Axillary Artery Injury with Intact Radial Pulse following Fracture-Dislocation of Shoulder: A Case Report

@#The occurrence of axillary artery injury following proximal humerus fracture dislocation in elderly patient with low velocity fall is uncommon. The patient could have diverse clinical presentations in spite of intact peripheral pulses. We report the case of an 85-year-old lady who presented to our emergency department with greater tuberosity fracture of the humerus with dislocation of the right shoulder. After closed manipulative reduction of the dislocation, it was observed that the patient had brachial plexus palsy with intact radial pulse. An expanding swelling and bruise around the shoulder was noted and a steady drop in haemoglobin level. CT angiogram revealed avulsion of the posterior circumflex artery which was then treated successfully with stenting.

Closed Intramedullary Locking Nailing for Metacarpal Fractures: A Retrospective Study of Sixty-six Fractures

@#Introduction:Metacarpal fractures are frequent injuries in the young male working population and the majority are treated non-operatively. There is a growing trend to surgically treat these fractures, with the aim of reducing the deformity and shortening the rehabilitation period. The aim of this retrospective case series is to report on our experience and clinical outcomes of using percutaneous flexible locking nails for the management of displaced metacarpal fractures. This study is a retrospective review of 66 fractures that were managed at our centre over a 7-year period. Materials and Methods: Records of 60 patients were retrospectively reviewed. Indications for surgery were a displaced metacarpal shaft or neck fracture with associated rotational deformity, or multiple metacarpal fractures. The fracture was reduced by closed manipulation, and a flexible pre-bent locked intramedullary nail (1.6mm diameter) was inserted through a percutaneous dorsal antegrade approach, facilitated by a specially designed pre-fabricated awl. The implant was removed at union. Patients were followed-up in clinic until the fracture had united. Results:The mean union time was seven weeks (range 2 to 22 weeks) and there were nine (14%) delayed unions (>3 months) and no non-unions. The nail had migrated in three cases (5%) and caused skin impingement in two cases (3%). There was one infected case (2%). Rotational clinical deformity was evident for two (3%) cases. Conclusion: The use of a minimally-invasive locked intramedullary nailing for unstable metacarpal fractures has a significantly low complication rate, with predictable union times and good functional outcomes.

Atraumatic Insufficiency Fractures of the Tarsal Bones-An Unusual Cause of Recurrent Heel Pain in a Patient with Rheumatoid Arthritis: A Case Report

@#The incidence of insufficiency fractures is approximately 1% in rheumatoid arthritis patients. The predisposing factors are chronic inflammation, skeletal deformities, biomechanical stresses and osteoporosis. The medications used in the treatment of rheumatoid arthritis such as Glucocorticosteroids and Methotrexate also contribute to the development of osteoporosis and insufficiency fractures. A 68-year old lady who was suffering from rheumatoid arthritis and on long term Methotrexate was seen in the outpatient clinic with recurrent episodes of heel pain. Examination revealed diffuse tenderness around the heel with full range of ankle movements but painful limitation of subtalar joint movements. Radiographic examination of the ankle showed a highly suspicious fracture of the calcaneus and confirmed on MRI as an insufficiency fracture. She was treated successfully with oral bisphosphonates and moon boot brace. She presented after two years with recurrent episodes of heel pain. The plain radiograph and MRI scan confirmed an insufficiency fracture of the talus. She was treated nonoperatively with intravenous Zolendronic acid and bracing. In chronic rheumatoid arthritis patients especially on Methotrexate and Glucocorticoids a high index of suspicion of insufficiency fractures should be considered if they present with bone pain. MRI scan is the investigation of choice and is conclusive.

Drug induced chronic acquired pure red cell aplasia in adolescent boy.

Acquired Pure red cell Aplasia (PRCA) is a disorder seen rarely in children and adolescents. Drugs like sodium valproate and carbamazepine have emerged as an important cause of acquired PRCA, when used for a long duration. Apart from the neurological side-effects, haematological side-effects in form of aplastic anemia and agranulocytosis are well-documented in carbamazepine therapy. The haematologic side-effects of carbamazepine, although not common, should nevertheless be borne in mind due to the serious, prolonged and sometimes even fatal consequences. Carbamazepine is a commonly prescribed drug in today’s scenario and it is important to be aware about its common and uncommon side-effects. We report a case of Carbamazepine induced pure red cell aplasia in an adolescent boy. Since, this drug induced PRCA is reversible if recognised early, it is worthwhile to be aware of this complication to prevent permanent morbidity due to generalised bone marrow hypoplasia.

Comparative study of peripheral blood smear, quantitative buffy coat and modified centrifuged blood smear in malaria diagnosis.

The present study was aimed at modifying the centrifuged blood smear (modified centrifuged blood smear or MCBS), to make it a feasible and standardized procedure. The results obtained were compared with the current diagnostic methods - peripheral blood smear (PBS) and quantitative buffy coat (QBC). Blood samples collected from 100 suspected malaria patients were subjected to all three tests. It was found that PBS had 86.79% sensitivity and was absolutely specific. QBC was 96.22% sensitive and 93.61% specific. The majority of variations occurred in PBS negative cases; cases with parasite count Plasmodium falciparum. It was seen that by the addition of centrifugation to the conventional smear technique (MCBS) improved its sensitivity from 86.79% to near 100%. QBC and MCBS were found superior to PBS. Since MCBS combines principles of both QBC and PBS, it is as sensitive as QBC, as specific as PBS, and above all, easily performed and affordable.

Nasopharyngeal angiofibroma treated with radiotherapy.

Nasopharyngeal angiofibroma is a rare, highly vascular, benign, locally aggressive tumor, affecting boys of adolescent age. The aggressiveness and high vascularity makes surgery and even a biopsy difficult in majority of cases. Although surgery is the treatment of choice in early cases, considerable debate exists regarding the treatment of advanced disease with intracranial extension. Radiotherapy provides a good response and also avoids surgery-associated morbidity. We are herewith reporting a case of nasopharyngeal angiofibroma who showed complete hemostasis and improvement in vision to radiotherapy.

The assessment of a good teacher: student's paradigm.

OBJECTIVE: To comprehend the students' behavioural attitudes and attributes in referring to a teacher as 'bad or good' so as to establish a better communication between the teachers and the taught and promote more effective teaching and learning in medical school. MATERIALS AND METHODOLOGY: Q-methodology questionnaire was distributed randomly on open-call to 94 final year medical students, who had been exposed to about 160 teachers of various departments of a medical college, to recognize Q-factors. Observations were analysed on adequacy score to derive normalized factor and frequency distribution. RESULTS: Three Q-factors have been constructed on distinct items. Teachers' recognition stands on different traits and trends. In fact, universal acceptance is still elusive. Factor-1 Teacher is practical and up-to-date, neither too strict nor witty and shows no evidence of favour. Factor-2 Teacher is a disciplinarian and is intolerant to misbehaviour and relies on examination performance to label students good/bad. Factor-3 Teacher is dynamic and enthusiastic but not very knowledgeable and do not mind misbehaviour of students in the classroom and do not impose workload. CONCLUSION: Q-methodology teachers' assessment appears to be a viable tool to mend and uplift the teaching standards.

Trends of acute poisoning in south Karnataka.

BACKGROUND: In recent times poisoning with agricultural chemicals either accidental or suicidal has become common due to easy availability and low cost. So it has become essential to find out the burden of poisoning to the victims, family and to hospital and morbidity and mortality among the victims. AIMS: To determine the trends of poisoning along with various parameters such as mode of poisoning, type of poison used, outcome of the poisoning, the most vulnerable age group, occupation of the victim, and the marital status. METHOD: A 5 year retrospective study in which all the patients of acute poisoning admitted to Govt. Wenlock Hospital, Mangalore during the period from 1st Jan 1999 to 31st December 2003 were included. A total of 546 cases were admitted due to acute poisoning during the study period. RESULTS: Three hundred and eighty (69.6%) males and one hundred and sixty six (30.4%) females were admitted to the hospital due to poisoning. Organophosphates were the most commonly used suicidal poison irrespective of age, sex and occupation of the victim. There were two hundred and thirty five cases of male suicidal poisoning and one hundred and twenty six female cases of suicidal poisoning. Majority of poisoning cases were seen in manual labourers. The increasing trend of poisoning was observed for the period of 1999 to 2003 except for the year of 2003. CONCLUSION: The study highlights about the problem of poisoning in the region. Since the majority of the victims of the poisoning are from low socio economic status. There is economic burden on the family members of the victim of poisoning as the earning member of the family becomes ill (for treatment), dies (loss of earning member) and also emotional setback and disturbance.

Oral health status of the institutionalized elderly in Mangalore, India.

This study was carried out among 287 institutionalized elderly aged 60 years and above residing in Mangalore. The oral health status was assessed using the modified Oral Health Assessment Form. The most frequently observed periodontal condition was shallow pockets seen in 32.29% of the dentate subjects. None of the subjects were found to have a completely healthy periodontium. The dental caries prevalence was found to be 77.6%. The mean DFT of the dentate subjects was 3.64 with the mean DT and FT being 3.58 and 0.06 respectively. The mean DFT was found to increase with advancing age. Findings also suggest that edentulousness is directly proportional to the period of stay in the old age home and inversely proportional to the mobility of the individual.

Finite element analysis of a three unit fixed partial denture cast with nickel-chromium alloy.

A two dimensional mathematical model was generated, representing a three unit fixed-fixed partial denture and its supporting structures. Second premolar and second molar were used as abutments with first molar as pontic. A load of 1 kg was applied to the occlusal surface of the casting. Stresses and displacement developed at various regions were analyzed with STAAD III/ISDS program. Maximum stresses were developed in the pontic and connectors with distal connector experiencing the maximum stresses. Stresses transmitted to the dentin were comparatively lower and more of compressive in nature. The underying bone experienced moderate amount of both compressive and tensile stresses but the displacement in this tissue were minimal compared to the rest.

Distribution of malarial parasites: effect of gender of construction workers.

The city of Mangalore in South India was having increasing number of malaria cases from 1990. Concerned over the import of cases through migrant construction workers, a screening was done among them using clinical and parasitological methods. This demonstrated 6.28% slide positivity rate with statistically insignificant difference in prevalence of infection between males and females. There were many asymptomatic individuals reporting positive only on peripheral smear examination. Yet, clinical symptoms like fever were found to have good predictive value on logistic regression. It was more so with the P. falciparum which is a relatively new entrant to Mangalore.

Exponential model for weight using 'RJ index'.

We screened a sample of 204 children between the age of 3 months to 5 years and 3 months were during a general health survey conducted by the Department of Community Medicine, Kasturba Medical College, Mangalore from March 1992 to December 1993 at Kumpala village under PHC Ullal about 10 kms from Mangalore City. We developed a new index RJ as RJ = Mid upper Arm Circumference x (Height)2 x 10(-4) and tested the correlation of RJ index and weight for age. We found the correlation coefficient (r = 0.8) to be very significant (P < 0.001). Thus we propose the model as Weight = A x exp (RJ x B). We found that the available data fit in this model. We hope that this study will be a new step in looking at arm circumference as a tool in estimating weight of pre-school children.