Urine Specific Gravity Measurement for Fluid Balance in Neonates on Intravenous Fluids in a Neonatal Intensive Care Unit: An Open Label Randomized Controlled Trial

Background: Urine specific gravity reflects hydration status and correlates well with urine osmolality. Objective: To compare intravenous fluid therapy guided with and without inclusion of urine specific gravity to the standard parameters for maintaining postnatal weight loss within permissible limits in neonates admitted to the intensive care unit. Methods: An open-label randomized controlled trial was conducted, including neonates requiring intravenous fluids for ?72 hours, randomized into the study (urine specific gravity guided fluids) and control arms. The outcomes of the study were to determine proportion of neonates with weight loss within permissible limits, mean percentage weight loss and number of days to reach maximum weight loss. Results: 80 preterm and term neonates (40 in each arm) were enrolled. A comparable proportion of neonates had weight loss within permissible limits in study arm and in control arms [39 (97.5%) vs 36 (90%); P=0.165]. The (mean (SD) percentage weight loss was significantly less in the study arm compared to control arm [All neonates: 7.2(2.6) vs 9.3(3.5); P=0.004); preterm neonates: 7.7 (2.8) vs 11 (3.9); P=0.008)]. Preterm neonates in the study arm attained nadir weight significantly earlier than in the controls (P=0.03) and attained complete enteral feeding earlier. Urine specific gravity showed a moderate negative correlation with the percentage weight loss. Conclusion: Using urine specific gravity to regulate intravenous fluids in neonates resulted in a significant reduction in postnatal weight loss, especially in preterm neonates

Compound Heterozygous Sickle and Thalassemia Trait: A Case Report.

Sickle cell disease is a type of hemoglobinopathy, which is fairly common in certain parts of the world. We would like to report an interesting case of a child who was labeled as sickle cell anemia but subsequently turned out to be a case of compound heterozygous sickle cell and thalassemia trait.

External fixator in the management of trochanteric fractures in high risk geriatric patients--a friend to the elderly.

The best treatment option for trochanteric fracture in a geriatric high risk patient with all associated medical and surgical problems remains debatable. Conservative methods of treatment are associated with dangerous complications of prolonged recumbency while open reduction and internal fixation under anaesthesia significantly increases the mortality and morbidity rates. We treated 110 elderly patients who were unfit or high risk cases for anaesthesia and major surgery for internal fixation due to associated medical and surgical conditions, by external fixation under local anaesthesia. The average age was 65 years and mean follow up was 18 months. 83.3% were ambulatory with support and 97.2% were able to manage activities of daily living at the time of discharge. At 18 months post surgery, 74% were ambulatory with a stick or better. The fracture united in an average of 16.4 weeks. Overall satisfaction rate was 80% at end follow up. The mortality rates were comparable to series of open reduction and internal fixation. Pin tract infection and knee stiffness were the major complications. External fixation done under local anaesthesia offers advantages in the form of a quick, simple relatively inexpensive procedure with negligible blood loss, preserves fracture haematoma, can be easily removed as an out patient procedure, besides it provides earliest possible ambulation and day care to the elderly high risk patient.

Cubitus varus--correction by distraction osteogenesis.

Cubitus varus deformity in thirty children was corrected by gradual medial opening wedge osteotomy. The osteotomy was stabilized and distracted by simple external fixator-cum-distractor. The patients of both sexes and age from 6 to 14 years, had varus deformity from 17 degrees to 43 degrees. We achieved good to excellent results in 28 cases as regards to correction of deformity and range of motion at elbow joint. None of the cases had neurological deficit or permanent stiffness. One case had fair result due to under-correction and another case had a poor result as osteotomy united before correction. The main complication faced was superficial pin-site infection particularly in summer season and a in fatty children but was managed by good pinsite dressing and care. The technique has been found to be quite effective, technically simple, cosmetically acceptable and with little, if any, lazy S deformity.

Functional restoration by excision arthroplasty in temporomandibular joint ankylosis--a report of 35 cases.

OBJECTIVE: To evaluate the long term functional results of excision arthroplasty in treatment of temporomandibular joint (TMJ) ankylosis. MATERIAL AND METHODS: This retrospective study includes 35 patients of TMJ ankylosis who were treated by excision arthroplasty and followed for a maximum period of eight years after surgery. Past trauma was documented as a major etiological factor in 63% cases. Fibrous ankylosis & unilateral involvement was found to be more common. Peroperatively a gap of 1 1/2 to 2 cm was created. The results were assessed according to a criteria based on inter-incial month opening, deviation of jaw and complications. They were satisfactory in 29 cases and there were 3 recurrences. CONCLUSION: Childhood trauma is a major cause of TMJ ankylosis in India. Long term results of excision arthroplasty are satisfactory & comparable to other surgical modalities that are in vogue, provided the patients are operated when young, the ankylosis is in early stage, gap created is adequate and post operative exercise regimen is followed diligently.