Primary interlocking nailing for open fractures of tibial shaft: a clinical study

Background: The excellent method for treating fractures of the tibial shaft was the closed intramedullary nailing technique. But because of limited references related to the results, incidence of infection, non-union of open injury. Hence, it was decided to analyse open tibial fractures treatment by primary interlocking nailing.Methods: 50 Patients with open fractures of the tibial shaft which were treated with primary interlocking nail were studied in the period of 14 months.Results: In present study 18 (36%) type I, 22 (44%) type II and 10 (20%) type IIIA Gustilo open fractures were treated. The average duration of time between injury and nailing was 3.5 hours (range was 1.5 hours to 4 hours). After reaming, 40 (80%) fractures were fixed, without reaming, 10 (20%) of fractures were fixed. The average time to union was 27 weeks for type I fractures, 30 weeks for type II fractures and 33 weeks for type IIIA fractures. There was 1 non-union. There were 4 deep infections.Conclusions: The best mode of therapy was primary interlocking intramedullary nailing for open fractures

Cost-effectiveness of intensified interventions to control healthcare-associated MRSA infections – A systematic literature review

Methicillin Resistant Staphylococcus aureus healthcare-associated infections (MRSA HAIs) are a major cause of morbidity in hospitalized patients. They pose great economic burden to hospitals caring for these patients. Intensified Interventions aim to control MRSA HAIs. Cost-effectiveness of Intensified Interventions is largely unclear. We performed a review of cost-effectiveness literature on Intensified Interventions , and provide a summary of study findings, the status of economic research in the area, and information that will help decision-makers at regional level and guide future research. We conducted literature search using electronic database PubMed, EBSCO, and The Cochrane Library. We limited our search to English articles published after 1999. We reviewed a total of 1,356 titles, and after applying our inclusion and exclusion criteria selected seven articles for our final review. We modified the Economic Evaluation Abstraction Form provided by CDC, and used this form to abstract data from studies. Of the seven selected articles two were cohort studies and the remaining five were modeling studies. They were done in various countries, in different study settings, and with different variations of the Intensified Intervention . Overall, six of the seven studies reported that Intensified Interventions were dominant or at least cost-effective in their study setting. This effect persisted on sensitivity testing. We identified many gaps in research in this field. The cost-effectiveness research in the field is mostly composed of modeling studies. The studies do not always clearly describe the intervention. The intervention and infection costs and the sources for these costs are not always explicit or are missing. In modeling studies, there is uncertainty associated with some key model inputs, but these inputs are not always identified. The models utilized in the modeling studies are not always tested for internal consistency or validity. Studies usually test the short term cost-effectiveness of Intensified Interventions but not the long results. Our study limitation was the inability to adjust for differences in study settings, intervention costs, disease costs, or effectiveness measures. Our study strength is the presentation of a focused literature review of Intensified Interventions in hospital settings. Through this study we provide information that will help decision makers at regional level, help guide future research, and might change clinical care and policies

A Prospective Study of Surgical Management of Chronic Neglected Tendoachilles Rupture With Teuffer Technique

Introduction: Reconstruction of degenerated tendonachil ruptures is a task. The ruptured tendons and the remaining tendon ends are irregular. A number of methods have been identified in the literature on the reconstruction of tendoachilles, but with variable results. Aims: Repair of damaged Achilles tendon in ignored cases is one of the difficult and challenging procedures for surgeon. Here, we share our experience with the use of two innovative approaches for repair of chronic rupture of Achilles tendon. Materials and methods: It is a prospective study included 23 patients of chronic neglected tendoachilles rupture were operated under spinal anaesthesia with Teuffer’s technique for a period of one year .At the final follow-up, patients’ satisfaction was assessed with Kerkhoffs’ Modified Rupp Scoring system. Results:In present studyaverage dorsiflexion was 18° (compared to 24°on the noninjured side) and average plantarflexion was 26° ( compared to 36°on the non-injured side ). Results of testing the patient’s ability to toe raise for 60 seconds, 43 patients were able to sustain, while 6 patients were able to raise the toe but could not sustain it. 3 patients could not do raise the toe at all. 4 patients complained of sensory hypoesthesia.  For Rupp scoring , 82 % patients had excellent or good results and 18% had fair or poor results. Conclusions: Results of reconstruction of chronic Achilles tendon ruptures using Teuffer technique have shown that the technique is a good and stable repair that enables early weighting and ambulation, with favourable clinical outcomes, in most cases

Determination of heavy metals in selected drug substances by inductively coupled plasma – mass spectrometry

229-231Heavy metal contents in dicyclomineHCl, ethambutol, pyrazinamide and furazolidone drugs were determined by inductively coupled plasma (ICP) - mass spectrometry (MS). The drugs were analyzed for Ti, Cr, Mn, Fe, Co, Ni, Cu, Zn, Cd, Hg, Pb metals by selecting a suitable isotope. Cr, Fe, Ti and Cu were observed to be highest in dicyclomineHCl, ethambutol, pyrazinamide and furazolidone respectively. Ni and Hg were absent in all the four drugs, while traces of Cd were present in ethambutol and pyrazinamide. Analytical results showed that ICP-MS method is useful for monitoring inorganic impurities present in such drugs

Providing Consistent State to Distributed Storage System

In cloud storage systems, users must be able to shut down the application when not in use and restart it from the last consistent state when required. BlobSeer is a data storage application, specially designed for distributed systems, that was built as an alternative solution for the existing popular open-source storage system-Hadoop Distributed File System (HDFS). In a cloud model, all the components need to stop and restart from a consistent state when the user requires it. One of the limitations of BlobSeer DFS is the possibility of data loss when the system restarts. As such, it is important to provide a consistent start and stop state to BlobSeer components when used in a Cloud environment to prevent any data loss. In this paper, we investigate the possibility of BlobSeer providing a consistent state distributed data storage system with the integration of checkpointing restart functionality. To demonstrate the availability of a consistent state, we set up a cluster with multiple machines and deploy BlobSeer entities with checkpointing functionality on various machines. We consider uncoordinated checkpoint algorithms for their associated benefits over other alternatives while integrating the functionality to various BlobSeer components such as the Version Manager (VM) and the Data Provider. The experimental results show that with the integration of the checkpointing functionality, a consistent state can be ensured for a distributed storage system even when the system restarts, preventing any possible data loss after the system has encountered various system errors and failures

Online Auction and List Price Revenue Management

We analyze a revenue management problem in which a seller facing a Poisson arrival stream of consumers operates an online multiunit auction. Consumers can get the product from an alternative list price channel. We consider two variants of this problem: In the first variant, the list price is an external channel run by another firm. In the second one, the seller manages both the auction and the list price channels. Each consumer, trying to maximize his own surplus, must decide either to buy at the posted price and get the item at no risk, or to join the auction and wait until its end, when the winners are revealed and the auction price is disclosed. Our approach consists of two parts. First, we study structural properties of the problem, and show that the equilibrium strategy for both versions of this game is of the threshold type, meaning that a consumer will join the auction only if his arrival time is above a function of his own valuation. This consumer's strategy can be computed using an iterative algorithm in a function space, provably convergent under some conditions. Unfortunately, this procedure is computationally intensive. Second, and to overcome this limitation, we formulate an asymptotic version of the problem, in which the demand rate and the initial number of units grow proportionally large. We obtain a simple closed-form expression for the equilibrium strategy in this regime, which is then used as an approximate solution to the original problem. Numerical computations show that this heuristic is very accurate. The asymptotic solution culminates in simple and precise recipes of how bidders should behave, as well as how the seller should structure the auction, and price the product in the dual-channel case.revenue management, online auction, dual channel, strategic behavior, asymptotic analysis

A Real-World Study of Safety, Immunogenicity and Efficacy of Bevacizumab in Patients With Solid Malignancies: A Phase IV, Post-Marketing Study in India

Objective: The aim of this study was to evaluate the post-marketing safety, tolerability, immunogenicity and efficacy of Bevacizumab (manufactured by Hetero Biopharma) in a broader population of patients with solid tumors. Patients And Methods: This phase IV, prospective, multi-centric clinical study was carried out in Indian patients with solid malignancies (metastatic colorectal cancer, non-squamous non-small-cell lung cancer, metastatic renal cell carcinoma) treated with Bevacizumab between April 2018 and July 2019. This study included 203 patients from 16 tertiary care oncology centers across India for safety assessment, of which a subset of 115 patients who have consented were also evaluated for efficacy and immunogenicity. This study was prospectively registered in the Clinical Trial Registry of India (CTRI), and was commenced only after receiving approval from the competent authority (Central Drugs Standard Control Organization, CDSCO). Results: Out of the 203 enrolled patients, 121 (59.6%) patients reported 338 adverse events (AEs) during this study. Of 338 reported AEs, 14 serious adverse events (SAEs) were reported by 13 patients including 6 fatal SAEs, assessed as unrelated to the study medication and 7 non-fatal SAEs, 5 assessed as related, and 3 unrelated to Bevacizumab. Most AEs reported in this study (33.9%) were general disorders and administration site conditions, followed by gastrointestinal disorders (29.1%). The most frequently reported AEs were diarrhea (11.3%), asthenia (10.3%), headache (8.9%), pain (7.4%), vomiting (7.9%), and neutropenia (5.9%). At the end of the study, 2 (1.75%) of 69 patients reported antibodies to Bevacizumab without affecting safety and efficacy. However, at the end of 12 months, no patient had reported antibodies to Bevacizumab. Complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) were reported in 18.3%, 22.6%, 9.6%, and 8.7% of patients, respectively. The overall response rate (CR + PR) was reported in 40.9% of patients at the end of the study. Disease control rate (DCR), also known as the clinical benefit rate (CBR) was reported in 50.4% of patients. Conclusions: Bevacizumab (Cizumab, Hetero Biopharma) was observed to be safe, well tolerated, lacking immunogenicity, and efficacious in the treatment of solid tumors. The findings of this phase IV study of Bevacizumab, primarily as a combination therapy regimen suggest its suitability and rationality for usage in multiple solid malignancies. Clinical Trial Registry Number: CTRI/2018/4/13371 [Registered on CTRI http://ctri.nic.in/Clinicaltrials/advsearch.php : 19/04/2018]; Trial Registered Prospectively