Evaluation of clinical and functional outcome of open reduction/closed reduction with intra medullary interlocking nailing and `Poller' blocking screws in tibial metaphyseal fractures

INTRODUCTION: Interlocking nailing of tibial fractures are most desirable because these are load sharing devices in compare to load bearing plate osteosynthesis implants. Biological fixation of the fracture is possible in the method of nailing without opening the fracture site, further it is possible to spare the extra osseous blood supply and we can avoid extensive soft tissue dissection. Nailing of metaphyseal fractures with short proximal or distal fragment is associated with an increase in malalignment particularly in coronal plane, so there is always a chance for mal union, rarely non union and need for secondary procedures to achieve union. The cause has been attributed to both displacing muscular forces and medullary canal anatomical factors. As there is always a mismatch between the diameters of the nail and the medullary canal, with no nail-cortex contact, the nail may translate coronally or sagittaly particularly in proximal tibial fractures. Due to this there is a increased stress on the locking screws to maintain fracture alignment after surgery, which further leads to periprosthetic fractures and implant failure. Various techniques have been recommended to improve nailing procedures for the metaphyseal fractures these are, “poller” blocking screws, temporary unicortical plating, different nail designs with different proximal bends in case of proximal third fractures and fibular plating in case of distal third fractures. Poller screws are named after a traffic guiding device used in European countries to guide the traffic on the roads. They are used for the following three purposes: a) Achievement of the fracture alignment, by using screw as a reduction tool. b) Improvement of the stability of the bone – implant Construct by reducing the medullary canal width. c) Maintenance the fracture alignment till union with poller screws in situ. AIM OF THE STUDY: To evaluate the Clinical and Functional Outcome of Closed Reduction / Open Reduction and Internal fixation with Intramedullary Inter Locking Nailing and “POLLER” BLOCKING SCREWS in Tibial Metaphyseal Fractures. MATERIALS AND METHODS: This is a prospective study of 20 cases of tibial metaphyseal fractures treated with open reduction/closed reduction with statically locked intra medullary nailing an ‘ poller screws’ between August 2010 and September 2012 at Govt. Rajaji Hospital, Madurai Medical College, Maduari. Patients Inclusion criteria: •Adult patients more than 20 years of age. •Either proximal or distal metaphyseal fractures. •Unstable, comminuted metaphyseal fractures of tibia with varying soft tissue injuries. •Segmental fractures with involvement of metaphysis. Exclusion criteria: •Adolescent patients <20 yrs of age. •Very minimally (or) undisplaced fractures. •Tibial metaphyseal fractures involving the articular surface. •Associated with previous anatomic deformities. •Fractures with wound at the nail entry site. •Compound Gr II, Gr III A-C. RESULTS: Multiple measurements are made on the same individual at different point of times. In line with this, the variables in our study were the angle at the fracture site measured within the same subjects at different point of times. Because few extreme values of variables of normal distribution should not mislead the interpretation of analysis, 95 % upper and lower confidence limits were preferred over range to express the variables.Karlstorm-Olerud score which was used to asses the functional outcome is an independent measurement, not influenced by other co-morbid conditions and associated injuries. CONCLUSION: We conclude that the surgical management of, open reduction/closed eduction with intra medullary interlocking nailing and poller screws in tibial metaphyseal fractures. •Is effective in achieving the fracture alignment with poller screw acting as a reduction tool •Gives improved stability of the bone – implant construct, with the poller screw functionally reducing the medullary width. •Maintains the fracture alignment till union, preventing loss of initial reduction with poller blocking screw in situ

Seaweed distribution on diversity on the intertidal rocks at Nochiyurani coast of Gulf of Mannar

The present study deals with 21 seaweed species from the intertidal rocks at nine sampling stations along Nochiyurani coast during six month period from January to June 2014. Among the different species of seaweeds, the dominant species Gracilaria corticata in all the sampling stations indicated it's adaptability to the surf zone. Acanthophora spicifera and Caulerpa scalpellifomis var. denticulata were the next two dominant species. The present study reveals that intertidal rocks occurring along the entire coast of Nochiyurani offer suitable substratum for the luxuriant growth of seaweeds. The lack of anthropogenic activity along this coast favours for the good growth of different seaweeds

The Impact of Hypothyroidism on Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention

Introduction: Hypothyroidism either subclinical (SCH) or overt is independently associated with an increased risk of coronary artery disease (CAD). The combined effects of SCH and overt hypothyroidism on clinical outcomes after percutaneous coronary intervention (PCI) are largely unknown. Aim: The aim of the study is to assess the impact of subclinical and overt hypothyroidism among patients presenting with CAD undergoing PCI. Materials and Methods: A total of 102 patients who were referred to the Madras Medical Mission Hospital for PCI from September 2020 to March 2021 were enrolled in the study. These patients were categorized into three groups. Each group has 34 patients and was followed for one year. Group 1: Patients with normal TSH levels (TSH-0.45 -5mlU/Liter) and euthyroid at T3, T4 levels. Group 2: Patients with subclinical hypothyroidism with elevated TSH levels (TSH=5-15mlU/liter) and normal thyroid with T3, T4 levels. Group 3: Patients with a family history of overt hypothyroidism or high TSH levels(&lt;15mlU/liter) and low T3 and T4 levels [16]. Results: We applied ANOVA to find the PCI outcomes. A p-value of &lt;0.05 was accepted as significant. Age (p-0.03), recent myocardial infarction (p-0.04), diabetes mellitus (p&lt;0.001), HbA1C (p-0.012), and systolic blood pressure (p-0.04) were found to be significant. Post-PCI bleeding complications (p&lt;0.001) during one month, six months, and one-year follow-up were the main observation of the study. Conclusion: The prior history of DM and elevated HbA1c levels observed in the overt hypothyroid group indicate that DM was one of the key factors associated with overt hypothyroidism. Despite the fact that PCI was safe for patients with hypothyroidism, the risk of early post-PCI bleeding was of concern

Developing a Secure Image Steganographic System Using TPVD Adaptive LSB Matching Revisited Algorithm for Maximizing the Embedding Rate, Journal of Telecommunications and Information Technology, 2011, nr 2

Steganography is the approach for hiding any secret message in a variety of multimedia carriers like images, audio or video files. Whenever we are hiding a data, it is very important to make it invisible, so that it could be protected. A number of steganographic algorithms have been proposed based on this property of a steganographic system. This paper concentrates on integrating Tri way pixel value differencing approach and LSB matching revisited. The secret data embedded in images were images, text and audio signals so far. The proposed scheme has also come with the executable file as secret data. Also, the experimentation results show that, the important properties of a steganographic system such as imperceptibility, capacity of the carrier image and also resistance against the various steganalytic tools have also been achieved with this stego-system

Prevalence of non-communicable chronic conditions, multimorbidity and its correlates among older adults in rural Nepal : a cross-sectional study

Objectives This study's objectives were to estimate the prevalence of major non-communicable conditions and multimorbidity among older adults in rural Nepal and examine the associated socioeconomic and behavioural risk factors. Design This was a community-based cross-sectional study conducted between January and April 2018. Setting Rural municipalities of Sunsari and Morang districts in eastern Nepal. Participants 794 older Nepalese adults, 60 years and older, were recruited using a multistage cluster sampling approach. Primary outcome measure(s) Prevalence of four major non-communicable chronic conditions (osteoarthritis, cardiovascular disease, diabetes and chronic obstructive pulmonary disease (COPD) and multimorbidity. Results Almost half (48.9%: men 45.3%; women 52.4%) of the participants had at least one of four non-communicable chronic conditions, and 14.6% (men 12.5%; women 16.8%) had two or more conditions. The prevalence of individual conditions included: osteoarthritis-41.7% (men 37.5%; women 45.9%), cardiovascular disease-2.4% (men 2.8%; women 2.0%), diabetes-5.3% (men 6.0%; women 4.6%) and COPD-15.4% (men 13.3%; women 17.5%). In the adjusted model, older adults aged 70-79 years (adjusted OR (AOR): 1.62; 95% CI: 1.04 to 2.54), those from Madhesi and other ethnic groups (AOR: 1.08; 95% CI: 1.02 to 1.72), without a history of alcohol drinking (AOR: 1.53; 95% CI: 1.18 to 2.01) and those physically inactive (AOR: 5.02; 95% CI: 1.47 to 17.17) had significantly higher odds of multimorbidity. Conclusions This study found one in seven study participants had multimorbidity. The prevalence of multimorbidity and associated socioeconomic and behavioural correlates need to be addressed by integrating social programmes with health prevention and management at multiple levels. Moreover, a longitudinal study is suggested to understand the temporal relationship between lifestyle predictors and multimorbidity among older Nepalese adults

In vitro Cytotoxic and Antioxidant Activity of Leaf Extracts of Mangrove Plant, Phoenix paludosa Roxb

Purpose: To investigate the anti-proliferative and antioxidant potentials of four different solvent extracts of Phoenix paludosa Roxb leaves.Methods: Four different solvent (hexane, chloroform, ethyl acetate and methanol) leaf extracts of the plant were tested for cytotoxicity against four cancer cells, viz, MCF-7 (oestrogen positive breast cancer cell line), MDA-MB-231 (triple negative breast cancer cell line), SK-BR-3 (breast adenocarcinoma) and ACHN (renal adenocarcinoma) as well as two normal cell lines, namely, HEK-293 (embryonic kidney cells) and MCF-10A (normal mammary epithelial cells)]. 2, 2-Diphenyl-1-picrylhydrazyl (DPPH) and 2, 29-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid (ABTS) free radical scavenging assays were used to evaluate the antioxidant activity of the crude extracts.Results: The methanol extract showed the highest antioxidant activity (DPPH, half maximal inhibitory concentration (IC50) = 30.17 ± 6.21 μg/mL) and (ABTS, IC50 = 27.91 ± 3.21 μg/mL). Of the four extracts, methanol extract showed the strongest significant (p &lt; 0.05) cytotoxicity to all four cancer cell lines at 24 and 48 h of incubation followed by the chloroform extract (IC50 of methanol extract (24 and 48 h): 36.71 ± 8.72 and 33.19 ± 5.53 μg/mL (MCF-7), 159.7 ± 32.09 and 141.9 ± 26.2 μg/mL (MDA-MB-231), 103.3 ± 18.9 and 75.39 ± 19.39 μg/mL (SKBR-3), 57.21 ± 3.72 and 43.16 ± 10.25 μg/mL (MCF-10A), 37.48 ± 5.75 and 26.99 ± 1.85 (ACHN) and 66.83 ± 14.26 and 60.34 ± 10.66 μg/mL (HEK-293)). Furthermore, the methanol extract was least cytotoxic to normal cell lines.Conclusion: The results obtained indicate that the methanol leaf extract of P. paludosa exhibit potent antioxidant and cytotoxic activities and has the potential of being developed into an anti-cancer agent.Keywords: Phoenix paludosa, antiproliferative, antioxidant, cytotoxicit

Fire retardancy and morphology of nylon 6-clay nanocomposite compositions

We investigated the effect of organically modified clay on the thermal and flammability behavior of nylon 6 nanocomposites. We also used zinc borate along with layered silicate with an aim of achieving synergistic effect in flame retardancy. It is found that addition of 10 wt% clay reduced the onset decomposition (5% wt loss) temperature of nylon 6 by 20°C, while addition of 5 wt% zinc borate and 5 wt% clay in combination reduced it by around 10°C. Differential thermogravimetric analysis indicated that the peak decomposition temperature was not affected by the addition of clay, but the rate of weight loss decreased with increasing clay concentration. The horizontal burning behavior of the nanocomposite films of approximately 0.5mm thickness changed with additive concentration. The nanocomposites with 2.5 wt% and 5 wt% clay burned for almost the same duration as neat nylon 6 but dripping was reduced. The 10 wt% clay nanocomposite sample burned without any dripping and the flame spread rate was reduced by 25-30%. The burn rate of 5 wt % zinc borate/5 wt% clay nanocomposite sample was about 20% higher than that of 10 wt% clay nanocomposite sample, which could be attributed to varying char morphology. Scanning electron microscopy images of the 10wt% clay nanocomposite char surface and cross- section revealed an integrated layer of clay platelets with increasing density gradient from the center to the surface, while the 5 wt% zinc borate/5 wt% clay nanocomposite char appeared foamy and porous. The 5 wt% zinc borate and 5 wt% clay sample developed into a very good intumescent system in cone calorimeter test, swelling about 10-13mm height prior to ignition forming a cellular char structure. This was as effective as the 10wt% clay nanocomposite sample in reducing the heat release and mass loss rate of nylon 6 by around 65%. Fourier transform infrared spectroscopy of the 10 wt% clay nanocomposite char showed the presence of amides, indicating possible residual polymer within the shielded char

Envenomation by box Jelly fish

During the month of August 2016, two cases of envenomation by jellyfishes were reported from Dhanushkodi and Rameswaram. In the Dhanuskodi incident, two fishermen were stung by jellyfish tentacles attached to the gill net they were operating. Initially both these fishermen felt that the pain due to the sting would go within a few hours. However their pain started to increase with severe low back pain, excruciating muscle cramps and nausea. This kind of pain development due to jellyfish sting is characteristic of Irukandji syndrome. Enquiries with local fishermen revealed that a box jellyfish locally known as “ Naalu Moolai Sori” was responsible. In the second incidence, a fisherman working in a trawler was stung when he handled the box jellyfish in the catch

Emerging fishery for stargazers

Fishes commonly known as stargazers, of thefamily Uranoscopidae, is emerging as a lucrativefishery along the Pamban coast of Tamil Nadu. Thefish is generally characterized by large head, dorsolaterally directed eyes placed on the large flattenedhead, dark brownish body and head with or withoutirregular whitish blotches on the back. The fisheswere landed at Pamban Light House landing centreby fibre boats having an overall length (OAL) of 8m, fitted with a 60 hp engine

Impact of Splenic Artery Embolization on the Success Rate of Nonoperative Management for Blunt Splenic Injury

Introduction Nonoperative management (NOM) has become the treatment of choice for hemodynamically stable patients with blunt splenic injury. Results of outcome after NOM are predominantly based on large-volume studies from level 1 trauma centers in the United States. This study was designed to assess the results of NOM in a relatively low-volume Dutch level 1 trauma center. Methods An analysis of a prospective trauma registry was performed for a 6-year period before (period 1) and after the introduction and implementation of splenic artery embolization (SAE) (period 2). Primary outcome was the failure rate of initial treatment. Results A total of 151 patients were reviewed. An increased use of SAE and a reduction of splenic operations during the second period was observed. Compared with period 1, the failure rate after observation in period 2 decreased from 25% to 10%. The failure rate after SAE in period 2 was 18%. The splenic salvage rate (SSR) after observation increased from 79% in the first period to 100% in the second period. During the second period, all patients with failure after observation were successfully treated with SAE. The SSR after SAE in periods 1 and 2 was respectively 100% and 86%. Conclusions SAE of patients with blunt splenic injuries is associated with a reduction in splenic operations. The failure and splenic salvage rates in this current study were comparable with the results from large-volume studies of level 1 trauma centers. Nonoperative management also is feasible in a relatively low-volume level 1 trauma center outside the United State