Mid-term outcome of arthroscopic TightRope fixation of displaced lateral end clavicular fractures: Average follow-up of 6.1 years / 中华创伤杂志(英文版)

PURPOSE@#Various surgical modalities are available to treat Neer types 2 and 5 unstable fractures of lateral end clavicle but none of them are standardized. Arthroscopic fixation of the displaced lateral end clavicle fractures provides good short-term results but mid- to long-term outcomes are not available. The purpose of this study was to show the mid- to long-term radiological and functional outcomes of these fractures treated arthroscopically by a TightRope device, and to show the complications associated with this procedure.@*METHODS@#A retrospective study was conducted over 2 years from January 2014 to December 2015 with a minimum 5-year follow-up. Active patients aged 18-50 years with acute (less than 3 weeks) displaced fracture of lateral end of the clavicle, with a minimum 5-year follow-up were included in the study. Patients with associated fractures of the proximal humerus, glenoid, scapula and acromioclavicular joint injuries were excluded from the study along with open fractures and neurovascular injuries. The outcomes were assessed by objective (complications and radiographic examination) and subjective criteria (quick disabilities of the arm, shoulder and hand score, the Constant-Murley score and the visual pain analogue scale). The data were analyzed by SPSS version 21.0.@*RESULTS@#Totally, 42 patients were operated during the study period and 37 were available with a minimum 5-year follow-up. Thirty were male and 7 were female with a mean age of 29.5 years and a mean follow-up of 6.1 years. The mean quick disabilities of the arm, shoulder and hand score was 68.2 ± 4.6 preoperatively and 1.27 ± 2.32 at final follow-up (p < 0.001); the mean visual pain analogue scale score was 6.85 ± 2.2 preoperatively and 0.86 ± 1.60 at final follow-up (p < 0.001). The average Constant-Murley score was 93.38 ± 3.25 at the end of the follow-up. There were 2 fixation failures, with established non-union and 3 patients developed radiographic acromioclavicular joint arthritis.@*CONCLUSIONS@#Arthroscopic TightRope fixation of displaced lateral end clavicular fractures provides good radiological and functional outcomes at mid- to long-term follow-up. With the low complication rates and high patient satisfaction, this technique can be considered as a primary option in the surgical treatment of these fractures.

A comparative study of tarsorrhaphy and amniotic membrane transplantation in the healing of persistent corneal epithelial defects

Purpose: To compare and study the clinical outcome of tarsorrhaphy and amniotic membrane transplant in the healing of persistent corneal epithelial defects in terms of clinical improvement and symptomatic relief. Methods: This was an interventional, prospective study in which a total of 60 patients with persistent epithelial defects (PED's), randomly divided into two groups of 30 patients each who underwent tarsorrhaphy (Group A) or amniotic membrane transplantation (Group B) with a 4-week-follow-up period, were included. The main parameters studied were the size of an epithelial defect, total healing time, pain score, and complications. Results: The study included 60 eyes of 60 patients with PED. The healing time was 9.83 � 6.51 days in Group A (median = 9.50 days, IQR = 1�days) vs. 18.33 � 13.46 days (median = 19.50 days, IQR = 1� days) in Group B. A total of ten eyes (16.7%) did not heal at the end of 4 weeks. Conclusion: There was a significant reduction in the area of epithelial defect at the end of the 1 week and 2 week follow up postoperatively, in both the treatment forms. The mean healing time in patients of Group A was less as compared to that of the patients in Group B.

Public health impact of marital violence against women in India

The public health ramifications of marital violence are well documented and include injury, mental health concerns and physical health consequences for women and their offspring. Unfortunately, there remains social tolerance and even acceptance of these abuses against women, and health systems in India have done little to support victims despite their greater health risks. However, there are promising efforts and important advancements in India that could be built on for more effective prevention and support for women. Men and boys should be engaged in gender transformative interventions with male role models to alter men's attitudes of acceptability of and justification for marital violence and consequently their actual abusive behaviours. Given the strong demonstrated connection between men's risky and problem alcohol use and marital violence, alcohol interventions may also be beneficial. We must support women and girls vulnerable to marital violence, a group disproportionately affected by violence in their natal families as well, so they know that violence need not be part of their marriage relationship, and have skills on how to engage and communicate with or even leave their male partners to reduce their risk for violence. Formal services should be expanded for those in immediate danger and particularly for rural areas, where prevalence of marital violence is highest and supports are weakest. Finally, given the pervasiveness of attitudes accepting husbands' marital violence against women, and the fact that these have remained largely unchanged in India for a decade, large scale community and social change efforts are needed.

High-dose chemotherapy followed by autologous stem cell transplant for multiple myeloma: Predictors of long-term outcome

Background & objectives: Survival of patients with multiple myeloma (MM) has improved in the past two decades following use of novel agents and autologous stem cell transplantation. To determine predictors of long-term outcome, data of MM patients who underwent autologous stem cell transplantation (ASCT) at a tertiary care centre in north India were retrospectively analyzed. Methods: Between 1995 and 2016, 349 MM patients underwent ASCT. Patients' median age was 52 yr, ranging from 29 to 68 yr, 68.2 per cent were males. Thirty three per cent patients had international staging system (ISS) Stage III and 68.5 per cent had received novel agents-based induction. High-dose melphalan (200 mg/m2) was used for conditioning; patients with renal insufficiency (estimated glomerular filtration rate <40 ml/min) received melphalan 140-150 mg/m2. Results: Post-transplant, 317 of 349 (90.8%) patients responded; complete [complete response (CR)] ?213 (61%)], very good partial response (VGPR) ?62 (17.8%) and PR in 42 (12%)]. Induction with novel agents, pre-transplant chemosensitive disease, transplant in first remission and serum albumin (?3.5 g/dl) were predictors of significant response. At a median follow up of 73 months, median overall survival (OS) was 90 months [95% confidence interval (CI) 70.8-109.2], and progression-free survival (PFS) was 41 months (95% CI 33.0-49.0). On multivariate analysis, achievement of CR post-transplant, transplant in first remission, ISS Stages I and II (vs. III), absence of extramedullary disease and serum albumin ?3.5 g/dl were predictors of prolonged OS. For PFS, achievement of post-transplant CR and transplant in first remission were predictors of superior outcome. Interpretation & conclusions: Treatment with novel agents, achievement of complete remission post-transplant, ISS Stages I and II, absence of extramedullary disease and transplant in first remission were predictors of long-term survival for patients with MM.

Internet addiction among students of Teerthanker Mahaveer University, Moradabad - A cross-sectional study

Background: Internet has become a widely used tool in a developing country like India as in the developed world and has shown exponential growth particularly in the past 10 years or so. There has been a growing worry among the intellectuals about what level of use can be termed as “more than desirable” and when should it be termed to be “Addiction.” Objectives: The objectives of this study were to find the sociobehavioral correlates and prevalence of internet addiction (IA), study the relationship of IA with internet use profile, and evaluate the risk factors associated with it among university students of TMU, Moradabad. Materials and Methods: A longitudinal cross-sectional survey was executed with sample size of 587 students from medical, nursing, physiotherapy, and engineering courses in the University of TMU after securing permission from their respective college authorities. Semi-structured, pre-designed, and pre-tested survey instrument consisting of “The IATest (Young, 1998)” after instructing them briefly was administered. Results: Of the total of 552 study subjects who took part in the study, 182 (32.97%) were girls and 370 (67.03%) were boys. The mean age of the students was found to be 19.5 years. Majority (64.31%) subjects were only mild users or non-addicts. On application of Young’s original criteria, as much as 2.54% of students were found to be addicts. Conclusion: In the modern days, obsession for having “All-knowledge” at fingertips, hype for social media and has variety to entertainment to name the few, the use of internet is but must; apart from the indispensable uses of internet, the college students are highly susceptible to IA that may cause wasting of the precious study time as well as their time for relaxation and recreational activities, ultimately affecting the educational situation unfavorably. Hence, the Universities/Educational Institutes should wake up to the impending problem and extenuate the use of internet mainly for scholastic purposes.

Factors affecting the serological testing of cadaveric donor cornea

Purpose: The purpose of this study was to evaluate the serological profile of the eye donors and to study the influence of various factors on serological test results. Methods: A cross-sectional, observational study was conducted, and data of 509 donors were reviewed from the records of eye bank from December 2012 to June 2017. Various details of donors analyzed included the age, sex of the donor, cause of death, source of tissue, time since blood collection after death, macroscopic appearance of blood sample, and details of discarded tissues. Serological examination of blood was performed for human immunodeficiency virus (HIV), hepatitis B virus, hepatitis C virus (HCV), venereal disease research laboratory (VDRL), and serology reports reactive or nonreactive were analyzed. Results: Among the 509 donors, 295 (58%) were male, and 420 (82.50%) belonged to age group ?60 years. Most donors (354, 69.5%) died due to cardiac arrest. Macroscopically, sera were normal in the majority of 488 (95.9%) cases. Among 509 donors, 475 (93.3%) were nonreactive, 12 (2.4%) donors were found to be reactive to hepatitis B surface antigen (HBsAg), and 1 (0.2%) was reactive to HCV, but no donor serology was reactive to HIV or VDRL. Twenty-one (4.12%) donors' sera were not fit for serological testing. Among all donors, 475 (93.32%) donors were accepted and 34 (6.67%) were rejected or discarded on the basis of serological testing. Cause of death and macroscopic aspect of sera influenced the serological results in a highly significant manner (P = 0.00). Acceptance or rejection of the donor was significantly influenced by the serological results of the donor (P = 0.00). Conclusion: The seroprevalence among eye donor for HBsAg and HCV was 12 (2.4%) and 1 (0.2%), respectively. Factors such as cause of death and macroscopic aspect of sera influence the serological results. Time since blood collection or sampling will not show any impact on viral serological results if postmortem sampling will be done in < 10 hours(h) after death which can improve the safety and utility of the donor cornea.

Multiple Dens Invaginatus - A case report and review of literature.

Dens invaginatus is a developmental variation of a tooth resulting from an alteration in the normal growth pattern of the dental papilla. It is clinically characterized by a palatine furrow that can be limited to the coronal pulp or may extend to the radicular apex. The commonly affected tooth is maxillary lateral incisor. The occurrence of multiple dens invaginatus is extremely rare. Although a clinical examination may reveal a deep pit or fissure on the lingual surfaces of maxillary anterior teeth, the radiographic examination is the choice for diagnosis of dens invaginatus. Familiarity with the radiographic appearance of this anomaly is essential for the dental practitioner. The purpose of this paper is to present a clinical case of multiple dens invaginatus involving maxillary anterior teeth which was diagnosed during routine radiographic evaluation.

Outbreak of chickenpox in a Union Territory of North India.

Purpose: Primary infection with a varicella‑zoster virus (VZV) leads to chickenpox. Though the incidence of the disease has decreased in many developed countries due to the introduction of the varicella vaccine, outbreaks continue to occur in developing countries. Materials and Methods: The present study reports an outbreak of varicella in an urbanised village in the vicinity of Chandigarh City in North India in November 2013. The outbreak was confirmed by the detection of VZV IgM antibodies in serum samples of clinically suspected patients. Vesicular fluid samples were collected from 8 patients with active lesions and tested for VZV DNA by polymerase chain reaction. Blood samples were also collected from 17 healthy controls residing in the same locality and tested for the presence of VZV IgM and IgG antibodies. Results: A total of 18 cases occurred, and the majority of them (67%) were <15 years of age. Of 17 samples collected from patients with the clinically suspected disease, 13 (76.5%) showed the presence of VZV IgM antibodies. Of the healthy controls, 6 were VZV IgM positive and 4 of them developed symptomatic disease on follow‑up. VZV DNA was positive in 5/8 (62.5%) of the patients. In one patient, VZV DNA was detected in the absence of an IgM antibody response. Conclusion: The introduction of varicella vaccine in the universal immunisation programme of India may help to prevent these outbreaks; however, the cost‑benefit analysis needs to be carried out before making such policies.

Opportunities for medical students to perform four common ward procedures in a Malaysian teaching hospital

Introduction: Undergraduate medical education should be broad-based, holistic, integrated and should promote a framework for the development of higher order cognitive skills like communication, professionalism and teamwork to prepare the student for a life-long challenging medical career. Recent calls for a competency-based medical education require, in addition, competency in clinical and procedural skills prior to graduation. This study investigates how often opportunities exist for medical students to perform four common ward procedures prior to graduation. Method: A prospective cross-sectional study to assess the opportunities a medical student have in performing four common ward procedures, comprising intravenous cannulation, nasogastric tube insertion, urinary catheterisation and chest tube insertion, in a State General hospital in Malaysia was done. Results: A medical student has sufficient opportunity to perform only intravenous cannulation prior to graduation. He has a remote chance to insert a urinary catheter and is unlikely to have the opportunity to insert a nasogastric tube or insert a chest tube prior to graduation. Conclusion: Although competency in clinical skills and procedural skills prior to graduation are desirable, this is increasingly difficult to achieve due to shortage of clinical material, teachers to supervise, the large numbers of medical students and house officers, the short time spent on the main disciplines and the failure of many universities to invest heavily in skills laboratories staffed by full time clinicians. The calls to introduce competency-based medical education in undergraduate medical education, particularly in procedural competence, should take into account the challenges in delivery and the realities in the hospitals today. This is necessary to avoid demoralising students who are unable to achieve their quota of procedures through no fault of theirs.

Development of process dental nursing care standards

Assessing the needs and determining health priorities are essential to focus the attention in the right direction and use the scarce resources in the most efficient way that would positively affect the oral health status of the population, and help in maximizing the oral health results and enforcing equity. The present study was aimed at developing process dental nursing care standards based on literature review and eliciting participant's opinions regarding the importance of proposed standards. A methodological research design was used to determine the importance of proposed standards from point view of participants. The study was conducted in [34] governmental and nongovernmental dental clinics in Jenin district West Bank in Palestine. Subjects of the study included two groups consisted of [128] participants. Nursing group divided into two categories included [53] dental nurses, and [22] nurse managers, while dentistry group included [53]dentists. Data collection included Arabic questionnaire sheet aimed at determining the importance of tasks by eliciting participant's opinions. Results showed that majority of participants agreed upon importance of most proposed standards related to process dental nursing care, followed by development of these standards. As a conclusion, the developed standards are ready for application in study settings where they are urgently needed. It is recommended to apply developed standards in study settings and also in similar settings in other districts in Palestine. Training sessions about dental nursing care plan steps should be conducted for dental nurses to increase their knowledge

Acute meningitis complicated by transverse myelitis

Myelopathy is an infrequently reported complication of bacterial meningitis. We report the case of 32-year old Nepali male who developed acute transverse myelopathy, confirmed by MRI, subsequent to acute bacterial meningitis

Inter-specific hybridization between freshwater catfish Mystus cavasius (Ham & Buch) and M. seenghala (Sykes) by artificial fertilization.

By employing the technique of induced ovulation for artificial fertilization, inter-specific hybrids between the threatened catfish species (Mystus cavasius x M. seenghala) were produced. Fertilization, hatching and survival were significantly different between control and hybrids. The hatching time of the hybrid was significantly lower than that of the control. The average performance viz., hatching time and viability of larvae of the control fish, was significantly better than that of the hybrids. In the hybrid cross, hatchlings were mostly deformed and abnormal and after yolk absorption ultimately succumbed.

Backcrossing on f1 and f2 plants to reuse maize F! seeds

An experiment was conducted in the fields of state Board of Agric. Research, during fall seasons in 2000 and 2001. The objective was to estimate the ability of improving F2 and F3 seeds of maize hybrids. The single cross hybrid Shahed [844 x 834] with its inbreds, Fl and F2 plants were used. In the first season, crosses were done between the plants of Fl and F2 generations as female parents and inbred lines 834 and 844 as male parents. In the second season variatal trial for 8 genotypes was carried out using a randomized complete block design, with three replications. The single cross hybrid was superior to both parents with positive heterosis for all the characters. The results showed that crossing Fl and F2 plants with the parent 834 decreased inbreeding depression more than the parent 844, in all the traits. This indicates that the effect of crosses difference was due to the genotype of the parent, high heterosis [14.6, 4.5, 15.7, 21.4, 7.1 and 33.6%] and low inbreeding depression [3.0, 5.4, 1.8, 3.0 and 8.3%] for the characters, ear length, number of rows/ ear, number of grains/ row, grain weight, number of grains/ ear and grain yield [kg/ ha.], occurred in the Fl and the crosses of [Fl x 834], respectively. It was concluded that crossing of Fl plants with the best parent, [of higher combining ability] reduced inbreeding depression

Malignant nasal paraganglioma: a case report and review of the literature.

A rare case of malignant nasal paraganglioma is described. A 30 year old female patient presented with a one year history of bilateralnasal obstruction, nasal deformity and recurrent epistaxis. CT scan demonstrated an enhancing mass occupying both nasal cavities, right maxillary antrum and anterior ethmoid sinus. Histopathologic diagnosis was malignant paraganglioma. A total maxillectomy with excision of growth was performed. Post-operative radiotherapy and chemotherapy was given but patient expired before the completion of therapy. Nose being a rare site for paragangliomas, these lesions present a diagnostic challenge to histopathologists and clinicians alike. A review of the four previously described malignant nasal paragangliomas is also presented.

Evaluation of an indigenously manufactured rapid immunochromatographic test for detection of HBsAg.

A 'rapid' one step immunochromatographic, visually read, antigen capture assay--the "HEPACARD" (J Mitra & Co. Ltd., New Delhi, India) used for rapid screening of HBsAg was evaluated. Thousand consecutive sera sent to our laboratory for the purpose of HBsAg screening were tested by this device and by a third generation enzyme immunoassay (EIA) (Auszyme Monoclonal, Abbott Laboratories, Chicago, Illinois) or an automated Axsym microparticle enzyme immunoassay (MEIA) (Axsym HBsAg V2, Abbott Laboratories, Abbott Park, Chicago, Illinois, ISA). Hepacard showed a sensitivity of 79% (CU: 57.3-92%) and specificity of 98.9% (CI: 97.9-99.4%) when compared to the findings by the third generation EIA assays. This study suggested that this particular rapid HBsAg test results have to be confirmed by either an EIA or MEIA where the facility exists. The test may be used only in a small hospital setting where the facilities for enzyme immuno assays do not exist.