A Prospective Study Of Fixation Of Fracture Lateral End Clavicle By A Novel Technique & Its Early Results

Background: Fracture Lateral end clavicle can be managed by various treatment modalities, with different pros & cons. Our study is a prospective study, showing a novel technique & its early results. We found initial results to be very encouraging. Material & Methods: We had utilized this novel fixation technique on 16 patients & operative indication in all patients was Neer type 2 lateral end clavicle fractures. In this study, 14 patients were male while 2 were female in age group 25 to 58 years (mean 41 years). All the patients were operated within 2 weeks of sustaining trauma to clavicle .Early results were encouraging in these patients with minimum follow up of 4 months & maximum of 12 months. Constant murley scores measured & compared were found to be approaching at the opposite shoulder levels at the end of 6 months after surgery. Results: All 16 patients were available for evolution after minimum follow up of 4 months and maximum of 12 months. All the patients regained pain less shoulder with bony union & returned to pre–injury activity level after a mean of 4 months. During post operative follow up after 2 weeks, 2 months & 4 month post–operative radiographs demonstrated good hold of initial bony reduction Conclusion: The concept of this technique is novel and provides for a strong fixation across the fracture site in addition to other benefits outlined above. Further studies with longer follow up and more number of patients need to be done to elucidate out correct surgical utility of technique over others.

Changing epidemiology of dengue in South-East Asia.

The burden of dengue and its potential threat to global health are now globally recognized, with 2.5 billion people at risk worldwide. The pathogenesis of severe dengue is particularly intriguing with the involvement of different immune factors. Also, the epidemiology of dengue in South-East Asia is undergoing a change in the human host, the dengue virus and the vector bionomics. Shift in affected age groups, sex differences and expansion to rural areas are evident, while the virulence and genotype of the virus determine the severity and time interval between sequential infections. The Aedes mosquito, a potent and adaptive vector, has evolved in longevity and survival, affected by seasonality and climate variability, socio-cultural and economic factors of human habitation and development. This review provides insights into the changing epidemiology and its factors in South-East Asia, one of the most important epicentres of dengue in the world, highlighting the major factors influencing these rapid changes. Addressing the changes may help mitigate the challenges in the current dengue control and prevention efforts.

Pandemic (H1N1) 2009: Epidemiological, clinical and prevention aspects.

The influenza pandemic caused by the new H1N1 virus has by now affected all the continents of the world. However, the extent and likely impact are still uncertain. Like seasonal flu, the illness is mild and self-limiting in a great majority of cases, with only 1%–2% of patients requiring hospitalization. In a few cases, the clinical course can deteriorate in a matter of hours, leading to severe complications and eventually death. The risk of complications is higher among those who have preexisting diseases, such as asthma, heart disease and kidney disease, and among pregnant women. In such cases, antiviral treatment should not be delayed pending laboratory confirmation. The preferred antiviral drug is oseltamivir, and zanamivir is an alternative. Antiviral treatment is not necessary for those who are otherwise healthy, and have mild or uncomplicated illness. It is beneficial for patients with progressive lower respiratory tract disease or pneumonia, and those with underlying medical conditions and pregnant patients. As the supply of antivirals is limited, they should be used judiciously and where appropriate. There is a limited supply of pandemic influenza vaccine available in a few countries and efforts to produce it in India are presently underway. Effective personal preventive measures include shielding one’s mouth and nose while coughing and sneezing, frequent washing of hands with soap, avoiding mass gatherings and voluntary isolation by symptomatic individuals. While at present the virus is causing a mild disease, the next wave may be more severe. Hence, enhanced surge capacity of health services is required for the clinical management of an increased patient load.

Preventing avian influenza in humans: the role of simple public health interventions.

An influenza pandemic due to influenza virus A H5N1 subtype is considered highly likely. Strategies for prevention and control of a pandemic include actions that need to be taken by the national authorities and communities. The availability of a vaccine and antiviral drugs in sufficient quantities for billions of people in the developing world is doubtful. Simple cost effective public health interventions can significantly reduce the risk of contracting infection. These interventions include precautions that will prevent people from contracting infection from sick or dying poultry and their products, human cases and a contaminated environment. Specific measures are based on principles of cutting short the transmission of infection in humans and inactivating the virus at its source. The paper describes context specific actions that can be implemented in both rural and urban settings by the communities themselves.

Sensitivity index of antimicrobial agents as a simple solution for multidrug resistance in Salmonella Typhi.

BACKGROUND & OBJECTIVE: Multi drug-resistant (MDR) typhoid in India is an escalating problem. MDR isolates of Salmonella Typhi are on rise and are becoming a challenge for timely and appropriate treatment. Occurrence of per cent sensitive (%S), per cent resistant (%R) and per cent intermediate (%I) isolates may vary geographically and treatment decided on the basis of only one of these three subpopulations may lead to selection of inappropriate drug for treatment and thus treatment failure. Determination of sensitivity index (SI) of antimicrobial agents, instead of %S or %R subpopulations, may give clearer insight regarding selection of appropriate antimicrobial for treatment of typhoid. In present work, the data of sensitivity testing were analysed and interpreted both in terms of SI as well as %S, %I and %R. METHODS: A total of 205 isolates of Salmonella Typhi were collected during June 2000 and August 2002 from a network of five institutes- Lady Hardinge Medical College (LHMC, N=110), Ram Manohar Lohia Hospital (RML, N=14), Majeedia Hospital (MH, N=48), Lal's Pathology Lab (LAL, N=28) and All India Institute of Medical Sciences (AIIMS, N=5) on nutrient agar slopes. Of these, 142 isolates were subjected to phage typing and biotyping at National Salmonella Phage Typing Centre, New Delhi. Five isolates resistant to 3-7 and one isolate susceptible to all of total 12 antimicrobial tested were subjected to plasmid analysis. SI for various antimicrobials was determined as the ratio of %S and %R values derived form %RIS analysis using WHONET5. RESULTS: 18 (8.7%) isolates were susceptible to all tested antimicrobials and 124 (60%) were MDR. Of the 142 isolates, 103 were phage type E1 and biotype I. SI of antimicrobials rather than individual %S or %R or %I population presents a better criterion for interpretation of sensitivity testing data as well as selection of the most appropriate antimicrobial for timely treatment. Presence of 140, 48 and 23 Kb size plasmids in all 5 MDR isolates and none in susceptible isolate was observed. INTERPRETATION & CONCLUSION: Re-emergence of chloramphenicol sensitivity in Salmonella typhi was observed in the present study. Interpretation in terms of SI criteria warrants that reintroduction of chloramphenicol at present for treatment of typhoid may rebound resistance. Current empiric therapy used for treatment of typhoid may soon become ineffective. SI being a ratio will not only eliminate geographical variation of %RIS data but also its interpretation. SI can provide guidelines for clinicians in remote areas where facilities for sensitivity testing are not available.