Numbness Following Total Knee Arthroplasty: Role of Incision Length And Position -A Randomized Study

Background@#One of the symptoms annoying patients after total knee replacement (TKR) is numbness around the operative scar. Some studies have shown that altering the incision in terms of placement or length may decrease the incidence of numbness. It still remains unknown whether numbness affects patient-reported outcomes. @*Methods@#We conducted a randomized study to compare a short-length incision (n = 50) and a lateral exit incision (n = 50) with a standard midline TKR incision (n = 50) in terms of the incidence of numbness and its progress over 1 year of follow-up. Our secondary objective was to look at the involved zone, area of numbness, and secondary symptoms. We also looked at patient-reported outcome in terms of satisfaction in all groups using a visual analog scale and Forgotten Joint Score. @*Results@#At 3 months postoperatively, the incidence of numbness was least in the lateral exit group: 46.2% as compared to midline (62%) and short (58.3%), but the difference was not significant (p = 0.07). At 6 months, the short incision group had a significantly lower incidence (8%) of residual numbness as compared to 30% in the other two groups (p = 0.003). At 1 year, most patients recovered sensation loss and had similar function. @*Conclusions@#Placement or length of an incision did not significantly affect the incidence of numbness; however, the short incision led to early recovery of numbness. At 1 year of follow-up, most patients did not complain of loss of sensation and had similar functional outcome.

Dhat Syndrome Assessment Using Mixed Methodology

Objectives: Dhat syndrome is a cultural bound syndrome in which affected individuals have morbid pre-occupation with semen loss in their urine and its impact on the body. Previous studies have explored the symptomatology and perception regarding seminal discharge of such patients while there is lacked of literature on the assessment by quacks and practitioner of alternative and complementary practitioners (ACMP). Therefore, in addition to objectives of previous studies, this study explores the reprehensibility of such practitioners as they may not be giving correct advice to such patients. Methods: For duration of three months, this mixed method study was conducted in Rohilkhand Medical College campus; individuals were approached both in and outside the Psychiatric Outpatient Department using purposive sampling procedure. ICD-10 diagnostic criterion was used to include affected individual in the study sample. Subsequently, a semi-structured questionnaire to document their socio-demographic data and symptomatology was used. Further, previous consultation to quack, ACMPs and allopathic practitioners other than psychiatrist and advice given to the patient by them was obtained via in-depth interview. The quantitative data was analyzed through proportions whereas qualitative data via thematic analysis. Results: There were 38 out of 110 with Dhat syndrome. Invariably, they complained of undue concern regarding debilitating effects of seminal discharge and harmful for the body. A total 21.1% had prior consultation to ACMPs and attributing it to masturbation and hot weather. Surprisingly, allopathic practitioners consulted gave incorrect advices. Conclusion: Dhat syndrome affects individuals irrespective of their social and education background. Sex education among the masses and emphasis for awareness of this syndrome among ACMPs and allopathic practitioners other than psychiatrist is necessary to reduce this cultural bound syndrome.

Management of intrarticular fractures of distal end of humerus using modification of the triceps aponeurosis tongue approach

Objective: To evaluate the functional outcome and extensor apparatus of operative management of intraarticular fractures of distal humerus using modification of the Triceps Tongue Flap approach

Methods: This prospective study was conducted between June, 2012 to April,2014 in NIMS Medical College and Hospital, Jaipur, Rajasthan[India]. We included 23 patients with intraarticular fractures of distal humerus that were managed surgically. Modification of Triceps Tongue Flap approach with Triceps flap in inverted 'V' shape was used. Follow-up was done using standard radiograph anteroposterior/lateral [AP/Lat] at immediate postoperative day, 1,3, 6 and 12 month intervals. Functional outcome was assessed using range of motion at elbow joint, Disability of Arm, Shoulder and Hand [DASH]Score and Objective Muscle Strength Testing [MRC Grade] of triceps muscle at 1,2, 3,6 and 12 month follow-up

Results: Overall we included 23 patients of whom 16 [69.5%] were men and 7 [30.5%] were women with mean age of 34.6 +/- 4.8years. Mean duration of the follow-up was 12.9 +/- 1.1 months. Mean DASH Score at final follow up was 7.7 +/- 1.1 [indicating mild residal impairment]. Mean muscle strength at final follow-up was 4.7 +/- 0.4 [Range 3 to 5]. Mean flexion deformity at elbow was 9.2 +/- 0.9 [Range 5 to 45] degrees and mean arc of flexion extension as 119 +/- 3.4[Range 65 to 140] degrees

Conclusion: This approach provides an excellent exposure as well as a good functional outcome as measured by DASH score and full range of motion at the elbow joint with return of almost complete power of the extensor apparatus in patients with intra-articular fractures of distal humerus

Treatment of small keloids with intralesional 5- fluorouracil alone vs. intralesional triamcinolone acetonide with 5-fluorouracil

Keloid is a benign well demarcated area of dense, fibrous tissue overgrowth that extends beyond the original defect. To compare the efficacy of intralesional 5-fluorouracil [5-FU] alone vs. intralesional triamcinolone acetonide [TAC] in combination with 5-fluorouracil. Study on 50 clinically diagnosed lesions of keloids from 28 patients was conducted. In group A, 25 keloid lesions were subjected to 50 mg/ml 5-FU intralesionally while in group B, 25 keloid lesions were injected intralesionally with a combination of 40 mg/ml triamcinolone acetonide [0.1 ml] and 5-FU 50mg/ml [0.9 ml]. Both the procedures were repeated at weekly intervals for 4 weeks, then bimonthly for 2 months and then monthly until the keloid lesions in both groups virtually assumed the same level as that of surrounding tissue or for a maximum of 3 months. Good to excellent response was seen in 96% cases in group B in contrast to 72% cases only in group A. The group B lesions showed better improvement than group A lesions in pruritus, pain, tenderness, restriction of movements and cosmetic problem. No recurrence was seen in any of the lesions. The combination of 5-FU and triamcinolone acetonide is a better modality of treatment of small keloids compared with 5-FU alone

comparative study of depression and anxiety in psoriasis and other chronic skin diseases

Psoriasis is often associated with psychological disorders and social discomfort. To compare depression and subcomponents of anxiety among psoriasis patients and controls with other chronic skin disorders. 162 psoriasis patients and 200 patients with other chronic skin disorders in the age group of 14-60 years were selected from Dermatology and Venereology Outpatient Department of Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar. The participants responded to IPAT Anxiety scale and Zungs Self-Rating Depression Scale. The data was analyzed statistically. The results of present study clearly revealed that psoriasis patients scored higher on depression and different sub-components of anxiety namely low self control, suspicion, apprehension and tension as compared to the control group. The findings of the present study highlight the higher prevalence of depression and anxiety in the psoriasis patients as compared to patients with other chronic skin diseases; it also shows importance of psychological adjustment in patient with psoriasis. It is recommended that the patients with psoriasis require psychological evaluation and management along with medical treatment

Conjunctival malignant melanoma in xeroderma pigmentosum - a case report

Xeroderma pigmentosum [XP] is a rare autosomal recessive disease characterised by photosensitivity, pigmentary changes, premature skin ageing and development of various cutaneous and internal malignancies at an early age due to defective nucleotide excision repair following exposure to ultraviolet radiations. Conjunctival malignant melanoma has a very rare association with XP. In this regard, we report a case of a 14-year-old boy suffering from XP with malignant melanoma of conjunctiva