Management of Neglected Pubic Symphysis Diastasis and Sacroiliac Joint Disruption With Erectile Dysfunction in Polytrauma: A Case Report.

Pelvic fractures are the most common among patients sustaining high-energy trauma. They are associated with high morbidity and mortality rates, often because of high blood loss and injury to the lumbosacral plexus, genitourinary system, and gastrointestinal system. The age, complexity of the pelvic fracture, and pubic symphysis diastasis would represent risk factors for erectile dysfunction after major and neglected pelvic injuries; the neglected pelvic ring injuries could cause disabilities that manifest with symptoms like pain, lower limb length discrepancy, standing or sitting imbalance and even sexual dysfunction. Herein, we report a case of a young adult who sustained polytrauma and was diagnosed with neglected pubic symphysis diastasis, sacroiliac joint disruption, and erectile dysfunction. The patient regained erectile function after the surgical management of pubic symphysis diastasis and sacroiliac joint disruption.

A Multi-armed Unfurling Actuator for Airway Lumen Measurement.

Objective measurement of the lumen area demands an intraoperative diagnostic tool to aid on-site decision-making. We present a compliant mechanism-based unfurling actuator assembly integrated with a shaft connected to a motorized encoder to translate torque from the user at the proximal end to the actuator at the distal end. The actuator assembly has flexible arms coiled inside a cylindrical casing that moves radially outward upon actuation. Leveraging 3D printing of flexible materials, the unfurling actuator's four-arm design enables patency measurements in circumferential tracheal stenosis of varying grades. The rotary encoder output is correlated with the radially outward movement of the unfurling arms to estimate the lumen diameter. The measurement stability is analyzed using process control charts; data distribution over ten iterations reveals nearly 100% of process data falls between ±3 sigma (Upper and Lower control limits). Comparing measurements from the tool with direct measurement (vernier caliper) and ImageJ analysis, one-way ANOVA for circular morphology yields no significant differences in diameter p = 0.974 and area measurements p = 0.975.Clinical Relevance- Central airway narrowing reduces the effective lumen area in the tracheal and bronchial segments. Grading the degree of narrowing is often based on a suspicion index. A quick but thorough assessment of the airway caliber is essential in emergent or planned intubation, whether congenital, iatrogenic, or idiopathic tracheal stenosis.

A Prospective, Randomized Comparison of the Classical Altemir's Method With the Newer Seldinger's Technique of Submental Intubation.

BACKGROUND: Submental intubation performed using the classical Altemir's technique is a well-accepted, safe technique for providing optimal operating field to the maxillofacial surgeon, in cases where either nasotracheal or orotracheal intubation is impossible. We propose a new, percutaneous Seldinger's technique of submental intubation as an interesting alternative to the classical Altemir's technique, wherein a percutaneous dilatational tracheostomy kit is used to dilate the submental tract, instead of bluntly dissecting it. We hypothesized that Seldinger's technique would be associated with reduced procedure time and minimal scar formation in patients with maxillofacial fractures. METHODS: We enrolled 60 patients scheduled to undergo maxillofacial injury fixation under general anesthesia. After consent, the cohort was randomly allocated to undergo submental intubation by either the classical Altemir's technique or Seldinger's technique. As our primary objective, we noted the time taken to complete the procedure of submental intubation. Our secondary objectives were the components of primary outcome, such as disconnection/apnea time, bleeding, and technical difficulties during the procedure. We also observed for complications such as presence of salivary fistula/infection at hospital discharge and scar characteristics at 1- and 3-month follow-up. RESULTS: The median time for performing submental intubation in the Seldinger group was significantly lower than that in the Altemir group (170.5 [136.5-256.0] seconds vs 220.0 [205.5-289.0] seconds; P value, .040). The median disconnection time was also significantly lower in the Seldinger group (12.0 [10.8-20.0] seconds vs 19.0 [15.0-23.0] seconds; P value, .036). Furthermore, significant bleeding was absent in nearly 53.8% of the study participants in the Seldinger group as compared to 25.9% in the Altemir group. At follow-up, there was no evidence of differences in scar characteristics between the 2 groups. CONCLUSIONS: Seldinger's technique is associated with shorter procedure time and reduced apnea time due to easier and better tract formation, thus minimizing the effort required to exteriorize the endotracheal tube. Furthermore, as dilation reduces tissue damage, Seldinger's technique is associated with significantly less procedural bleeding. Thus, Seldinger's technique can be safe, easy, and faster to perform compared with the classical Altemir's technique of submental intubation in patients with maxillofacial trauma.

Palatal Rash Sign is Reliable Predictor of Severe Thrombocytopenia in Dengue Fever.

In dengue, which is an arthropod borne illness increasing in prevalence in India, a sudden drop in platelet count has serious connotations, and is frequently evidenced by a palatal rash.

Detection of antibodies to co-trimoxazole (preservative drug) interfering with routine red cell antibody screening.

Drug-dependent antibodies can rarely cause interference in pretransfusion antibody screening. The diluents for commercial reagent red blood cells contain different antibiotics, such as chloramphenicol, neomycin sulfate, and gentamycin as a preservative. The presence of antibodies to a given drug in patient may lead to positive results when performing antibody identification. We present a rare case of detection of anti-co-trimoxazole antibody during routine antibody screening in a female patient undergoing neurosurgery. These antibodies mimicked as antibody against high-frequency red cell antigens reacting in both saline phase as well as antiglobulin phase. Anti-co-trimoxazole antibody was confirmed by repeating antibody screen using reagent red cells of different manufacturers with and without co-trimoxazole drug as preservative as well as using washed red cell panels. There were no associated clinical or laboratory evidence of hemolysis.

Opinions about Blood Donation amongst Medical Personnel's.

OBJECTIVE: There is limited literature in the Indian subcontinent on the attitude of the medical personnel regarding blood donation. The purpose of the present study was to identify and assess the barriers that prevent people from becoming blood donors and also to devise recruitment strategies to increase the blood collection. MATERIALS AND METHODS: This study was conducted in a tertiary care centre with attached medical college in Tamilnadu amongst 750 medical personnel. A self administered questionnaire was used for data collection from each individual. RESULTS: Amongst the 750 medical personnel under study, 470 were never donors and 280 were lapsed donors. The foremost reason for not donating blood among lapsed donors and non donors was never being asked again. CONCLUSION: Donors often donate blood once and rarely return to make a second or subsequent donation. Further education, motivation and dissemination of information would help in recruitment and retention of non-remunerated blood donors.