Operative Management of Calcaneal Fractures using Mippo Technique

Introduction: Calcaneal fractures continues to be a topic ofcontroversy in terms of the optimal management modality.Current study aimed to access the sinus tarsi approach forthe fixation of calcaneal fractures in terms of radiological andfunctional results.Material and Methods: Study was conducted on 30 patientsof both genders aged between 20 and 60 years with both jointdepression and tongue type fractures, Sanders type 2 and type3 fractures.Results: In our study, as per AOFAS Scale at 3 months, 19(63.33%) calcaneum cases fell into the excellent group, 9 (30%)into good and 2(6.66%) into poor result group. The Mean ±SDAOFAS scale was 78.43±7.17 (range 55-85). At 6 months, theresult as per AOFAS scale showed further improvement with 28(93.33%) calcaneum cases falling into the excellent group and 2(6.66%) falling into the good result group. None of them fell inpoor group at 6 months follow up. The Mean ±SD AOFAS scalewas 90.03±5.24 (range 74-95).Conclusion: Fixation with plate using MIPPO techniquethrough sinus tarsi approach is an effective and safe methodwith good clinical and radiological results, for the treatmentof calcaneal fractures; to achieve anatomical restoration undervision, stable fixation and early mobilization with minimal softtissue complications.

Angiographic anatomy of the coronary sinus venous system in adult Kashmiri population

Background: Knowledge of the coronary sinus venous anatomy is an important factor because of its relevance in electrophysiological procedures such as chronic resynchronisation therapy, mapping and ablation of arrhythmias. The advent of advanced invasive and interventional cardiac treatment and management tools for common disorders like heart failure has made understanding of coronary sinus anatomy necessary. The aim was to study the angiographic anatomy of coronary sinus and its tributaries in adult Kashmiri population and provide anatomical basis for cannulation of coronary sinus and its tributaries.Methods: Authors analysed the levophase angiogram of 150 subjects undergoing routine coronary angiography in the right anterior oblique and left anterior oblique view with the necessary caudal or cranial angulations.Results: The coronary sinus was formed by the union of GCV+LMV in 93.3% of subjects and by the union of GCV+PLV in 6.7% of subjects. The GCV and the MCV were the most consistent tributaries present in all the subjects. The mean length of CS was 71.70±9.7 mm when it was formed by GCV+LMV and 70.18±14.98 mm in case of GCV+PLV. The diameter of the CS ostium was 8.48±1.21mm. The mean diameter of GCV was 2.90±1.24 mm, MCV was 2.76±1.08 mm, LMV was 2.23±0.51 mm and the PLV was 2.25±0.53 mm. The opening angle of GCV was obtuse in all the cases, MCV drained at an acute angle in 62% subjects and LMV draining angle was acute in 31.33% cases. The valve of the CS was present in 32.7% subjects and absent in 67.3% subjects. The tortuosity was absent in 75.3%. The distance between CS ostium and the ostium of the vein ideal for lead implantation was between 10-40 mm in 76% subjects.Conclusions: The basic knowledge of coronary sinus and its tributaries play a significant role during electrophysiological procedures. The data obtained from the study can be utilised by interventional cardiologist for cannulation of coronary sinus in Kashmiri population.

Comparative Study of Carrying Angle between Dominant and Non Dominanat Limb in Kashmiri Population

Introduction: Carrying angle (CA) is the angle subtendedby median axis of the arm with fully extended and supinatedforearm. There is scarcity of evidence in the literature regardingdifferences between the CA in both sexes depending uponthe ossification of arm and forearm bones and comparison ofCA between dominant and non dominant limb. Study aimedat comparison of data obtained by measuring CA by manualmethod between dominant and non dominant limb in agegroup 18 – 30 years.Material and Methods: CA was measured in 200 individualsof both sexes by clinical method with a manual goniometer.Results: Present study shows the significant gender differenceand significant difference between dominant and non dominantlimb.Conclusion: Unnecessary x ray exposure to children, youngadults and pregnant women can be avoided, by measuring CAby clinical methods.

Observations on Sagittal Alignment of Lumbo-Sacral Spine in Asymptomatic Adults in Kashmir

Introduction: Sacropelvic parameters in various spine and hipdisorders have been published in various studies. We aimed tostudy the normal sacropelvic parameters and curvatures of thespine and their correlation in asymptomatic Indian adults inrelation to variations in sex and age.Material and Methods: 200 Volunteers were taken fromgeneral population with age ranging from 18-50. Patientwas made to stand and left lateral radiograph exposing C7 toS1 and both the hips with a long 30x90 cm cassette placedat 230 cm from the X-ray tube was performed by a singleradiographer to avoid bias.Results: The average LL, SS, PI, PT, and SVA values wereaverage 55.61±10.68, 38.38±8.33,47.94±10.24,10.16±6.23 and 17.27±9.72 respectively. No statistically significantdifference was observed in statistical values with regardsto sex. Our study showed that PI has significant positivecorrelations with SS, LL and PT, and also affects LL. SS hassignificant positive correlation with LL.Conclusion: The current results could contribute to not onlythe understanding of normal sagittal spinal alignment, but alsoserve as a basis for realignment strategies in young Kashmiriadults.

Predicting the prognosis of Conservative Treatment in Acute Cholecystitis using an Artificial Neural Network

Introduction: In majority of the cases clinicians usually choose the conservative mode of treatment as the first line of treatment in case of acute cholecystitis. But studies have shown that in most of the cases patients do not show any significant improvement and eventually are referred to cholecystectomy. This delay in referral catalyses complications like septic conditions and development of gangrenous cholecystitis. Computational structures like artificial neural networks are excellent tools for predicting outcomes apriori. So a neural network was employed to predict the prognosis of conservative treatment mode in cholecystitis and avoid the otherwise imminent complications. Materials and Methods: A neural network was developed and trained on clinically significant data from a set of 150 medical records pertaining to patients who presented themselves with diagnosis of acute cholecystitis at a tertiary care hospital.  The performance of the network was tested on this training set and a separate validation set comprising of data from 100 such patients. Results: The developed network demonstrated excellent prognostic capabilities with respect to the success/failure of conservative treatment in acute cholecystitis. Conclusion: A neural network can predict the outcome of conservative treatment in cholecystitis with significant accuracy and could prove to be an indispensable tool to clinicians

Double blind placebo controlled study on "efficacy of lignocaine pretreatment in reducing pain during injection of propofol" in patients undergoing elective maxillofacial surgeries

This study was undertaken to evaluate the incidence and severity of pain on Injection of Propofol and to find the efficacy of lignocaine pretreatment in reducing such pain. 150 patients undergoing different Maxillofacial Surgeries with American Society of Anesthesiologists class 1 and 2 [ASA 1 and 2] were randomly allocated in two groups, Group A [Saline group] and Group B [Lignocaine group] who received saline and lignocaine as pretreatment respectively. Another anesthetist who was blinded to study recorded pain on a 4-point pain scale. The incidence of pain on giving Propofol was 57.33%. There was reduction of pain by 32% in the patient group who received Lignocaine pretreatment. It was concluded that lignocaine is an effective measure to decrease the incidence and severity of pain on injection of Propofol

Spectrum of complications of snake bites - a tertiary care hospital experience

To highlight the spectrum of haematological, central nervous system complications and treatment outcome in cases of ophitoxaemia. This descriptive analytical study was carried out at Combined Military Hospital, Kharian. All cases of ophitoxaemia admitted in Combined Military Hospital [CMH] Kharian cantonment from June 2007 to November 2008. During the study period a total of fifty cases of snake bites were admitted in CMH Kharian. These cases reported between June 2007 to Nov 2007 and then between June 2008 to Nov 2008. No case of snake bite reported from December 2007 till May 2008. There were 33 [66%] male and 17 [34%] females. The mean age was 34.8 years. The mean hospital stay was 5.06 days [maximum 13 days]. There were 34 events of haematological complications and nine patients developed central nervous system [CNS] complications including respiratory failure in seven patients warranting mechanical ventilator support. Antivenom [AV] was administered to 32 patients only. Dose of AV ranged from 40-200 ml with a mean value of 37.29 ml. The administration of AV was associated with allergic febrile reactions in twenty five patients [78.1%]. In this study four patients died with mortality rate of 8%. The bite to needle time in the patients with fatal outcome was > 24 hours. Snake bites are still associated with fatal outcome, mainly because of late administration of AV. Successful management of haematological and central nervous complications requires the availability of facilities for mechanical ventilator support and blood components