Outcome of fracture of intra articular distal femur treated with distal femur locking compression plate

Background: Intra articular fracture of the distal femur is a composite and complex injury that poses various challenges for orthopaedic surgeon starting from management of fracture to a protracted recovery of the patient.Methods: We have done retrospective study of 25 patients with intra articular distal femur fracture operated during the period of 2008 to 2014. NEER score is used as criteria for evaluation of patients.Results: With use of DFLCP, anatomical reduction and rigid fixation, early mobilization and aggressive physiotherapy can be started with the use of these plates.Conclusions: Our study shows that distal femur locking compression plate (DFLCP) is the evolving approach to treat distal femur fractures

Comparison of the effect for fracture resistance of different coronally extended post length with two different post materials

Aims and Objectives: To compare the effect for fracture resistance of different coronally extended post length with two different post materials. Materials and Methods: One hundred and sixty endodontically treated maxillary central incisors embedded in acrylic resin with decoronated root portion were taken for the study. The postspaces were prepared according to standard protocol. The samples were divided into two groups according to the post material: glass-fiber post and Quartz fiber post. These groups were further subdivided on the basis of coronal extension of 4 and 6 mm for glass fiber and Quartz fiber posts, respectively. The posts were then luted with dual-polymerizing resin cement followed by core buildup. Samples were subjected to increasing compressive oblique load until fracture occurred in a universal testing machine. Data were analyzed with one-way ANOVA and independent Student's t-test. Analysis was done using SPSS version 15 (SPSS Inc., Chicago, IL, USA) Windows software program. Results: Glass fiber post with coronal extension of 4 mm (182.8 N) showed better results than with 6-mm length (124.1 N). Similarly, in quartz fiber posts group, 4-mm postlength (314 N) was better when compared with 6 mm (160 N). The 4-mm coronal extension of quartz fiber post displayed superior fracture resistance. Conclusions: Glass fiber posts showed better fracture resistance than Quartz fiber posts. 4-mm coronal length showed more fracture resistance than 6 mm

ATTENUATION OF HAEMODYNAMIC RESPONSE DURING LARYNGOSCOPIC INTUBATION WITH FENTANYL

Introduction: Identified as a depth-of-anesthesia-dependent influencing factor, endotracheal intubation has been suggested to be one of the most invasive stimuli in anesthesia, particularly during induction3 and after tracheal intubation. The objective of the study was to find a safe and effective means of attenuating the cardiovascular response to laryngoscopy and tracheal intubation. Methodology: S.A.L Hospital and Medical institute and KESAR SAL Medical College and Research Institute, Ahmedabad during 2008-2010 in 100 patients, divided in two groups having 50 patients in each group. One group received intravenous fentanyl while other group termed as control group received intravenous normal saline. The following hemodynamic variables were considered for study: changes in heart rate and comparison of the controlled group with the group who received fentanyl; & changes in systolic arterial pressure and diastolic arterial pressure in the fentanyl treated group in comparison to the control group. Results: At induction both the groups were observed to have a 5% decrease in heart rate in comparison to basal levels. At intubation, however, the fentanyl group had a highly significant mean heart rate at 12% below the control group (P≤0.0001). Highly significant attenuation of systolic blood pressure was observed in the fentanyl group with a 10% average lower value than the control over all measured points. As with SBP, high attenuation of the DBP pressor response to intubation in the fentanyl group was observed at all measured times – on average 10% greater attenuation than the control group. Conclusion: In conclusion, fentanyl attenuated the cardiovascular response to laryngoscopy & intubation, and was more effective in attenuating these responses. DBP was maintained in the fentanyl group. No patient manifested any ischemic ECG changes so fentanyl is safe in patients of ASA physical status I/II

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030