Functional outcome and result of intra-articular injection hyaluronic acid in treatment of osteoarthritis of knee

2016-11-07T01-40-29Z
Source: International Journal of Research in Medical Sciences
Deepak Chaudhary, Yasir Ali Khan.
Background: Osteoarthritis (OA) is the most common disease of joints in adults around the world. Worldwide, it is estimated to be the fourth leading cause of disability. Objective of the study was to assess functional outcome and results of injection of hyaluronic acid in symptomatic osteoarthritis knee. Methods: It was a prospective clinical study with 3 months of follow-up. Clinically proven sixty patients of osteoarthritis knee (OA) included in study according to inclusion and exclusion criteria on OPD basis after getting written and informed consent, treated by weekly intra articular injection of Hyaluronic acid (20 mcg/2ml) in affected knee joint for 5 weeks by single author . Functional outcome and clinical assessment was done by pain at visual analogue score (VAS) and by knee range of movements, patients global assessment of treatment and physician global assessment of treatment. The occurrences of adverse events were also assessed at 3 month. Results: Sixty patients participated in study and reported statistically significant improvement in VAS score in mild and moderate osteoarthritis of knee from 4.46±0.52 and 6.57±0.72 points respectively pre-treatment level to 2.26±0.43 and 4.36±0.24 points respectively at three months post Hyaluronic acid injection follow up, improvement in joint tenderness and patients & physicians global assessment score also improved significantly clinically as well as statistically in mild to moderate group while in severe group no clinical and statistically significant improvement was observed in any parameters, change in range of motion at three months was not significant in any group. Conclusions: Visco-supplementation with intra articular injection hyaluronic acid should be considered as safe and effective modality of treatment in selected group of mild to moderate osteoarthritis before mechanical changes takes place and patient complies with regular exercise, weight control and postural habits.


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A randomized control trial: effect of tranexamic acid on the need of post-operative blood transfusion following total hip replacement surgery

2016-11-07T01-40-29Z
Source: International Journal of Research in Medical Sciences
Deepak Chaudhary, Yasir Ali Khan.
Background: Total hip replacement surgery is one of the most advanced and technically demanding surgeries in orthopaedics in which blood loss is inevitable. Most of the patients are elderly with multiple co morbidities and the estimated one-year mortality is about 25%. Objective of the study was to assess the need of post-operative blood transfusion in total hip replacement surgery in patients given tranexamic acid versus control. Methods: It was a randomized controlled trial. Hundred patients of both sexes undergoing total hip replacement surgery included in study according to inclusion and exclusion criteria after getting written and informed consent. Equal patients 50-50 (50%) divided in two groups tranexamic acid group and control group based on a computer-generated random number table. The tranexamic acid group received two doses of 10mg/kg body weight of tranexamic acid just before surgery and two hours later intravenously. The control group received two doses of 10mg/kg body weight of normal saline at similar intervals. Numbers of blood transfusions required postoperatively were noted based on the postoperative haemoglobin readings. Results: Mean post-op haemoglobin for the tranexamic acid group was 10.4±2.6 g/dl and for the control group it was 8.6±2.4 g/dl (p=0.007). Eight patients (16%) in intervention group required blood transfusion compared to 22 (44%) in control group (p=0.009). The relative risk (RR) for transfusion was 0.51 when TXA was administered compared to when placebo was administered. Conclusions: Perioperative tranexamic acid is a safe and useful method of reducing intra op bleeding and need of post-operative blood transfusion postoperatively in THR patients.


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Retinoblastoma – pattern, presentation and management: a quintessential experience of 5 years

2016-11-07T01-40-29Z
Source: International Journal of Research in Medical Sciences
Anvesh Karthik Yalavarthy, Manjunath I. Nandennavar, Shashidhar V. Karpurmath.
Background: Retinoblastoma (RB) is the most common intraocular malignancy of childhood. It accounts for 10-15% of cancers that occur in infants. Objective of the study was to determine the pattern, presentation and management of Retinoblastoma (RB) patients at a tertiary cancer care center in South India, during a period of 5 years (1st November 2009 to 1st December 2014). Methods: This study was a retrospective analysis of the medical records of patients diagnosed as having retinoblastoma obtained from hospital information system and our cancer registry. Data sought was demographic characteristics, clinical presentation, investigations done, the methods of management and the treatment outcome of retinoblastoma patients. Results: Total number of cases studied was 31 and total number of eyes studied was 47. Out of 31 cases, 58% were female. 52% had bilateral involvement. The median age at presentation was 24 months. The commonest mode of presentation was leukocoria (55%) followed by proptosis (22%). Out of 47 eyes studied, 87% were advanced tumours belonging to Group D or Group E. Metastasis to the central nervous system was noted in 22.6% patients belonging to either Group D or Group E. Out of the 31 patients, 64.6% patients underwent enucleation. 6 out of 31 cases succumbed to death. Conclusions: Retinoblastoma continues to be a challenge in developing countries. Lack of awareness and inaccessibility to proper healthcare facilities are major stumbling blocks in achieving high cure rates. Educating the public and healthcare professionals, importance of early diagnosis and prompt referral are vital in reducing morbidity and mortality associated with the disease.


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Neonatal outcomes as per gestational age in late preterm births: a retrospective study

2016-11-07T00-10-25Z
Source: International Journal of Contemporary Pediatrics
Ankur Gupta, Soujanya B. S., Kamath K. Madhava.
Background: Late preterm infants (34 week to 36 week + 6 days of gestation) are physiologically immature and have limited compensatory responses to the extra-uterine environment. Aim of the study was to compare the incidence of neonatal complications of late preterm infants compared to those born at term gestation and admitted in neonatal intensive care unit in a tertiary care hospital in south India. Methods: We retrospectively analyzed late preterm deliveries reported in 24 months period. Late preterm were divided in 3 sub-groups according to gestational age at delivery: 34 week + 6 days, 35 week + 6 days, 36 week + 6 days of gestation. The incidence of major clinical complications was evaluated. Statistical analysis was performed by using the Z- test. All babies admitted from March 2014 to February 2016 were retrospectively studied. Results: Among late preterm deliveries 53% were admitted to the neonatal intensive care unit. Out of which 35% presented with neonatal jaundice, 27% Respiratory distress syndrome (RDS), and sepsis 18 % .The incidence of RDS, jaundice and sepsis was significantly higher at 34 0/6 and 35 0/6 weeks of gestation, compared to full-term infants. Finally, the incidence of jaundice and RDS results significantly higher in all the 3 subgroups of late preterm, in contrast to full term infants. Conclusions: Results demonstrated an increased risk of morbidity in the late preterm period in contrast with term infants. Results also displayed that the gestational age at delivery of late preterm can influence the risk of adverse neonatal outcomes


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Screening for overall mental health status using mental health inventory amongst medical students of a government medical college in North Karnataka, India

2016-11-05T07-56-51Z
Source: International Journal of Community Medicine and Public Health
Yuvaraj B. Y., Poornima S., Rashmi S..
Background: In developing countries like India, seeking mental health care is still a taboo, and a lot of stigma is attached to consulting a psychiatric specialist or a counselor. This problem magnifies when budding doctors have a mental health issue. Objective of the study was to assess the overall mental health status of undergraduate medical students studying in a Government Medical College of North Karnataka by using the mental health inventory (MHI) questionnaire. Methods: A cross-sectional study was carried out during the period of July to September 2016 amongst 210 undergraduate medical students at Government Medical College, Koppal, Karnataka by administer a standard 18 items MHI questionnaire. The raw MHI scores (0-6) and computed MHI scores (0-100) were calculated for overall and four subscales (i.e. anxiety, depression, behavioural control, and positive affect) were also calculated. Results: Out of total 210 study participants, 119 (56.67%) were male and 91 (43.33%) female students. The overall computed MHI scores (0-100) total score ranges from 58-74, mean score 63.5, median 64.43 and a standard deviation of 4.01. However, computed MHI (0-100) scores for subgroups like anxiety ranged from 8 to 60, mean score 47.36, depression ranged from 8 to 84, mean score 50.29, behavior control ranged from 30 to 85, mean score 67.76, and positive affect ranged from 25 to 100, mean score 42.7. Conclusions: Poor mental health and presence of some emotional health problems among medical students is substantially high. Early screening, diagnosis, care and support should be made available to all the medical students.


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Gastric Perforation After Incidental Ingestion Of Datun: Report Of An Unusual Case

2016-11-05T05-14-52Z
Source: The Southeast Asian Journal of Case Report and Review
Pal Naresh, Griwanmahavir S , Singhbikram J .
Gastric perforation is an extremely rare complication of foreign body ingestion, which usually presents with peritonitis. Ingestion of foreign bodies is a fairly common presentation and most of these cases can be managed conservatively. Larger foreign bodies however, can sometimes be difficult to manage. We present a peculiar case of gastric perforation following involuntary ingestion of a large foreign body i.e. Datun (It is a tree twig commonly used for cleaning teeth in rural India). A 57-year male presented to our accident and emergency department with complaints of pain in upper abdomen following involuntary ingestion of Datun while brushing his teeth 7-8 days back. During this period the patient was passing flatus and stools normally. He also had history of smoking and occasional consumption of alcohol. On examination of the abdomen the patient was found to have tenderness and guarding in upper abdomen. He was investigated further with a provisional diagnosis of perforation peritonitis. Free air under the diaphragm was evident on chest X ray. Upon exploratory laparotomy the patient was found to have a perforation in the body of the stomach with one half of the Datun protruding out of it. Primary closure of perforation was done after removal of the foreign body. Postoperative period was uneventful and the patient was discharged on the 5th post operative day. Symptomatic giant ingested FBscan be challenging to manage and may even require urgent surgical intervention if perforation is suspected. Although ingested foreign bodies are rarely symptomatic they should be considered in differential diagnosis of abdominal pain as well as possible cause of acute abdomen.


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Amyand’s Hernia: An incidental Diagnosis

2016-11-05T05-14-52Z
Source: The Southeast Asian Journal of Case Report and Review
Manish Swarnkar, Gaurav Pal, Raju Shinde.
Inguinal hernia repair is commonplace in general surgery practice. Amyands hernia is an extremely rare condition in which the appendix is positioned in the inguinal hernia sac. We report the intra-operative findings of a standard inguinal hernia repair and discuss the management of the Amyands hernia.


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