Effect of alcohol on Glasgow Coma score in traumatic brain injury: a single, center, cross-sectional study

Background: To study the effect of blood alcohol levels on GCS in Traumatic brain injury patients (TBI) and relate the findings to brain injury severity based on the admission CT scan. Methods: This cross-sectional study with a comparison group is conducted in Emergency Department (ED) of Pushpagiri Institute of Medical Sciences and Research Centre, Central Travancore, Kerala, India from April 2016 to September 2017 including all patients of 18 - 70 years of age presenting with head injury. 200 participants, 100 each of alcohol intoxicated and non- intoxicated were selected by consecutive sampling. GCS, Blood alcohol concentration-BAC (derived from the reading of alcohol breath analyzer) and admission CT Rotterdam Score are collected and analyzed at the end of study. Results: When CT Rotterdam Score is 1-3, GCS was found to decrease with increase in BAC (Chi-square test p value=0.011; Spearman’s Rank Correlation coefficient rs=-0.326). Independent t –test showed that at BAC 1-100 mg/dl, mean GCS decrease by 1.6 while only same decrease is found when the BAC levels ranges from 100-400 mg/dl. When the CT Rotterdam score is 4-6, no significant correlation was found between GCS and BAC (p value=0.092; rs=0.214). In the presence of alcohol, GCS had sensitivity 87.5% and specificity 70% in comparison to alcohol absent TBI patients (sensitivity 98.5%, specificity 69.7%). When features of hypoxia and shock are present, GCS have good agreement with actual CT findings of TBI. (Kappa coefficient: K 0.659, sensitivity 76%, specificity 100% in alcoholics and K 0.756, sensitivity 100%, specificity 80.6% in nonalcoholic). Conclusions: Even in the setting of alcohol intoxicated TBI patient, Glasgow coma score is a useful tool for quick decision making in emergency department

Does patellar tilt affect the outcome of total knee arthroplasty? a retrospective study

Background: Patellofemoral joint management during total knee replacement remains a controversial topic among knee surgeons. The purpose of this study is to evaluate the influence of resurfaced patellar component tilt on the functional outcome of total knee arthroplasty.Methods: This is a retrospective study reviewing all the patients who underwent total knee arthroplasty in our institution, operated by a single surgeon using a single implant design.Results: A total of 48 patients and 82 knees were enrolled into this study. Patients were evaluated by Oxford knee score, knee society score, Melbourne patellar score, anteroposterior, lateral, and Merchant’s view radiographs. The patellar tilt was divided into three grades according the measurement obtained from knee radiographs.Conclusions: A higher degree of patella tilt (more than 10 degree) is associated with poor outcome following total knee arthroplasty. Melbourne patella score is more sensitive than knee society score and Oxford score in assessing the effect of patella tilt on the outcome of total knee arthroplasty

The variability of sagittal spino-pelvic mobility in Indian population

Background: Abnormal spino-pelvic mobility is increasingly recognized as a leading cause for hip instability following arthroplasty.Methods: We studied the lateral spino-pelvic radiographs of 90 patients, with no spine/hip pathology in standing and sitting positions. We measured the change in sacral slope and grouped them into three spino-pelvic patterns.Results: We found that 50% of study subjects had normal spino-pelvic mobility. The remaining 50% were either hypermobile (24%) or stiff (26%). The stiff spines were either fixed (11%) or hypomobile (15%).Conclusions: Our study shows that in a normal population without any prior hip/spine pathology a significant percentage (50%) have abnormal spino-pelvic mobility. The significance of spinal stiffness in younger age group need to be looked further to make any changes in acetabular cup placement during hip replacement

Comparison of sterile water irrigation versus intravesical mitomycin C in preventing recurrence of nonmuscle invasive bladder cancer after transurethral resection

Introduction: Early recurrence of nonmuscle invasive bladder cancer (NMIBC) following transurethral resection (TUR) remains relatively high. An immediate single instillation of mitomycin C (MMC) reduces the recurrence rates in the first 2 years but has not shown benefits in tumor progression or overall survival. Distilled water irrigation has shown to delay tumor recurrence by osmolysis of tumor cells. There are only limited clinical studies comparing the efficacy of MMC with continuous sterile water irrigation (CSWI) in preventing the recurrence of NMIBC after TUR in clinical setting.Materials and Methods: A prospective, randomized, open-label, two-arm, single-center, pilot study was conducted between December 2013 and September 2015 at a tertiary-care center in South India. Patients were randomized into CSWI group (n = 19) or single dose intravesical MMC group (n = 17) following TUR for NMIBC and analyzed. All patients were followed up with flexible cystoscopy and urine cytology at 3 months interval for 1 year. Recurrence-free rate was estimated as the primary criterion for outcome analysis.Results: At the end of 12 months, recurrence-free rates for MMC and CSWI groups were 47.1% and 52.6%, respectively. The mean recurrence-free interval for MMC and CSWI groups were 10.9 months and 9.8 months, respectively. The difference in recurrence-free rate or recurrence-free interval between two groups was statistically nonsignificant. Further, the complications in MMC group were significantly higher than that in CSWI group (P = 0.047).Conclusions: Continuous bladder irrigation with sterile water after TUR may be comparable to immediate single dose intravesical MMC in preventing tumor recurrence in NMIBC

Thoracic curlicue: A case of ureteral herniation

Isolated herniation of ureter into thoracic cavity due to a defect in the diaphragm is a very rare entity. We present clinical details and radiographic images of an incidentally detected herniation of right ureter into the thorax in an elderly lady with no previous history of trauma or urinary tract symptoms. This acquired but asymptomatic condition is confirmed by radiologic imaging that reveals the classical loop configuration which is described as the curlicue sign. Further evaluation had revealed mild renal failure but with no definite evidence of obstruction. In view of age and asymptomatic status, patient was offered non-surgical management

Basal cell hyperplasia of prostate - an entity a urologist must know

We report 2 cases of basal cell hyperplasia of prostate, which is an uncommon and elusive lesion. It is commonly associated with benign prostatic hyperplasia (BPH) and may sometimes be mistaken for malignancy. The know-ledge about this disease helps in the correct diagnosis and avoidance of unnecessary or overtreatment

Supernumerary nipples and urinary tract abnormalities

A high rate of association between supernumerary nipples (SNN) and genitourinary abnormalities has been reported previously. We examined all patients attend-ing one particular unit, in the age group between 12 and 20 years for the presence of SNN and urinary tract abnormalities. We could find only a weak association between these two conditions