Functional outcome of distal radius fractures treated with fixation by percutaneous cannulated screw

Background: In the present study primary objectives were to evaluate the clinical and functional outcome and union rates, whereas secondary objective was to study complications associated with closed reduction percutaneous fixation of displaced unstable fractures of distal radius in adults by using cannulated cancellous (CC) screw.Methods: Thirty two patients aged more than 18 years, with unstable displaced distal radial fracture were included in this prospective observational study. Patients were treated by closed reduction and percutaneous fixation by CC screw. Radiological parameters like radial inclination, radial height, ulnar variance, volar tilt were measured. Mayo wrist score and range of motion were noted. Patients were followed up for six months. Continuous variables were compared by using paired and unpaired ‘t’ test.Results: Mean Mayo wrist score at six months post-operative follow-up (82.8) was significantly higher compared to six weeks post-operative follow-up (64.4). Mean early post-operative radial height, mean radial inclination, and mean volar tilt were significantly higher compared to mean six months post-operatively. Mean early post-operative ulnar variance was significantly lower compared to mean six months post-operatively. Mean flexion, mean extension, mean supination, mean pronation, mean radial deviation, and mean ulnar deviation was significantly higher six months post-operative follow-up compared to six week post-operative follow-up. Mean grip strength was significantly higher six months post-operative follow-up compared to six week post-operative follow-up.Conclusions: Clinical and functional outcomes associated with closed reduction and percutaneous fixation by cannulated cancellous screw was excellent. Mayo wrist score was increased over six months follow up period

Neutrophil to lymphocyte ratio and red blood cell distribution width as predictors of microalbuminuria in type 2 diabetes mellitus

Background: Diabetic nephropathy (DN) is a common and feared complication of diabetes mellitus, linked to higher morbidity and mortality rates. Very few studies have assessed the possible clinical value of biomarkers such as neutrophil-to-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) in DN in type 2 diabetes mellitus (T2DM) patients. The present cross-sectional observational study aimed to find the correlation of NLR and RDW with microalbuminuria in T2DM patients. Methods: One hundred and sixty-nine patients aged ≥40 years of either sex, with duration T2DM >4 years, and diagnosed according to the American Diabetes Association criteria, were included in this cross-sectional observational study. NLR, RDW and urine microalbumin were noted. The primary outcome measures were to find the correlation between NLR and RDW with microalbuminuria, whereas the secondary outcome measures were to study the predictive value of NLR and RDW for microalbuminuria in T2DM patients. Results: There was a significant positive correlation between NLR and microalbuminuria (r=0.165) and a significant negative correlation between RDW and microalbuminuria (r=-0.159). The mean serum albumin and NLR were significantly higher in patients having microalbuminuria.  The sensitivity of NLR and RDW to predict microalbuminuria was 82.4% and 64.7% respectively. Conclusions: NLR and RDW significantly correlated with microalbuminuria and have good sensitivity for microalbuminuria in T2DM patients. NLR and RDW are cheap and inexpensive methods for detecting DN

Anticipated difficult airway management in a case of hemifacial microsomia

Airway management in paediatric patients with facial abnormalities is challenging for an experienced anaesthesiologist. Both mask ventilation and intubation can be difficult or impossible, especially with associated congenital facial anomalies. Hemifacial microsomia (HFM) is linked with mandibular hypoplasia and temporomandibular joint anomalies. These abnormalities may cause problems for direct laryngoscopy and endotracheal intubation.  A case report of a two-year-old child having HFM with a history of failed intubation in the past is presented here. We did manoeuvres for proper fitting of mask and to prevent air leak during mask ventilation. As there was a history of failed intubation, we kept difficult intubation kit including fiberoptic bronchoscopy, video laryngoscopy and ultrasound ready

Similarities and Differences between Coronavirus Disease 2019-related Multisystem Inflammatory Syndrome in Children and Kawasaki Disease in Indian Patients

Background: There is a marked overlap of clinical and laboratory features of multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD); resulting in a diagnostic dilemma. Studies comparing MIS-C and KD in Indian children are limited. The present study was conducted to describe the similarities and differences between MIS-C and KD which may help in diagnosis. Materials and methods: This prospective observational and retrospective study was conducted between April 2022 and March 2023. A total of 82 children <18 years of age were included; 41 with MIS-C and 41 diagnosed as KD admitted in the same hospital as controls. The primary objectives were to compare the gastrointestinal manifestations between the two groups, whereas the secondary objectives were to compare the mucocutaneous and cardiac manifestations. Results: The mean duration of fever was significantly longer in children with KD compared to those with MIS-C. Gastrointestinal manifestations were notably more prevalent in the MIS-C group, whereas mucocutaneous signs were more frequently observed in the KD group (KDG). Evidence of shock, the use of inotropes, and the need for respiratory support were significantly higher in the MIS-C group than in the KDG. Myocardial dysfunction and pericardial effusion/regurgitation were also more prevalent in the MIS-C group, whereas coronary dilatation/aneurysm was significantly lower compared to the KDG. Mean white blood cell (WBC) count, percentage of lymphocytes, absolute lymphocyte count (ALC), and platelet count were notably higher in the KDG compared to the MIS-C group. Liver function tests (LFTs), renal function tests (RFTs), and inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were comparable between the two groups. Conclusion: There were vast similarities between KD and MIS-C, suggesting that they lie along the same clinical spectrum. However, there are several differences between the two disease entities

An association of plasma cyclophilin A with severity of coronary artery disease

Background: Plasma cyclophilin A (CyPA), an emerging biomarker of cardiovascular disease, is likely to play a crucial role in all stages of atherosclerosis. Very few studies have been conducted on the association of plasma CyPA with coronary artery disease (CAD) in India. The aim of the present study was to determine an association between plasma CyPA levels and CAD severity. Methods: The present cross-sectional observational study was conducted on 100 patients aged ≥18 years who presented with symptoms suggestive of CAD. The presence or absence of cardiovascular risk factors such as gender, hypertension, diabetes mellitus, dyslipidaemia, family H/O CAD, smoking, etc. were noted. Coronary angiography was performed on each patient. Quantitative estimation of plasma CypA levels and high-sensitivity C-reactive protein (hs-CRP) was done. Results: The mean serum CypA (66.6 Vs 44.9 ng/ml) and hs-CRP (29.8 Vs 21.4 mg/l) were significantly higher in patients with obstructive CAD as compared to non-obstructive CAD. There was a statistically significant positive correlation (r=0.251) between CypA levels and hs-CRP (p value=0.012). The mean low-density lipoprotein cholesterol (181 Vs 160.8 mg/dL) and mean triglycerides (179 Vs 168 mg/dl) were significantly higher in patients with obstructive CAD as compared to non-obstructive CAD. There was no statistically significant difference between the type of CAD and mean total cholesterol and high-density lipoprotein cholesterol. Conclusions: CypA levels were increased in obstructive CAD patients. High CypA serum levels could be a novel biomarker in CAD patients associated with severe CAD

Long Bilateral Horseshoe-Shaped Anal Fistula (without Internal Opening) Treated by Kshar Sutra: A Rare Case Report

Anal fistulae can be of different shapes and lengths with multiple openings or branches. Bilateral horseshoe-shaped fistula is a rare and aggressive form of anal fistula. The treatment of the anal fistula has continued a big challenge to date. Only a few cases of a long bilateral horseshoe shape anal fistula without internal opening have been reported. We present a rare case of a 17-cm long bilateral horseshoe-shaped anal fistula with two external openings and without internal openings. The patient was treated using Kshar Sutra (a medicated thread) with weekly thread changes. C-arm imaging guidance was used to insert the thread perfectly in the fistula track. The entire procedure was performed under local anaesthesia. Medicines were not given for infection control. There were no complications after the procedure. The patient was completely cured and fistula-free for 8 years. The Kshar Sutra technique can be an effective alternative treatment to cure fistula-in-ano

Comparison of the Clinical Outcome and Complications in Laparoscopic Hernia Repair of Inguinal Hernia With Mesh Fixation Using Fibrin Glue vs Tacker

Although laparoscopic repair offers a quick and less morbid way of treating hernias, complications like hematoma, seroma, neuralgia, recurrence, mesh infection, hydrocele, etc. are known. The present study was undertaken to compare various clinical outcomes between mesh fixation using fibrin glue and mesh fixation with tacker in a 3-months follow-up. One hundred patients aged 18 to 60 years having inguinal hernia admitted in Poona Hospital and Research Centre, Pune, between October 2012 and November 2014 for laparoscopic hernia surgery and ready to participate in this study were included. All of them underwent laparoscopic repair of hernia by total extra peritoneal (TEP) method following sample surgical protocol in all of them except for method of mesh fixation. Mean time calculated from insertion of the first trocar to beginning of skin suturing was 54.9 min in tacker group and 50.3 min in fibrin glue group with no statistically significant difference between the two. The incidence of urinary retention was significantly higher in tacker (34 %) as compared to fibrin glue (12 %) group. Incidence of hematoma was significantly higher in tacker group in 15-day follow-up, but there was no significant difference in hematoma formation at hernial sites in both groups after 15 days of follow-up. The incidence of neuralgia was significantly higher in the tacker group (24 %) compared with the fibrin glue group (2 %). Significantly, more number of people in the fibrin glue group 68 and 90 %, respectively, returned to work during 15 and 30 days follow-up as compared to the tacker group 46 and 64 %. Fibrin glue can be considered as an alternative to tacker for mesh fixation