Prospective comparative evaluation of intraoperative joint stability and component placement between posterior approach to hip and its quadriceps coxae sparing modification for primary hip arthroplasty.

Background: Efforts at minimizing the propensity of posterior approach of hip for post-operative dislocation after total hip arthroplasty have been a subject of continual research. We comparatively evaluated the posterior approach to hip and its quadriceps coxae sparing (QCS) modification with regard to joint stability and component placement.Questions/Purposes: (1) Does sparing of Quadriceps Coxae tendons vis a vis their sectioning in posterior approach help in achieving better intraoperative stability? (2) Does sparing of Quadriceps Coxae tendons come in the way of adequate surgical exposure sufficient to place hip components accurately? (3) Does sparing of Quadriceps Coxae tendons result in better early functional outcome? Methods: Seventy-two patients requiring THA were enrolled prospectively and randomized into two groups: group A (posterior approach) and group B quadriceps coxae sparing (QCS) approach. They were compared for intraoperative joint stability, accuracy of component placement, duration of surgery, blood loss, any event of hip dislocation, and functional outcome. Results: QCS approach resulted in better intraoperative hip stability as the hips tolerated a higher value of 43.50±3.5° mean internal rotation (at 90° of flexion and 20° of adduction) in this group versus a mean value of 33.50±5.5° in posterior approach group (p < 0.01). No significant difference was observed for femoral version, acetabular inclination, and acetabular version in the two groups (p > 0.05). There was no difference between the two groups in terms of duration of surgery, intraoperative blood loss, and functional outcome at one year (p > 0.05). No event of hip dislocation was observed in QCS approach, whereas, one such event happened in the posterior-approach group. Conclusion: Preservation of the QC tendons improves the intraoperative stability of THA and they do not cause any hindrance in the exposure required for optimum component placement.

Effect of storage age and containers on the physicochemical degradation of guggul oleo-resin.

Guggul is a gum oleo-resin, tapped from a data deficient plant- Commiphora wightii (Arnott.) Bhandari in India. It is extensively used in ayurvedic drugs and formulations since ages. Natural plant-based products; especially aromatic ones like guggul gum oleo-resin deteriorates, qualitatively during its storage and transits before reaching the industry for its value addition. This economical and ecological loss can be avoided if it is stored in proper containers. Physico-chemical degradation of guggul samples stored were analysed by scanned electron microscopy, fourier transformed infra red, thermogravimatric, Powdered X-ray diffraction and elemental analysis for carbon, hydrogen, nitrogen and sulphur. Physico-chemical degradation of guggul oleo-resin occurs with the age of storage and the type of storage containers used. Among the four storage containers (earthen pot, plastic jar, polythene bag, jute bag) evaluated, earthen pot was found to be the best in checking the qualitative loss of guggul even upto 24 months. The qualitative information generated in the study on guggul storage may be useful to the drug industry and guggul traders. It may encourage them practice storing guggul in earthen pots against current practice of using jute bags and polythene bags, to store it.

Assessment of Hearing Impairment in Sick Newborns: A Prospective Observational Study.

BACKGROUND:  Undiagnosed neonatal hearing loss causes severe language, cognitive, and behavioral problems in children. Sick newborns who spend 48 hours in the neonatal intensive care unit (NICU) have a 10- to 20-fold increased risk of permanent hearing loss. The aim of this study is to identify hearing impairment in high-risk sick newborns who spend at least 48 hours in the NICU. METHODS:  The present prospective observational study was conducted at a single center. All sick neonates admitted to the NICU for a minimum of 48 hours at the JK Lon Hospital, Zanana Hospital, and Mahila Chikitsalaya, Sawai Man Singh (SMS) Medical College, Jaipur, Rajasthan, India, from June 2017 to May 2018 were considered eligible for the study. The primary outcome was the assessment of hearing loss of high-risk newborns using otoacoustic emissions at the time of discharge, six weeks of age, and automated auditory brainstem response (AABR) at three months of chronological age. The secondary outcome was to analyze the association of hearing loss with different risk factors in high-risk neonates. RESULTS:  A total of 150 infants who had one or more risk factors were studied, 60 were female and 90 were male. No statistically significant difference in hearing loss was observed based on birth weight, sex, and gestational age. The first distortion-product otoacoustic emission (DPOAE) screening was done on infants at the time of discharge from the NICU. Eighty-three infants (55.33%) had "refer" on the first DPOAE and the remaining 67 (44.67%) were passed results at the time of discharge. At six weeks of life, on repeat screening with a second DPOAE test, 36% "refer" on the first screen had a "refer" result on the second DPOAE. However, 4.4% "pass" on the first screen turned out to be "refer" on the second screen. These 33 infants who had "refer" results on the second screen were subjected to testing. At 10 weeks of life, AABR was performed on 33 infants. Eleven infants out of 33 had sensorineural hearing loss (SNHL) on AABR. Hearing impairment with the DPOAE test was observed with risk factors neonatal hyperbilirubinemia (NHH), hypoxic ischemic encephalopathy (HIE), and very low birth weight (VLBW) and was statistically significant among all risk factors. But, no such association (between hearing impairment and risk factors) was observed with the AABR test. In our study, we found that the duration of mechanical ventilation in mean days 7.67±6.24 had statistically significant SNHL compared to the lesser duration of mechanical ventilation (p<0.001). CONCLUSION: Two-stage DPOAE done prior to AABR is helpful in the early detection of hearing loss.

Efficacy of transcutaneous bilirubinometry as compared to serum bilirubin in preterm newborn during phototherapy.

Transcutaneous measurement of bilirubin is being used for neonatal jaundice. Its utility during phototherapy in preterm babies is not established. The objective of our study was to assess the efficacy of transcutaneous bilirubin (TcB) measurement in comparison to total serum bilirubin in preterm newborns at admission and during phototherapy at the covered skin area (glabella). It was a prospective observational study and conducted at the neonatal intensive care unit of a tertiary care hospital from January 2017 to January 2019. One hundred eligible preterm neonates were enrolled. Babies who were very sick, with poor peripheral circulation, edematous, having conjugated hyperbilirubinemia, with major congenital malformations, already received phototherapy or exchange transfusion were excluded. Paired total serum bilirubin and transcutaneous bilirubin were measured at admission and 6 h and 24 h during phototherapy. TcB was measured from the area (glabella) covered by an eye protector during phototherapy. The sample for TsB was taken within 10 min of TcB measurement. The mean differences between TsB and TcB values at admission and 6 h and 24 h of phototherapy were - 0.005 (0.353) mg/dl, - 0.350 (0.611) mg/dl, and - 0.592 (0.353) mg/dl, respectively. At admission or before starting of phototherapy, the difference (TsB-TcB) was statistically not significant (p = .125), while the difference in these values was statistically significant at 6 h and 24 h of phototherapy.Conclusion: TcB measurements from the covered skin area in jaundiced preterm infants during phototherapy were not correlated with TsB and cannot be used as an alternate of serum bilirubin testing. What is known • HPLC bilirubin measurement is a gold standard test for bilirubin measurement but impractical for day to day use. Serum total bilirubin is used for clinical testing.. • There is evidence for use of transcutaneous bilirubinometry for assessment of bilirubin in term newborn. What is new • TcB measurements from a covered skin area in jaundiced preterm newborns under phototherapy were not correlated significantly at 6 h and 24 h of phototherapy, but correlated before phototherapy. • TcB cannot be used as an alternate of serum bilirubin testing in preterm infants during phototherapy.

Umbilical Cord Blood Culture in Diagnosis of Early Onset Neonatal Sepsis.

OBJECTIVE: To evaluate the use of umbilical cord blood culture (UCBC) as compared to neonatal blood culture (NBC) in the diagnosis of early onset neonatal sepsis (EONS). METHODS: This hospital based prospective observational study was conducted in the Department of Pediatrics and Department of Obstetrics & Gynaecology at a tertiary care centre of North India from 2017 through 2018. A total of 80 newborns with presence of two or more risk factors for sepsis were included in the study. Blood culture samples were collected from the umbilical cord at delivery and from the neonate within 1 h of birth. RESULTS: UCBC was positive in 17 (21.2%) neonates and NBC was positive in 15 (18.7%) neonates. Out of these positive cases, 10 (45.4%) neonates had similar bacteriological profile in both UCBC and NBC which included Burkholderia cepacia, Acinetobacter species, Enterobacter cloacae and Coagulase-negative Staphylococcus. UCBC had a sensitivity of 66.7%, a specificity of 89.2%, a positive predictive value 58.8% and a negative predictive value 92.1% for the diagnosis of EONS in high risk neonates, considering NBC as the gold standard test. CONCLUSIONS: UCBC is a reliable alternative to NBC for early etiological diagnosis of EONS in high risk neonates. Additional blood sampling from the newborn is suggested if there is any clinical sign of sepsis.