collected at the time of admission in emergency department. The baseline information like age, gender, etc and variables of 'toprs' score viz temperature, oxygen saturation, pulse rate, respiratory rate, sensorium and seizures were recorded. Variables were categorized as normal [score zero] or abnormal [score 1] based on systemic inflammatory response syndrome [SIRS] criteria and criteria mentioned in advanced pediatric life support [APLS] and the total scores were computed for each child. The outcome [death/discharge] was correlated with the study variables and total score. The predictive ability of score was calculated using receiver operating characteristic [ROC] curve analysis. Of the six variables, temperature, oxygen saturation and respiratory rate were found to be significantly associated with mortality. Mortality increased with the increase in the number of abnormal variables. Based on the regression coefficients, maximum possible score was 6.68. The predictive ability of score was 81.7 calculated using ROC curve. Maximum discrimination was observed at a score of 2.5. For triage in emergency, any patient with 2 or more abnormal variables should be closely monitored and evaluated. These patients require admission as they have a potential risk of death

Injection practices of healthcare professionals in a tertiary care hospital

Unsafe injection practices are prevalent worldwide and may result in spread of infection. Thus the present study was planned to observe the injection practices of healthcare professionals [HCP], including aseptic precautions and disposal of used syringes/needle. Injection practices were observed in the outpatients and inpatients departments. Questionnaire was designed, tested and administered for this purpose. 130 patients receiving injections were observed. Overall injection practices of the HCP were satisfactory. However, unsafe practices with respect to not washing hands [95.4%], not wearing/changing gloves [61.6%], recapping of needles [12.2%], wiping of needle with swab [15.4%] and breaking of ampoule with solid object [44.4%] were observed. The problem of unsafe injections can be successfully addressed by organizing continuing medical education/symposium/workshops for improving the knowledge, attitude and practices of the HCP. Periodic monitoring and such interventions may also further improve safe injection practices

Neuroprotective effect of BDNF in young and aged 6-OHDA treated rat model of Parkinson disease.

Brain derived neurotrophic factor (BDNF) has been shown to exert trophic effects on dopaminergic neurons against 6-hydroxydopamine (6-OHDA) in young rat. Since the degeneration of substantia nigra dopaminergic neurons that occurs in Parkinson's disease is more often than not confined to elderly individuals, it is of interest to determine whether the effects of BDNF against 6 hydroxydopamine (6-OHDA) in young rats can be extended to aged animals. 6-hydroxydopamine was stereotaxically injected into the striatum of young (3-months) and aged (24-months) rats, which were treated two hours earlier with BDNF. 6-OHDA results in almost complete destruction of substantia nigra pars compacta dopaminergic neurons. BDNF injection significantly changed apomorphine induced rotations from 132 +/- 15 to 181 +/- 10, staircase test from 73 +/- 2% to 61 +/- 3%, initiation time from 7 +/- 2 to 12 +/- 1 sec, and disengage time from 80 +/- 7 to 90 +/- 5 sec in young and aged animals, respectively. It is concluded that BDNF causes the limited behavior recovery of striatal DA systems from 6-OHDA toxicity in aged animals.

Unusual complication of internal jugular vein cannulation.

Internal jugular cannulation is a common procedure in the hospitals. We report a rare complication where the guide wire was pushed into the internal jugular vein without threading the catheter through. Complications due to central venous cannulation are also discussed.