The Outcomes of Flexor Tendon Injury Repair of the Hand: A Clinico-Epidemiological Study.

Background and objective The incidence of flexor tendon injury is estimated to be 7-14 per 100,000 population. In India, such injuries are common and about 5% of these injuries require repair of the flexor tendon. In the present study, we share our experience of hand flexor tendon repair at a tertiary care center in western India. Material and methods Over a period of three years, 45 patients were admitted for tendon repair. After performing a proper evaluation, patients were taken for tendon repair. Primary outcome and secondary outcome parameters were assessed at the end of three months. Physiotherapy was continued for a longer duration in patients with movement restrictions. Data were compiled at each stage. Results The mean age of the patients was 28.84 years (range: 13-68 years) with a majority of the cases belonging to the age group 15-60 years. The majority of hand injuries were accidental (caused by work-related accidents, machine injuries, or animal bites) amounting to 80% (n=36), followed by assault cases (11%, n=5) and self-inflicted injuries, i.e., attempted suicides (around 9%, n=4). Among all injuries, the majority were in zone V (60%, n=27) followed by 24.4% (n=11) of cases in zone II. A few cases were in zone I, III, and IV (2.2%, 11.2%, and 2.2% respectively). The Buck-Gramcko scoring for primary injury was excellent with a recovery rate of 57.78%. Conclusion Flexor tendon injuries should be repaired with the aim of recovering strength as well as mobility. For optimal outcomes, total active motion protocol should be commenced immediately after the surgical repair. However, long-term physiotherapy may be required for attaining desired benefits.

Relationship of antioxidant system and reactive oxygen species with clinical semen parameters in infertile men.

AIMS AND OBJECTIVES: To determine the correlation of antioxidant system and reactive oxygen species with clinical parameters in infertile semen samples. MATERIALS AND METHODS: Semen sample of fifty infertile men were divided into three groups: (1) Group I - Normospermic (count >15 million/ml), Group II - Asthenospermic (motility <32%), and Group III - Oligospermic (counts <15 million/ml) subjects based on the sperm count and sperm motility. The samples were also divided into two groups: (1) Group IV with semen pH >7.2 (25 samples) and Group V - Semen pH <7.2 (25 samples). The grouping was based on the WHO guideline for semen analysis (12). The semen antioxidant parameters like glucose-6-phosphate dehydrogenase (G-6-PDH) (spectrophotometric method Kornberg and Horecker, 1955). Catalase (Maehly and Chance 1954), glutathione peroxidase (GPX) (Rotruck method), glutathione (GSH) (dithiobisnitro-benzoate method), superoxide dismutase (SOD) (direct method), and malondialdehyde (MDA) (thiobarbituric acid reactive substances assay kit method) were investigated. Mann-Whitney U-test was applied to compare the findings. RESULTS: Of fifty semen samples there were 12 normospermic (sperm concentration ≥15 × 106/ml of ejaculates), 24 asthenospermic (sperm motility ≤32%), and 14 oligospermic (sperm concentration ≤15 × 106/ml of ejaculates) subjects. Results suggested that all asthenospermic males were found to have reduced motility and viability when compared with normospermic and oligospermic subjects. Activity of antioxidant parameters such as G-6-PDH, GPX, GSH, and SOD was decreased in case of asthenospermic subjects. The concentration of MDA was increased significantly (P < 0.001) in semen of asthenospermic subjects compared to normospermic and oligospermic subjects. CONCLUSION: The current study concludes that there is a significant relationship of ROS and semen parameters. Further studies will be needed in such subjects regarding role of effectiveness of dietary antioxidants in improving semen qualities.

Lethal multiple pterygium syndrome.

The multiple pterygium syndrome is consist of wide range of fetal malformations which have a genetic linkage. A defect in embryonic acetylcholine receptor which can be inherited as autosomal recessive, autosomal dominant, or X-linked fashion is the cause of this syndrome. We present a sporadic case of lethal multiple pterygium syndrome.

A prospective study evaluating utility of Mannheim peritonitis index in predicting prognosis of perforation peritonitis.

AIMS: We aimed to validate Mannheim peritonitis index (MPI) for prediction of outcome in patients with perforation peritonitis. MATERIALS AND METHODS: A prospective study involving 100 subjects operated for perforation peritonitis over the period of 2 years was designed. Postevaluation of predesigned performa, MPI score was calculated and analyzed for each patient with death being the main outcome measure. The MPI scores were divided into three categories; scores <15 (category 1), 16-25 (category 2), and >25 (category 3). RESULTS: Our study consisted of 82 males and 18 females (male:female ratio 4.56:1), with the mean patients age of 37.96 ± 17.49 years. 47, 26, and 27 cases belonged to MPI score categories 1, 2, and 3, respectively. The most common origin of sepsis was ileal with small intestine dominating the source of perforation. When the individual parameters of MPI score were assessed against the mortality only, age >50 years (P = 0.015), organ failure (P = 0.0001), noncolonic origin of sepsis (P = 0.002), and generalized peritonitis (P = 0.0001) significantly associated with mortality. The sensitivity of MPI was 92% with a specificity of 78% in receiver operating characteristic curves. CONCLUSION: MPI is an effective tool for prediction of mortality in cases of perforation peritonitis.

Menstrual characteristics and prevalence of dysmenorrhea in college going girls.

BACKGROUND: Dysmenorrhea is a common gynecological condition with painful menstrual cramps of uterine origin. Prevalence of primary dysmenorrhea is not yet clearly studied in central India. OBJECTIVE: To study prevalence of primary dysmenorrhea in young girls and to evaluate associated clinical markers of dysmenorrhea. MATERIALS AND METHODS: In a cross-sectional study, data was collected among 310 girls (18-25 years) on age at menarche, presence and absence of dysmenorrhea, dysmenorrhea duration, pre-menstrual symptoms (PMS), family history, menses irregularities, menstrual history, severity grading using visual analogue scale (VAS) using a semi-structured questionnaire. RESULTS: Dysmenorrhea was reported in 84.2% (261) girls and 15.8% (49) reported no dysmenorrhea. Using VAS, 34.2% of girls experienced severe pain, 36.6% moderate and 29.2% had mild pain. Bleeding duration was found to be significantly associated with dysmenorrhea (χ(2) = 10.5; P < 0.05), girls with bleeding duration more than 5 days had 1.9 times more chance of getting dysmenorrhea (OR: 1.9; 95% CI: 1.7-3). Moreover, girls with the presence of clots had 2.07 times higher chance of having dysmenorrhea (OR: 2.07; 95% CI: 1.04-4.1) (P < 0.05). Almost 53.7% girls who had some family history of dysmenorrhea, 90.9% experience the condition themselves (χ(2) = 11.5; P < 0.001). Girls with family history of dysmenorrhea had three times greater chance of having the same problem (OR: 3.0; 95% CI: 1.5-5.8; P = 0.001). CONCLUSION: Dysmenorrhea is found to be highly prevalent among college going girls. Family history, bleeding duration and presence of clots were significant risk factors for dysmenorrhea.