Surveillance for Developmental Dysplasia of the Hip in India: Consensus Guidelines From the Pediatric Orthopaedic Society of India, Indian Academy of Pediatrics, National Neonatology Forum of India, Indian Radiological and Imaging Association, Indian Federation of Ultrasound in Medicine and Biology, Federation of Obstetric and Gynaecological Societies of India, and Indian Orthopaedic Association

Justification: When developmental dysplasia of the hip (DDH) is diagnosed during infancy, conservative management is often successful, with good long-term outcomes. In India, DDH is often not diagnosed until walking age and there are limited guidelines for its screening. Process: A multidisciplinary Expert Group consisting of members of the Paediatric Orthopaedic Society of India, Indian Academy of Pediatrics, National Neonatology Forum of India, Indian Radiological and Imaging Association, Indian Federation of Ultrasound in Medicine and Biology, Federation of Obstetric and Gynaecological Societies of India, and Indian Orthopaedic Association worked collaboratively to develop surveillance guidelines for DDH. Objectives: To enhance the early detection rate of DDH in India through development and implementation of a standardized surveillance care pathway, thus reducing the burden of late-presenting DDH. Recommendations: Routine clinical hip examinations must be performed on all infants at birth and during immunization visits at these approximate time points: 6, 10, and 14 weeks; 6, 9, 12, 15, and 18 months of age. Assessments include Ortolani and Barlow tests for infants <14 weeks; limited hip abduction and leg length discrepancy for infants >14 weeks; and evaluation of limp in walking children. If clinical examination is abnormal or inconclusive, referral to orthopedics for further evaluation and management is recommended. In infants younger than 6 weeks with positive Barlow test but negative Ortolani test, hip ultrasound is recommended at 6 weeks of age. Infants must also be screened for DDH risk factors: breech presentation, family history of DDH, unsafe hip swaddling, and hip instability at any previous clinical examination. In infants with risk factors but normal clinical examination, further evaluation should include ultrasound taken no earlier than 6 weeks of age for infants younger than 14 weeks, ultrasound or X-ray for infants 14 weeks to 6 months of age, and X-ray for infants older than 6 months. Referral to an orthopedic surgeon is recommended if radiological tests are abnormal.

Compare outcome in patients of ileostomy and colostomy closure with surgical stapler versus ileostomy and colostomy closure with hand sewn anastomosis: a prospective study

Background: Diverting temporary stoma is created to protect the primary bowel pathology and distal anastomosis. Once that primary pathology has been overcome or distal anastomosis gets healed, closure of temporary stomas can be carried out. Invention of stapling devices for intestinal anastomosis provided another dimension than hand sewn method to the stoma closure techniques. In this study, we have compared two methods of loop stoma closure-hand sewn method versus stapler method.Methods: This is prospective comparative study in which 50 cases of loop ileostomy/colostomy were taken. 25 patients underwent ileostomy/colostomy closure by hand sewn anastomosis (group A). Another 25 patients underwent ileostomy/colostomy closure by stapler anastomosis (group B). Time taken for operation, initiation of oral intake, anastomotic leak, post-operative wound infection and total hospital stay duration were compared between these two groups to conclude about which method is superior and in the best interest of patient and surgeon.Results: Mean operation time 105.96 minutes (group A) and 72.84 minutes (group B). Mean time to start oral intake 5.36 days (group A), 3.6 days (group B). 16% patients (4/25) group A and 4% patients (1/25) group B developed anastomotic leak. 28% patients (7/25) group A and 8% patients (2/25) group B had post-operative wound infection. Mean hospital stay 10.4 days in group A and 7.84 days in group B.Conclusions: Stapler method provides significant benefits in terms of less operative time, early oral intake and less hospital stay. Overall stapler method for stoma closure is more efficient and cost effective.

The surgical management of diabetic foot.

Diabetes has proved itself a silent killer disease. Today in the world maximum numbers of the patients are suffering from this disease, and moreover they are passing through the associations of the complications too. In present study 50 cases of diabetic foot surgically managed has been studied at teaching institute in department of surgery. The limb was preserved in 35 out of 50 cases. 15 out of 50 cases despite of proper medical management and repeated debridement had to undergo local amputation-B\K amputation-A/K amputation. This was done to save the patients. It is concluded that we should be able to save 100% limbs in diabetic foot and no amputations provided.

Comparative study between open V/S laparoscopic cholecystectomy.

Gall stones are one of the major causes of morbidity and mortality all over the world. Differences in primary outcomes like mortality and complication proportions (particularly bile duct injuries) are important reasons to choose one of the two operative techniques open or laproscopic Cholecystectomy. The study consists of 100 patients with a diagnosis of calculus cholecystitis that underwent Cholecystectomy. Laparoscopic cholecystectomy is a considerable advancement in the treatment of gall bladder disease .technically the dissection of the cystic artery and cystic duct is very precise and bleeding is easily controlled with less per operative blood loss.LC is associated with less chances of wound infection and there is no risk of wound dehiscence. The only disadvantage of the laparoscopic Cholecystectomy over the open procedure is the duration of operating time which is significantly longer. In cardiac patient or in those patient where general anesthesia’s contra indicated, open Cholecystectomy can be carried out in regional anesthesia and in such patient when duet o co2 inflation cardiac arrhythmia can be provoked open Cholecystectomy is better option.

Chronic diarrhea--an unusual presentation of metastatic invasive lobular cancer of breast.

We report a 56-year-old lady with chronic diarrhea and weight loss. She had undergone lumpectomy with axillary clearance (node positive) four years ago for invasive lobular carcinoma of breast. Investigations revealed involvement of almost the entire gut with skip areas. Biopsies from the stomach showed presence of signet-ring cells, suggestive of metastases from invasive lobular carcinoma of breast. Estrogen receptor immuno-staining was positive, confirming the diagnosis. She was treated initially with octreotide and later with chemotherapeutic agents, with transient relief in diarrhea. She succumbed eight months later.

Understanding hepatitis B.

Advances in molecular virology and availability of new antiviral agents have made a positive impact on the treatment of hepatitis B. It is important to know the natural history of hepatitis B virus as high amount of virus may remain in the body for long periods of time without any significant liver disease. Whilst reactivation or mutation of hepatitis B virus and immune clearance may be associated with liver injury leading at times to liver failure. Serological and virological tests are routinely available to systematically evaluate a patient who is detected to have Hepatitis B virus infection. International guidelines have been formulated to suggest appropriate selection of the patient and drug for effective treatment. Therapeutic strategies for total eradication of hepatitis B virus from the liver still remain elusive. However it is now possible to ameliorate liver disease and alter the natural history with effective long-term suppression of the hepatitis B virus. New formulations of existing drugs and newer antiviral agents are constantly being looked into in clinical trials in the pursuit of an ideal therapy.

Safety and efficacy of an indigenous human recombinant interferon alpha 2b (Shanferon) in patients with chronic hepatitis B.

Interferon treatment is the established option for the treatment of patients with chronic hepatitis B without decompensated liver disease. However, such treatment is expensive. We report here our data of a multi-center, open-label trial of the use of an indigenously produced interferon in the treatment of chronic HBeAg-positive chronic hepatitis B. Adult patients with chronic HBeAg-positive hepatitis B with elevated serum transaminase activity and positive serum HBV DNA test were treated with 5 MU/day of an indigenously produced interferon (Shanferon; Shantha Biotechnics, Hyderabad, India) for 4 months, and were then followed up for 6 months. Of the 39 patients enrolled, 36 completed the treatment and 33 completed the post-treatment follow-up. Of the 33 patients who completed the study, end-of-treatment biochemical and virological responses were observed in 10 (30%) and 5 (15%) respectively. Sustained biochemical and virological responses were observed in 15 (45%) and 7 (21%), patients respectively. Adverse effects led to the discontinuation of treatment in only one patient. Our data suggest that safety and efficacy of the indigenously produced interferon were similar to those previously reported results with interferon from other sources.