Accuracy of Femoral Tunnel Placement between Anteromedial and Anterolateral Visualisation Portals in Anterior Cruciate Ligament Reconstruction - Outcomes of a CT based Cross-Sectional Study

@#Introduction: Anatomical femoral tunnel placement is critical for anterior cruciate ligament reconstruction (ACLR). Tunnel placement may vary with different surgical techniques. The aim of this study was to compare the accuracy of femoral tunnel placement between the Anteromedial (AM) and Anterolateral (AL) visualisation portals on post-operative CT scans among a cohort of ACLR patients. Materials and methods: This cross-sectional study was conducted from January 2018 to March 2020 after obtaining ethics clearance. Patients who went for arthroscopic ACLR in our institute were divided into an AM (group 1) and an AL (group 2) based on the visualisation portal for creating the femoral tunnel and a 3D CT scan was done. The femoral tunnel position was calculated in deep to shallow and high to low direction using the Bernard Hertel grid. Femoral tunnel angle was measured in the 2D coronal image. Statistical analysis was done with the data collected. Results: Fifty patients with an average age of 26.36 (18-55) years ±7.216 SD were enrolled in the study. In this study, the AM technique was significantly more accurate (p<0.01) than the AL technique in terms of femoral tunnel angle. Furthermore, the deep to the shallow position was significantly (p= 0.018) closer to normative values, as determined by the chi-square test. The chances of error in tunnel angle in femoral condyle are 2.6 times greater in the AL technique (minimal clinical difference). Conclusion: To conclude, in ACLR the anteromedial visualisation portal can facilitate accurate femoral tunnel placement compared to the anterolateral visualisation portal.

Predictors of Functional Outcome in Unstable Ankle Fractures Treated Surgically – A Prospective Cohort Study

@#Introduction: Unstable ankle injuries require anatomical reduction and stabilisation for optimal outcome. In spite of adequate care, a few patients have poor outcome. In this study, we assessed the risk factors that predict the clinical outcomes in surgically treated unstable ankle fractures. Material and methods: This prospective cohort study was conducted on 68 patients who underwent surgical management for an unstable ankle injury. Demographic details, fracture type and associated medical comorbidities were recorded. Pre-operative radiographic assessment was done for all patients. At the end of one year follow-up, clinical (American Orthopaedic foot and ankle societyAOFAS and Olerud-Molander ankle - OMAS) scores and radiological parameters were assessed and analysed. Results: Fracture dislocation (0.008), diabetes mellitus (0.017), level of alchohol consumption (0.008) and preoperative talocrural angle (TCA) > 100° (0.03) were significant predictors of poor outcomes as per AOFAS. Fracture dislocation (0.029), diabetes mellitus (0.004), preoperative TCA > 100° (0.009), female gender (0.001), age more than 60 years (0.002) and open injuries (0.034) had significantly poor outcome as per OMAS. Other parameters (smoking, hypertension, classification, syndesmotic injury, medial clear space and tibiofibular overlap) did not affect the outcome significantly. Conclusion: Our study showed that poor outcome predictors in unstable ankle fractures are age >60 years, female gender, diabetes mellitus, alcohol consumption, fracture dislocation, open fractures and pre-op TCA >100°.

Delayed Onset Sciatic Nerve Palsy Secondary to Wound Hematoma following Anticoagulant Therapy Post-Bipolar Hemiarthroplasty - an Uncommon Complication: A Case Report

@#A 58-year old female patient presented to us with a three months’ old fracture of the neck of femur. She underwent bipolar hemiarthroplasty. In the immediate postoperative period, she developed deep vein thrombosis for which she was started on anticoagulant therapy. Patient had persistent discharge from the wound since then and underwent regular dressings. On the eighth post-op day, she developed sciatic nerve palsy secondary to wound haematoma. The haematoma was decompressed immediately and she had a dramatic improvement in pain but her neurological deficit persisted. The wound healed completely without any complications. At three months follow up, she had recovered completely with grade 5/5 power in ankle and foot and full sensory recovery in the sciatic nerve distribution. She was ambulating comfortably with a walker. At final follow up around 20 months post-operation, she was pain-free and walking without any support. The wound had healed completely.

Comparative study on arterial and venous blood gas values in the initial evaluation of patients with diabetic ketoacidosis who are visiting the Emergency Department of Rajamutaiah Medical College and Hospital

Background: DKA is the most common serious and life-threatening acute complication of diabetes. The mortality rate is currently estimated at 2% to 10% for patients hospitalized with DKA. Mortality is predominantly due to underlying morbidities, such as sepsis or acute myocardial infarction, but deaths also occur as a result of hypokalemia induced arrhythmias and cerebral edema. Aim of the study: To compare arterial and venous blood gas values in the initial evaluation of patients with Diabetic Ketoacidosis (DKA). Materials and methods: The study was conducted in the division of emergency medicine at Rajah Muthiah Medical College and Hospital, Chidambaram in the year 2017 August to February 2018. Totally 61 patients were included in the study. Both sex in the age group of 14 to 70 years whose Capillary Blood Glucose equal to or greater than 250 mg/dl, Urine ketonuria (+) were included in the study. Results: 37% of patients had >12 urine ketone levels of the patients of patients were 2+ (15 mg/dl) which was 41.0%. 39.3% of patients were 1+ (5 mg/dl) and 19.7% of patients were 3+ (40 mg/dl). All G. Balaji, R. Devi. Comparative study on arterial and venous blood gas values in the initial evaluation of patients with diabetic ketoacidosis who are visiting the Emergency Department of Rajamutaiah Medical College and Hospital. IAIM, 2019; 6(5): 160-165. Page 161 patients were ketone positive. ABG pH valune in which 60.7% of patients were between the level of 7.01 – 7.4, 39.3% of them were from 6.7 – 7.0. ABG PCO2 value in which 44.3% of patients had values from 16-25, 21.3% of patients had values between 5-15 as well as 26-35 and 13.1% of patients had values from 36-45. In which about 65.7% of patients had HCO3 levels between 12.01-17, 15.2% of patients had HCO3 levels between 7.01-12 14.1 % of patients had levels between 17.01 – 18 and 5% of them between 2-7. VBG pH in DKA, in which, 57.4% were in between 7.01 – 7.41. 41% of patients had a pH from 6.7 – 7.0 and 1.6% were between 6.03 - 6.6. VBG HCO3 in which, 62.3% of patients had HCO3 levels from 12.01-17, 24.6% had from 7.01 – 12, 11.5% were in between 2-7 and 1.6% were showing levels in between 17.01-18. Conclusion: Venous blood gas measurements accurately and fairly demonstrate the degree of acidosis in the initial evaluation of patients with Diabetic Ketoacidosis in the Emergency Department in comparison with Arterial blood gas values.

Comparative study on sedative effects of midazolam and propofol in conscious, agitated, uncooperative patients those admitted in the Emergency Department of Rajah Muthiah Medical College and Hospital

Background: Sedation is the depression of a patient’s awareness of the environment and reduction of his or her responsiveness to external stimuli. Some decades ago, the emergency room procedures were conducted without adequate sedation of the patient, which landed upon various bitter events, like uncomfortableness for the patient, uncomfortableness for the doctor, failure of the procedure, high rate of complications. Aim of the study: To study the onset of action, duration of action, and necessity of additive doses of sedation requirement of midazolam and propofol, to compare the sedative effects of OD midazolam and propofol. Materials and methods: This observational study was conducted in the division of Emergency Medicine at Rajah Muthiah Medical College and Hospital, Chidambaram in the year October 2017 to August 2018. After formal approval from the Ethical committee, this study was conducted on 40 G. Balaji, C.R. Ramachandran. Comparative study on sedative effects of midazolam and propofol in conscious, agitated, uncooperative patients those admitted in the Emergency Department of Rajah Muthiah Medical College and Hospital. IAIM, 2019; 6(5): 154-159. Page 155 patients of either sex between age 20 – 50 years old. After proper IV access is acquired, calculated doses of Midazolam or Propofol were administered intravenously and data was collected. Selection of drug (either midazolam or propofol) was random. The patients were sorted into two groups namely, Group M – Midazolam received patients. Group P – Propofol received patients. Then the data were collected regarding the onset of action, duration of action, sedation scales, and vitals. Scales used to evaluate the effect of drugs were the Richmond Agitation Sedation Scale (RASS), and Ramsay scale. Results: 32.5% of patients belong to toxicology by diagnosis and 30% of patients were pure medical cases, 15% belongs to hanging, and 7.5% of patients are trauma cases. 50% of patients were sedated for securing the airway, and 37.5% of patients were sedated to do procedures. 7.5% of patients received sedation to control seizures and 5% for Cardioversion. In Group P only 15% of patients required top-up dose, whereas in Group M 25% of patients required top-up dose. In Group P, the mean score was 4.35 and in Group M is 3.9, and so there is a statistically significant difference in the Ramsay scale. The difference in fall in systolic BP and respiratory rate between Group P and Group M was statistically significant. Also, there is a significant rise in SpO2 in Group P compared to Group M. Conclusion: Propofol-induced sedation is quicker and effective than that of midazolam. The side effects produced by propofol are negligible and it is even safer when top-up doses are used. The recovery from propofol-induced sedation is faster, and it is even smoother than that of midazolam. So propofol can be safely used for effective sedation in ER.

Autism spectrum disorder (ASD): A current review of assessment, risk factors and prevention

Autism spectrum disorders (ASDs) are extremely heritable neurodevelopmental disorders observed in 1-2% of children, usually seen before they reach 3 years of age. ASD is characterized by impaired social behavior, poor communication, stereotypic behavior, abnormal sensitivity to sensory stimuli and self-injurious behavior. The exact causes of ASD are unclear but increased oxidative stress; hyperserotonemia and loss of purkinje cell integrity in the cerebellum are some pathological findings in ASD. This article reviews trends in assessment of this neurodevelopmental disorder, autism risk factors, and preventions for autism. Screening tools for ASD, such as checklist for autism in toddlers (CHAT), modified checklist for autism in toddlers (M-CHAT), autism behavior checklist (ABC) and the autism spectrum screening questionnaire (ASSQ), social communication questionnaire (SCQ), australian scale for asperger syndrome (ASAS), are available for use by general pediatricians. Pregnant ladies exposure to some toxic chemicals and selective serotonin reuptake inhibitors (SSRIs) may increase the risk of ASDs. Mother and child cohort study (MoBa) found prenatal folic acid supplements reduce the risk of autism spectrum disorders in children, but these findings cannot determine whether they protect against other neurodevelopmental disorders.