Long-Term Outcome of Valgus Osteotomy and Fixation with Double Angled Dynamic Hip Screw for Nonunion Fracture of the Neck of the Femur in Young Adults / Desfecho a longo prazo da osteotomia valgizante e fixação com parafuso dinâmico de quadril de ângulo duplo de fratura não consolidada do colo femoral em adultos jovens

Abstract Objective To evaluate the long-term results of valgus intertrochanteric osteotomy fixed with double angled dynamic hip screw for nonunion fracture of the neck of the femur in young adults. This implant allows more freedom of fixation in the sagittal plane. Very few studies have evaluated the long-term outcome for treatment of nonunion in fractures of the neck of the femur. Methods This is a prospective interventional study that included 20 patients with nonunion of the fracture of the neck of the femur aged < 60 years old without avascular necrosis of the head and significant resorption of the neck of the femur. A lateral closing wedge osteotomy was performed just above the lesser trochanter after inserting the Richard screw across the nonunion site, and it was fixed with a double-angle 120° barrel plate. The outcome was evaluated using union rate and the Harris Hip Score for functional outcome. Results The average postoperative decrease in the Pauwels angle was of 28.9°. A total of 80% of the cases progressed to union within a mean duration of 7.53 months. The mean Harris Hip Score at the final follow-up was 86.45. Conclusion Valgus intertrochanteric osteotomy and fixation with a double angled dynamic hip screw is a reliable and effective method for preservation of head and promoting union in an ununited fractured neck of the femur in young patients.

Resumo Objetivo Avaliar os resultados a longo prazo da osteotomia intertrocantérica valgizante, fixada com parafuso dinâmico de quadril (DHS, na sigla em inglês) de ângulo duplo, em fraturas não consolidadas do colo femoral em adultos jovens. Este implante permite uma liberdade maior de fixação no plano sagital. Muito poucos estudos avaliaram o desfecho do tratamento a longo prazo da fratura não consolidada do colo femoral. Métodos Trata-se de um estudo prospectivo de intervenção que incluiu 20 pacientes com fratura não consolidada do colo femoral com idade < 60 anos, sem necrose avascular da cabeça femoral e significativa reabsorção do colo femoral. Foi realizada uma osteotomia em cunha de fechamento lateral logo acima do trocânter menor após a inserção do parafuso tipo Richard no sítio do retardo da consolidação óssea, sendo fixada com uma placa cilíndrica de ângulo duplo de 120°. O resultado foi avaliado com o uso da taxa de consolidação e da escala Harris Hip Score quanto ao desfecho funcional. Resultados Foi obtida uma redução pós-operatória média de 28,9° do ângulo de Pauwels. Os casos que evoluíram para a consolidação alcançaram 80%, em um período médio de 7,53 meses. A média da escala Harris Hip Score foi de 86,45 no acompanhamento final. Conclusão A osteotomia intertrocantérica valgizante e a fixação com DHS de ângulo duplo é um método confiável e eficaz para a preservação da cabeça do fêmur, promovendo a consolidação de uma fratura não consolidada do colo femoral em pacientes jovens.

Isolated Anterior Dislocation of the Radial Head with Atypical Presentation in an Adult: A Case Report / Luxação anterior isolada da cabeça radial com apresentação atípica em um adulto: Relato de caso

Abstract Isolated anterior dislocation of the radial head is rarely reported. To date, only five cases have been reported in the world literature. In all of these cases, the patients presented with restricted supination-pronation movements of the forearm with maintained elbow flexion-extension. We report an unusual case of isolated anterior radial head dislocation in an 18-year-old male, who presented with maintained supination-pronation movements of the forearm but restricted elbow flexion-extension. Closed reduction was attempted, but it failed. Hence, an open reduction was performed. However, the reduction was unstable due to rupture of the annular ligament. Hence, the repair of the annular ligament was performed, and a radio-ulnar Kirschner wire was passed to maintain the reduction of the proximal radio-ulnar joint, thus keeping the annular ligament stress-free, facilitating its healing. At 12 months of follow-up, the patient had normal elbow function and complete range of motion.

Resumo A literatura sobre a luxação anterior isolada da cabeça do rádio é escassa, com apenas cinco casos relatados no mundo inteiro até hoje. Em todos esses casos, os pacientes apresentaram movimentos de supinação-pronação restritos do antebraço, e manutenção da flexão-extensão do cotovelo. Os autores apresentam um caso incomum de luxação de cabeça radial anterior isolada em um paciente do sexo masculino de 18 anos, que apresentou movimentos de supinação-pronação no antebraço e restrição na flexão-extensão do cotovelo. A redução fechada foi tentada, mas sem sucesso. Assim, foi feita a redução aberta. No entanto, a redução foi instável devido à ruptura do ligamento anular. Por isso, o reparo do ligamento anular foi realizado, e um fio de Kirschner rádio-ulnar foi inserido para manter a redução da articulação rádio-ulnar proximal, evitando estresse sobre o ligamento anular, facilitando sua cicatrização. Aos 12 meses de acompanhamento, o paciente apresentava função normal do cotovelo e amplitude de movimento completa.

A Clinical Study of Factors Influencing Graft Success after Repeat Penetrating Keratoplasty and their Management

Introduction: Corneal disease ranks 5th among the causes ofblindness and it forms 7.1% of total blindness and is a seriouspublic health problem resulting in medical and economicburden to the nation. A study was carried out to evaluateregrafts with emphasis on factors which caused failure oforiginal graft and factors influencing graft success after repeatPK.Material and methods: The prospective study consisted ofcases of graft failure attending Eye Bank Clinic at CommandHospital, Kolkata, from Jan 2017 to Dec 2018. Intervalbetween primary graft and repeat PK was minimum of 06months. All the surgeries were performed by a single surgeon.Results: Out of 164 PK, 28 regraft (17.07%) were performed.The regrafting were carried out on cases of graft failure dueto endothelial failure (39.3%), allograft rejection (17.8%),recurrence of disease (14.2%), secondary glaucoma (10.7%),ocular surface disorder and dry eye (10.7%), Pseudomonasinfection (3.6%) and unknown (3.6%). In 13 cases simplerepeat keratoplasty and in rest 15 cases combined procedureswere done. 17 cases (60.7%) had clear regrafts and in 11cases the regraft became opaque during follow up period of06 months to 2 years (average 12.6 months). Pseudophakicbullous keratopathy had greater rate of clear regrafts (71.4%).09 out of 11 cases of failure had one of the preoperative factorslike raised IOP, anterior synechiae, corneal vascularizationand younger recipient age group. Vascularization of recipientbed was associated with greater rate of graft failure (60%).Conclusions: Better visual outcome and graft survival inregraft can be achieved by understanding the underlyingpathology and formulating a preoperative plan.

The Prevalence of Various Eye Diseases Among Patients of Different Nationalities attending the Ophthalmology Clinic at a Tertiary Care United Nations Hospital: A 5 Year Retrospective Analysis

Introduction: Eye diseases incidence and prevalence varieswith the social and environmental factors. Present researchaimed to study the prevalence of various common eye diseasesat a Tertiary Care United Nations hospital.Material and methods: It is a retrospective study of all newpatients attending the eye OPD of a tertiary care UN hospitalduring three years period Sept 2007 to Aug 2012. All patientsunderwent a thorough routine eye examination involvingvision testing by Snellen’s chart, Refraction, Tonometry, Slitlamp examination of Anterior Segment, Fundus examinationand Color Vision. Cases were also subjected to automatedperimetry, laboratory and radiological investigations ifconsidered essential.Results: A total of 217 (401) new patients attended theeye clinic. Patients attending the eye clinic were of variednationality which included patients from India, Pakistan, SouthAfrica, Uruguay, Congo, England, Iraq, Italy, Bangladesh,Netherlands, Nepal, USA etc. The three most commoncauses of eye disorders were refractive error followed byallergic conjunctivitis and Presbyopia. However, cases ofOnchocerciasis were also seen especially in those belongingto Congo. Mostly the patients were in the age group of 30-40yrs (35.4%) and 40-50 yrs (41.01%) being active militarysoldiers. Presbyopia was more common in age group 40-50yrsof age (73.3%). Majority of patients were mainly extra ocularcases (95.4%).Conclusion: The pattern of prevalence of various oculardiseases is similar to other parts of world in this age groupand with a similar occupational profile. This study will go along way in ensuring optimum provisioning of eye health carepersonnel’s and equipment for efficient eye care services.

To Estimate and Compare the Incidence of Dentin Hypersensitivity Among Men and Women Before and After Tooth Preparation

Dentin hypersensitivity following tooth preparation is a frequently encountered oral health problem. The present study was conducted to estimate and compare the incidence of dentin hypersensitivity among men and women in an adult population sample who required replacement of missing tooth/teeth with a fixed partial prosthesis. Methods: The present study was conducted among 32 participants in which 16 were male and 16 were females who want replacement of missing tooth/teeth with a fixed partial prosthesis. The informed consent of all the participants who participated in this study was obtained. Detailed clinical and radiographic investigations were performed on all participants to exclude conditions of teeth, which might have caused pain similar to dentin hypersensitivity. There was at least one vital abutment tooth in each FPD. Each abutment tooth received two stimuli: tactile stimulus and thermal stimulus. Sensitive teeth were identified with an explorer passed cervically over the abutment tooth. Immediately following stimulation, the participants were asked to grade their overall sensitivity using a 10 cm Visual Analogue Scale (VAS). After the VAS was recorded before tooth preparation, the subjects underwent tooth preparation of the abutment teeth for the fixed partial denture. The VAS was recorded immediately after tooth preparation. The data was compiled and subjected to statistical analysis. Statistical analysis was done by using SPSS, version 22 (SPSS, Inc., Chicago, IL) and p<0.05 was considered statistically significant. Results: In the present study; total participants were 32, out of which 16 were male and 16 were females. The comparison of dentin hypersensitivity between men and women in which women reported more dentin hypersensitivity than men, although results were statistically non-significant. Conclusion: It was concluded that women reported more dentin hypersensitivity than men before and after tooth preparation

Six-Minute Walk Test Outcomes in Patients with Diffuse Parenchymal Lung Disease

The 6-minute walk test (6MWT) is used to measure exercise capacity and assess prognosis in diffuse parenchymal lung disease (DPLD). Although the 6MWT is usually considered to be a test of submaximal exercise capacity in DPLD, the physiological load imposed by this test is not well described and 6MWT outcomes are poorly understood. This study aimed to compare cardiorespiratory responses to 6MWT in people with DPLD. Methods: An observational crosssectional study was carried out in a single tertiary care center in northern India which included 50 consecutive subjects (age >12 years) who had diffuse parenchymal lung diseases. In this study, the clinical, radiological and histological data subjects was collected. 6MWT was done of all the patients and results tabulated. Result: Desaturation on 6MWT (SPo2 <88% or fall of 4% from baseline) were seen in total of 33(66%) patients with most cases being IPF in which 17 patients (89.47%) out 19 cases showed desaturation. This was followed by NSIP with 4(67%) of of 6 cases and CTD-ILD having 7(53.8%) out of 13 cases showed desaturation. More studies are required from developing countries to ascertain the spectrum of DPLDs in different geographic. Conclusion: On average, the 6MWT elicits a high but submaximal oxygen uptake in people with DPLD. Fibrosis is associated with maximum destauration in 6MWT. However the physiological load varies between individuals, with higher peak VO2 in those with more severe disease that may match or exceed that achieved on CPET. The 6MWT is not always a test of submaximal exercise capacity in people with DPLD.

Impact of percutaneous nephrolithotomy operation on non-operated kidney: a single center based study

Background: Effects of percutaneous nephrolithotomy (PCNL) operation on ipsilateral renal function are widely known but functional changes in opposite kidney are limited. Authors have conducted this study to evaluate the impact of PCNL operation on the contralateral side during early post-operative period.Methods: From 1st November 2016 to 30th September 2018, those patients presented with unilateral renal stone disease were enrolled. After exclusion they were subjected to PCNL operation under general anaesthesia. Along with preoperative period, 99 m Tc DTPA renal scan is repeated at 3rd and 14th post-operative period.Results: Out of 121 patients enrolled we included 96 patients after exclusion. They are divided into 3 age groups, 19-32, 33-47 and 48-60 years. The mean GFR at pre-operative, post-operative day-3 and 14 of normal kidney in these 3 age groups are 47.32, 47.63 and 42.32 ml/min, 44.29, 45.78 and 40.63 ml/min and 47.10, 48.47 and 41.01 ml/min respectively. At post op day-3 there are reduction of mean GFR in all age groups but statistically not significant (p >0.05). At post-operative day-14 GFR improved towards the pre-op value but the change is also not significant (p >0.05).Conclusions: There are reduction of GFR of contralateral normal kidney following PCNL operation in early post-operative period. So, along with operated kidney normal kidney also showed decrease GFR. It is better to avoid further trauma in post PCNL patient like avoidance of using nephrotoxic medication, contrast agents, ESWL, etc. This study can guide us to avoid further trauma of any kidney.

A questionnaire-based comparison of conventional teaching methods to computer assisted learning in experimental pharmacology for undergraduate medical students

Background: Computer Assisted Learning (CAL) for teaching experimental pharmacology is now widely accepted as alternative to animal experiments. The objective of this study was to compare the performance of undergraduate medical students by conventional teaching methods (lecture and discussion) and CAL.Methods: This was a questionnaire based observational study involving 109 MBBS students of fifth semester. The students were taught experimental pharmacology practical by both conventional methods (lecture with discussion) and computer assisted learning (CAL). Questionnaire and their filled responses by these students were taken at the end of lecture-discussion (pre-CAL) and after the CAL experiments (post-CAL), covering the same topics of experimental pharmacology. Pre-CAL and post-CAL data were assessed statistically.Results: In the pre-CAL session, only 53.39%, 47.56%, 53.39% and 49.5% of the students were having the scores above 40% in the rabbit eye, DRC and potentiation, frog heart and dog BP experiment respectively, which was increased to 77.44%, 75.48%, 75.47% and 75.48% of the students respectively in the post-CAL assessment. A statistically significant difference (p <0.05) in the performance was observed among the students in the pre-CAL and post-CAL assessment.Conclusions: CAL is a good alternative to animal experimentation. Lecture with discussion, followed by CAL experiments on the same topics, enhanced the performance of students as shown by improvement in post-CAL scores.

Clinicoradiological Profile of Patients with Diffuse Parenchymal Lung Disease

The profile of diffuse parenchymal lung disease (DPLD) has mainly been reported from the developed countries; the prevalence and outcome of DPLD is not studied well across India. The aim of this study is to describe the clinical radiological spectrum of various DPLDs from a tertiary care centre of a developing country. Methods: An observational cross-sectional study was carried out in a single tertiary care center in northern India which included 50 consecutive subjects (age >12 years) who had diffuse parenchymal lung diseases. In this study, the clinical, radiological and histological data subjects was collected. Results: Out of the total 50 subjects, mean age was 49.04 years with females constituting 58% of the total. Most common symptoms were gradually progressing dyspnoea (100%) followed by dry cough (76%). The commonest finding on chest radiograph in our series was reticular pattern (78%).The commonest pattern on high-resolution computed tomography was traction bronchiectasis (56%), followed by honeycombing (50%), septal thickening (46%).The commonest cause of DPLD in study was Idiopathic Pulmonary Fibrosis (38) %, followed by connective tissue – interstitial lung disease (CTD-ILD)(26%) and NSIP(12%). Smoking was one of the major risk factor associated with IPF, and 52.6% of patients with IPF were smokers (P<0.001). Conclusion: IPF (38%) was the commonest DPLD seen followed by CTD- ILD and NSIP at a tertiary center in northern India similar to the spectrum reported from developed countries. More studies are required from developing countries to ascertain the spectrum of DPLDs in different geographic

Clinicoradiological Profile of Patients with Connective Tissue related Diffuse Parenchymal Lung Disease

Diffuse Parenchymal Lung Disease (DPLD) is one of the most serious pulmonary complications associated with connective tissue diseases (CTDs), resulting in significant morbidity and mortality. Although the various CTDs associated with DPLD often are considered together because of their shared autoimmune nature, there are substantial differences in the clinical presentations and management of DPLD in each specific CTD. Methods: An observational crosssectional study was carried out in a single tertiary care center in northern India which included 50 consecutive subjects (age >12 years) of DPLD and amongst them patients having connective tissue diseases associated DPLD (CTD)-DPLD were studied.In this study, the clinical, radiological data of the subjects was collected. Results & Conclusion: Out of 50 patients, 13 patients turned out to be CTD-DPLD. The most common of these was Rheumatoid arthritis (53.8%) followed by Systemic sclerosis (38.4%) and sjogresn syndrome (7.7%). The average age in CTD-DPLD came out to be 47.8 years as opposed to 49.04 in DPLD patients. The average age in RA was 58.6 years, Systemic sclerosis was 40 years and Sjogrens syndrome was 45 years. Majority (92.3%) were females.

To Study the Prevalence of HIV Seropositivity in Drug Resistant- Tuberculosis Patients

Drug resistance is a threat to TB control program worldwide. Patient infected with multiple drug resistant strains are less likely to become cured. Multidrug – resistant and extensively drug -resistant tuberculosis continues to emerge in high HIV prevalence settings, and their mortality in HIV co-infected patients remain high. Methods: This retrospective study was carried out at DR-TB centre, Amritsar. This study included drug resistant TB cases registered over the period of 2012 to 2018 at DR-TB centre, Amritsar. Results: A total of 1163 patients of Drug resistant tuberculosis were registered during the period of 7 years , among these 1027, 39 and 97 patients were of MDR, XDR and isoniazid monoresistance respectively. The prevalence of HIV seropositivity was 2.7%, 2.9% and 2.6% in total drug resistant cases, MDR and XDR cases respectively. No case of isoniazid mono-resistance was found positive for HIV. And only one case with primary MDR tuberculosis was HIV positive. Conclusion: In this high drug-resistant TB settings, previous TB treatment failure was strong risk factor for both MDR and XDR-TB in HIV seropositive patients. And HIV seropositivity was more prevalent in MDR-TB cases.

Migrated K Wire Into Popliteal Fossa From Tension Band Wiring Of Patella: A Case Report

Despite being extensively used, k wires have their own set of complications, with loosening and eakage of these wires being the most significant one of them. We report a case of patella fracture treated with tension band wiring (TBW). After achieving fracture union, patient was lost to follow up. He reported four years later with a oken k–wire which had migrated posteriorly into the popliteal fossa and had to be removed as it was causing symptoms to the patient. We recommend following certain steps to prevent the occurrence of such a complication: following AO principles of fracture fixation, encouraging hardware removal after union of fracture wherever possible, close clinical and radiological follow up to detect the movement, eakage and migration of wires at the earliest and removal of migrated wires on priority basis, irrespective of patient being symptomatic or asymptomatic.

Penile Fracture With Complete Urethral Transection

Penile fracture with associated urethral injury is rare, but if it is associated with a complete urethral transection, then it is very rare and needs utmost attention to deal with it. This type of cases should be dealt with very precaution, and proper investigation should be done preoperatively to avoid post-operative complications. Here, we present a case of penile injury with complete urethral rupture and its successful management.

Unicystic ameloblastoma presenting as multilocular lesion: A case report.

Unicystic ameloblastoma (UA) refers to those cystic lesions that show clinical, radiographic, or gross features of a mandibular cyst, but on histological examination show a typical ameloblastomatous epithelium lining part of the cyst cavity, with or without luminal and/or mural tumour growth. In this case report we present a uncommon multilocular unicystic ameloblastoma encountered in a 40 year old female patient.

Morphometeric Analysis of Mental Foramen in Human Mandibles of South Gujarat.

Mental Foramen is found on the anterolateral aspect of the mandible and transmits mental nerves and vessels. The knowledge of anatomical morphometry of mental foramen is essential in clinical dentistry when administering regional anesthesia and performing periapical surgery in the mental region of the mandible. Mental nerve leaving the foramen is anesthetized during the dental procedures, suturing of soft tissue lacerations of mouth and biopsy. The aim of the study was to elucidate the morphological features and precise anatomical position of the mental foramen with reference to surrounding anatomical landmarks in an adult South Gujarat population, the area where this information is scanty. This study was conducted using 100 dried human mandibles of unknown sex obtained from the Department of Anatomy, S.M. Institute of Medical Education & Research and Government Medical College, Surat. The parameters including size, shape, number, location and dimensions of mental foramen with respect to the surgically encountered anatomical landmarks were studied. In most of the cases the foramen was oval in shape and situated in the line with the longitudinal axis of the 2nd premolar tooth. Its usual opening was in a postero-superior direction.

Effect of plumbagin free alcohol extract of Plumbago zeylanica Linn. root on reproductive system of female Wistar rats

OBJECTIVE@#To assess the effect of plumbagin-free alcohol extract (PFAE) of Plumbago zeylanica Linn. (Plumbaginaceae) (P. zeylanica) root, on female reproductive system and fertility of adult female wistar rats.@*METHODS@#After the oral acute toxicity study, the PFAE was administered at two dose levels to perform the estrous cycle study, anti-implantation and abortifacient activity and hormonal analysis. However, the estrogenic/antiestrogenic activity was evaluated at only one most effective dose.@*RESULTS@#LD(50) cut-off was 5,000 mg/kg body weight. The extract exhibited significant anti-implantation and abortifacient activity at the tested dose levels (300 and 500 mg/kg, p.o.) (P<0.01). The extract dose-dependently decreased the levels of serum progesterone, follicle stimulating hormone and luteinizing hormone, while a dose-dependent increase was observed in the concentration of serum prolactin. The extract did not show any significant changes in structure and function of uterus when given alone, but when given along with ethinyl estradiol, it exhibited significant antiestrogenic activity in immature overiectomized female rats(P<0.001). Biochemical parameters in the serum/blood and haematological parameters did not show appreciable changes throughout and after the course of investigation. However, all the altered parameters returned to normalcy within 30 days following withdrawal of treatment.@*CONCLUSIONS@#All findings suggest that the antifertility activity of extract could possibly be through the changes in the implantation site, altered hormonal levels, prolonged estrous cycle and anti-estrogenic activity. Hence, the extract possesses reversible antifertility activity without adverse toxicity in female rats.

A case of Von Recklinghausen disease.

A 67 years old man attended surgery OPD of Nepal Medical College and Teaching Hospital with complain of multiple painless swelling all around the body gradually increasing in numbers for last 15 years. Symptomatically some lumps were becoming large, covering skin of those swelling were sloughing with ulceration. Symptomatic lumps were excised. He was clinically diagnosed as Von Recklinghausen Disease. Histopathological report was Neurofibroma with non specific chronic inflammatory reaction.

Allergic eosinophilic esophagitis.

Allergic eosinophilic esophagitis is an increasingly recognized disease in various parts of the world. The clinical presentation mimics other gastrointestinal diseases, especially gastroesophageal reflux disease, making endoscopic examination and histological evaluation of esophageal mucosal biopsies crucial to accurate diagnosis. The pathogenesis likely involves allergen-initiated, TH2-dependent, IL-5 mediated infiltration of eosinophilis into the esophageal mucosa. Therapies currently favored include dietary modifications and use of corticosteroids.

Primary squamous cell carcinoma of gallbladder presenting as acute cholecystitis.

Primary squamous cell carcinoma of gallbladder accounts for only 0-12.7% of all cases of gallbladder cancer. We here report a case of primary squamous cell carcinoma of gallbladder presenting as acute cholecystitis. A 50 year old man was admitted with the complaints of pain in right hypochondrium and fever of 2 days duration. Abdominal examination revealed tenderness along with guarding and rigidity in right hypochondrium with positive Murphy's sign. The patient was conservatively treated as a case of acute cholecystitis. After 12 hrs of unrewarding treatment patient was operated upon and cholecystectomy done. The specimen revealed thick walled gallbladder with multiple calculi. Histopathology revealed squamous cell carcinoma grade II.