RESUMO
Disease control has increasingly shifted towards large scale, disease specific, public health interventions. The emerging problems of HIV, hepatitis, malaria, typhoid, tuberculosis, childhood pneumonia, and meningitis have made community based trials of interventions a cost effective long term investment for the health of a population. The authors conducted this study to explore the complexities involved in obtaining informed consent to participation in rural north India, and how people there make decisions related to participation in clinical research.
Assuntos
Consentimento Livre e Esclarecido/ética , Prática de Saúde Pública/ética , Ensaios Clínicos como Assunto , Ética Clínica , Humanos , Índia , População RuralRESUMO
A group of 30 patients of unstable tibial diaphyseal fractures were managed using unilateral tubular external fixator. The fixator assembly comprised a double stainless steel hollow rod with universal joints and schanz screws as principal implant. Reduction and controlled distraction or compression were achieved by means of distracter/compressor device. Early dynamization was resorted to. The union rate was 100% with average healing time between 20 weeks for closed unstable fractures and 27 weeks for open Gustilo grade-II fractures. Minor pin tract infections accounted for majority of the complications. The unilateral fixator assembly permits early ambulation in unstable tibial diaphyseal fractures without sacrificing a sound anatomical result.
RESUMO
The results of lumbar diskectomy for a sciatic syndrome in 90 patients were reviewed at an average of 8.5 years after operation. The best results were achieved in those patients who had their diskectomy within 12 months of the onset of their symptoms and through minimal approaches. Eighty-six percent of patients returned to gainful employment. Sixteen patients (18%) returned with low back pain attributable to the loss of intervertebral disk, of whom eight (9%) required secondary spinal fusion for control of pain. Seven of these latter patients obtained gratifying clinical and functional results. The findings suggest there is insufficient indication for routine spinal arthrodesis combined with lumbar disk excision. Those eight patients (9%) who developed a disabling postdiskectomy/postlaminectomy instability syndrome did so usually as a consequence of excessive bone and ligament excision and benefitted significantly from subsequent spinal arthrodesis.
