Treatment of Long Bone Fracture in Children by Titanium Elastic Nailing Stabilization

Purpose: To demonstrate the effectiveness of intramedullaryfixation of displaced long bones shaft fractures in skeletallyimmature children using the elastic stable intramedullary nails.Patients and Methods: The case records of 20 children whounderwent fixation with titanium intramedulary nails because oflong bones fractures were reviewed. There were 2 humeral, 3forearm, 10 femoral and 5 tibial fractures. The average age ofthe patients was 11 years, and they were followed-upto 20months. Subjective satisfaction was assessed.Results: All patients achieved complete healing at a mean of7.5 weeks. Complications observed in patients were: oneneuropraxia, six entry site skin irritations, two protrusions of thewires through the skin and two skin infections at the entry site.In a subjective measure of outcome at follow-up, 89% ofpatients were very satisfied while 11% were satisfied. Therewas no report of patient’s unsatisfaction. The implants wereremoved at a median time of six months from the indexoperation.Conclusion: Elastic Stable Intra-medullary Nailing isthe method of choice for the pediatric patients, because it isminimally invasive and shows very good functional andcosmetic results. It allows an early functional and cast-freefollow-up with a quick pain reduction.

A Comparative Correlation between Photographic Assessment of Clubfoot And Delmingo Scoring

Background: The aim of the study is to find correlationbetween photography and Delmingo scoring in the clubfeetmanaged by Ponseti technique.Methods & Materials: Total 30 subjects (42 club feet) werestudied, which were corrected by Ponseti technique. Thesubjects are evaluated photographically and clinically(Delmingo Scoring) both before and after the correction.Results: Severity of the deformities and clinical correction wasassessed by Delmingo Scoring and simultaneously byphotographs. All patients achieved good clinical results. Thepre and post correction difference in photographically wasstatistically significant.Conclusion: 4 photographic views proved as cost effectiveanalysis of its result. Various reported scores for congenitalTalipes Equinovarus are presented with observer variationsand lack in objective evidence of severity of deformity andcorrection was correlated and compared with Pirani scores 0.5-2, 2.5-4, 4.5-6 as grouped I to III for mean and StandardDeviation in 42 club feet in 30 children. Photography gives anobjective assessment of the severity of deformity and can beused as objective evidence of improvement/deterioration ofdeformity.

Insecticidal effect of plant extracts on Phlebotomus argentipes (Diptera: Psychodidae) in Bihar, India.

Background & objectives: Phlebotomus argentipes (Diptera: Psychodidae), the established vector for kala-azar is presently being controlled by indoor residual spray of DDT in kala-azar endemic areas in India. Search for non-hazardous and non-toxic biodegradable active molecules from botanicals may provide cost-effective and eco-friendly alternatives to synthetic insecticides. The present study was aimed at evaluating various plant extracts from endemic and non-endemic areas of Bihar for their insecticidal activity against sandfly to identify the most effective plant extract. Methods: Bio-assay test was conducted with larvae and adult of P. argentipes with different plant extracts collected in distilled water, hexane, ethyl acetate, acetone and methanol. Thin layer chromatography (TLC), column chromatography and high performance liquid chromatography (HPLC) were conducted for detection of active molecules. Results: Adults and larvae of sandflies exposed to the aqueous extract of Nicotiana tabacum resulted in 100 per cent mortality. The hexane extract of Clerodendrum infortunatum was found to kill 77 per cent adults but was ineffective against larvae. Bio-assay test of the ninth fraction (hexane extract-methanol phase) separated by column chromatography was found to be 63 per cent effective. The purple spot on the TLC of this fraction indicated the presence of a diterpenoid. HPLC of this fraction detected nine compounds with two peaks covering 20.44 and 56.52 per cent areas with retention time of 2.439 and 5.182 min, respectively supporting the TLC results. Interpretation & conclusions: The column separated 9th fraction of C. infortunatum extract was found to be effective in killing 63 per cent of adult P. argentipes. Compounds of this fraction need to be evaluated further for identification and characterization of the active molecule by conducting individual bio-assay tests followed by further fractionation and HPLC. Once the structure of the active molecule is identified and validated, it may be synthesized and formulated as a product.

Annual risk of tuberculosis infection in a rural population of South India and its relationship with prevalence of smear positive pulmonary tuberculosis.

Background: We conducted a tuberculin survey to estimate the annual risk of tuberculous infection (ARTI) among children in a sub-division of rural Bangalore district. A TB disease survey was conducted in the same area around the same time and has already been published. DOTS strategy is being implemented in the study area since 2002. Methods: The tuberculin survey was conducted during 2010-2011 among 3838, 5-9-year-old children attending 147 schools selected by simple random sampling. Children were tuberculin tested with 2TU PPD RT23 with Tween 80 and maximum diameter of induration was measured between 48-96 hours. ARTI was computed from prevalence of infection estimated by mirror-image technique. Prevalence of smear positive pulmonary TB estimated during the disease prevalence survey in 2008-10 was used to find out its relationship with ARTI. Results: Using the observed mode of tuberculin reaction sizes at 19 mm, among surveyed children, prevalence of infection was estimated at 7.3% (CI: 6.5-8.1); ARTI was computed at 1.05%. Considering the mean age of children, estimated ARTI most closely approximated to the year 2008. Every one per cent ARTI was found to correspond to a prevalence of 103 sputum smear positive patients of PTB, which was similar to the ratio of 106 found in the same study area during 1960s. Conclusion: There has been no change in the relationship between ARTI and prevalence of smear positive pulmonary TB from the pre-DOTS era and thus in the number of children infected by each adult point prevalent case of smear positive pulmonary TB each year suggesting the need for early case detection and treatment.

Journey of tuberculosis control movement in India: National tuberculosis programme to revised national tuberculosis control programme.

The presentation passes through the saga of important landmarks of the past dealing with Era of prechemotherapy, Conventional and Short Course Chemotherapy (SCC) over two decades and the present era of Directly Observed Treatment Short course (DOTS) spanning more than a decade. It also touches upon the likely challenges to be faced in the near future for Tuberculosis (TB) control.