Twin reversed arterial perfusion in twin pregnancy

An interesting case of twin reversed arterial perfusion “TRAP” from a larger apparently normal pump twin with VACTERL abnormality; to smaller structurally abnormal twin in a monoamniotic monochorionic twin pregnancy resulting in fetal demise with subsequent termination of pregnancy. Defect in early embryogenesis leads to such rare multiple presentations.

Inter-hospital transfer of referred trauma patients admitted to the trauma centre of King George Medical University

Background: Inter-hospital transfer is a common in trauma victims due to paucity of super-specialty care, lack of specialty beds, and lack of funding. The government of Uttar Pradesh introduced Emergency Medical Response system (EMRS). There is a need to audit and evaluate the transfer process since the introduction of the service. The objectives of this study were to identify critical gaps in the transfer of trauma patients and secondary over triage to the trauma centre of KGMU.Methods: This prospective observational study was conducted on trauma victims referred to the trauma centre. Patients were evaluated for clinical status, Injury Severity Score, protective patient devices present, type of intravenous fluid infusion, mode of transport, and level of referring hospital. Transfer records, transport vehicles and accompanying personal were evaluated.Results: Of the 342 patients enrolled in the study, 91 had a GCS score <8 and 112(32.74%) had a diastolic BP <60 mm Hg at arrival. Twenty patients (5.8%) were referred from tertiary care centers, 74(21.6%) were referred from district hospitals, 136(39.76%) were referred from primary care centers and 112(32.74%) were referred from private hospitals. Date and time of injury was not recorded in any of the patients. Referral time was recorded in 48(14.03%) patients. One hundred seventy-six patients (51.14%) were transferred in EMRS ambulances, 102(29.82%) patients met the criteria for secondary over triage.Conclusions: There is a need to adopt and strictly implement guidelines for transfer of trauma victims to plug the critical gaps in the transfer process.

Cemented monoblock hemiarthroplasty: a dependable option in femoral neck fracture in elderly

Background: Femoral neck fracture in elderly continues to pose a treatment dilemma. Associated co-morbidities and high mortality (1-year mortality of 25–30% and only 25% survivorship at 10 years) often skews the surgical decision. The underlying treatment goal is minimum revision and maximum functional outcome. Lack of clear guidelines is reflected by the continued debates regarding their management namely osteosynthesis vs arthroplasty; hemiarthroplasty vs total hip arthroplasty, unipolar vs bipolar and cemented vs uncemented. A review of joint registries, uniformly suggest that cemented fixation in elderly patient results in early mobilization, less residual pain and the lowest risk of revision. We analyzed clinical outcome of cemented monoblock hemi-arthroplasty (modified design) in femoral neck fracture in elderly.Methods: Total 94 cemented hemiarthroplasty, performed since January 2009, with a minimum follow up of 3 years are included in the study. Mean modified Haris Hip score at 2 years, 3 years and in the last follow up was 88 (72-91), 84 (70-89) and 81 (65-86) respectively. Acetabular erosion was noted in three patients (3.19%) (one was symptomatic) and aseptic loosening in another two patients (2.12%). Major complications such as deep wound infection, dislocation or peri-prosthetic fracture were not noted in any patient.Results: Result of the present study is consistent to marginally superior when compared to cemented Thompson monoblock and the cemented bipolar prostheses. We attribute this to routine use of cement in the elderly osteoporotic bone along with design modification of the monoblock stem. Long term result of THA is marginally (not statistically significant) better compared to hemiarthroplasty. However, it is associated with prolonged surgery, more blood loss and higher dislocation rate. The rates of dislocation following THA, bipolar and unipolar arthroplasty were 11%, 3%, and 2% respectively.Conclusions: Cemented monoblock hemiarthroplasty is effective and viable option in displaced femoral neck fracture in elderly in terms of excellent functional outcome, low reoperation without adversely affecting morbidity and mortality. Being cost effective procedure this may be considered as first line surgical option especially in socio-economically disadvantaged section of the society.

A Cross-Sectional Study Comparing the Use of Trans- Abdominal Verses Trans-Vaginal Ultra-Sonography in the Diagnosis of Ectopic Pregnancy.

Background: Ectopic pregnancy, also called as tubal pregnancy, is one of the complications of pregnancy in which the extra-uterine implantation of embryo occurs. The diagnosis of ectopic pregnancy is based mainly on ultrasonography (USG). The aim of the study is to decide which approach (trans vaginal or trans abdominal) is better to diagnose the ectopic pregnancy. Methods: The study was conducted on hundred patients in Santosh Medical College, Ghaziabad. The duration of study was two years. The transabdominal and transvaginal ultrasonographic findings were compared with the histopathology, which is considered as the gold standard. The data will be compared on the basis of sensitivity, specificity, positive predictive value and negative predictive value. Results: Mean age of the patient was found to be 33.33±10.4. The maximum number of patients having increased incidence of ectopic pregnancy are those having parity of 1-3. The most common risk factor of the ectopic pregnancy is irregular bleeding (74%), followed by lower abdominal pain (52%). The most common finding, which helps in making the diagnosis of ectopic pregnancy, is presence of extra-uterine gestational sac (96%). The trans vaginal route diagnosed 84 cases correctly whereas trans abdominal method diagnosed 80 cases. The false negative results were more in trans abdominal (14) as compared to trans vaginal (10). Conclusion: The diagnosis of the ectopic pregnancy can be made with TVS alone but TAS should always be ued in conjunction with TVS.

Use of periosteal membrane as a barrier membrane for the treatment of buccal Grade II furcation defects in lower molars: A novel technique.

Objective : To use the periosteum as a barrier in treatment of buccal Grade II furcation defects of lower molars. Materials and Methods : This technique was performed on 12 patients with bilateral buccal Grade II furcation defects of lower molars. On a random basis, one furcation defect of each pair was selected for the control group and other for the experimental group. Debridement was done in the defect area in both groups. In the control group, after debridement, mucoperiosteal flap was sutured back. In the experimental group, after reflection of the mucoperiosteal flap, a portion of the periosteum along with a layer of connective tissue (periosteal membrane) was incised and mobilized in the defect area for defect coverage as a barrier, and then the periosteal membrane and mucoperiosteal flap were fixed with suture, respectively. Horizontal dimension of the furcation defect was the primary outcome measure. Gingival index, probing attachment level (PAL), and vertical dimension of furcation defect were the secondary outcome measures. Clinical parameters were registered at baseline and at 6 months. Results : Every clinical parameter was improved by surgery. Significant gain in PAL as well as horizontal and vertical dimensions of the furcation defects was found. Conclusion: This periosteum displacement technique is effective for the treatment of buccal Grade II furcation defects of lower molars.

Distribution pattern of HCV genotypes & its association with viral load.

Background & objectives: Hepatitis C virus (HCV) has emerged as a leading cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma worldwide. Genotyping and assessment of the viral load in HCV patients is important for designing the therapeutic strategies. Thus the present study was designed to determine the distribution pattern of HCV genotypes in chronic hepatitis patients and their association with the viral load and biochemical profiles. Methods: Seventy one HCV RNA positive patients were included in the study. HCV genotyping was carried out by restriction fragment length polymorphism (RFLP) followed by the direct sequencing of the core region. Viral load estimation was carried out by Taqman real time PCR system. Results: Sixty three per cent (45/71) of cases were infected with genotype 3 followed by genotype 1 in 30.98 per cent (22/71) and genotype 2 in 5.63 per cent (4/71) of cases. Genotype 1 was associated with a significantly (P<0.001) higher viral load as compared to genotypes 3 and 2. There was no significant difference seen in the biochemical profile between the three groups of genotypes except in the levels of SGOT. The commonest mode of transmission was parenteral which accounted for 68 per cent of all the infected cases. Interpretation & conclusions: The present study revealed that HCV genotype 3 and 1 accounted for approximately 95 per cent of the HCV infection in Delhi and surrounding areas. Also two atypical subtypes like 3i and 3f were identified. Genotype 1 was associated with more severity of liver disease as compared to genotypes 3 and 2 as assessed by viral load.

Seroprevalence of hepatitis viruses in patients infected with the human immunodeficiency virus.

OBJECTIVE: The co-infection of Hepatitis B and C viruses with HIV accelerates disease progression and also has an effect on the management of patients infected with HIV. The prevalence of HIV co-infection with hepatitis viruses varies widely. This study is planned to evaluate the prevalence of HIV co-infection with Hepatitis B and C viruses in North India. MATERIALS AND METHODS: A total of 1178 patients enrolled in the ART center were retrospectively analyzed for the presence of HBV and HCV on the basis of the presence of HBsAg and anti-HCV markers. RESULTS: In patients infected with HIV, the prevalence of co-infection with HBV was 9.9% (117/1178), the prevalence of co-infection with HCV was 6.3% (74/1178) and the prevalence co-infection with both HBV and HCV was ~1% (12/1178). DISCUSSION: The prevalence rate of HBV and HCV are increasing in patients infected with HIV. Having acquired the knowledge about the importance of such a co-infection, it is essential that all the patients infected with HIV be screened for HBV and HCV co-infection.

Characteristics of dual infection of hepatitis B and C viruses among patients with chronic liver disease: a study from tertiary care hospital.

The major causes of chronic liver disease (CLD) are infection with Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) either alone or together. The clinical course of the disease varies in cases ofcoinfection with HCV and HBV as compared to single infection. The present study was carried out to determine the occurrence of coinfection of HCV with HBV in CLD patients and to look for the presence of suppressive effect of the two viruses on each other. The severity of liver disease was also assessed and correlated with biochemical profiles. Sera from 150 patients of CLD were tested serologically for the presence of HBsAg, IgG anti HBc and anti-HCV antibodies. HBV DNA and HCV RNA were also detected by amplifying surface region and 5' noncoding-core region respectively by polymerase chain reaction. Forty-seven (31.3%) cases showed the presence of HBsAg or anti IgG-HBc or HBV DNA either alone or together (Group A). Thirty-nine (26%) cases were found to be positive for HCV by detecting either anti-HCV antibodies or HCV RNA (Group B). Coinfection ofHCV with HBV (Group C) could be detected in twenty-four (16%) cases, of these twenty-one cases (87.5%) were positive both for HCV RNA and IgG anti-HBc without the presence of HBV DNA whereas in none of the cases could HBV DNA be detected in the absence of HCV RNA. Forty (26.6%) cases had neither HCV or HBV related CLD. Amongst, the biochemical parameters, the liver function test profiles were altered and found to be statistically significantly in HCV positive cases (Group B) when compared to the negative ones while in case of HBV (Group A) and coinfected (Group C) cases none of the parameters was statistically significant when compared with non-HBV and non-coinfected cases respectively. Thus, coinfection of HCV with HBV is seen in a substantial number of CLD cases. It is also revealed from the present study that HCV infection has a suppressive effect on the replication of HBV as seen by the loss of replicative markers like HBV DNA.