A controlled diaphyseal expansion osteotomy for the implantation of a wagner cone prosthesis in a stenotic femoral canal encountered in a polio limb: a case report of the technique

Dysplastic hips pose a significant technical challenge to arthroplasty surgeons. Such deformed hips might be encountered either in congenital and developmental conditions or as sequel of neuromuscular disorders (like poliomyelitis), following infections, or after childhood surgical procedures of the hip. The scientific literature, focussing on total hip arthroplasty (THA), for coxarthrosis in patients with residual poliomyelitis, is relatively rare. Several anatomical distortions seen in dysplastic femurs are described, one of which includes an undersized diaphysis with a stenotic medullary canal. We present a case of a 28 years old male with residual poliomyelitis who underwent a cementless THA for a non united transcervical neck of femur fracture. The patient had an extremely narrow medullary canal which posed a formidable difficulty in the procedure. This was overcome by a novel diaphyseal expansion osteotomy, which enabled the implantation of Wagner Cone prosthesis. This technique, which has hitherto not been described in the literature, can significantly facilitate the implantation of an appropriately sized stem in an undersized femur while at the same time ensuring a good long-term result

Epidemiology of fractures in indoor patients at a tertiary care centre in India: a study of 3000 cases

Background: Implementing appropriate fracture control measures and treatment protocols is crucial to maximizing health and development gains. This requires an in depth understanding of age-specific, sex-specific and cause-specific injury patterns at the national and subnational levels. No such study on fracture epidemiology has been undertaken in the Indian population.Methods: Study was conducted in a tertiary care centre (KEM hospital, Mumbai) which is one of the highest volume trauma centres in the country. Data of 3000 patients was obtained from the medical records department for the year 2016-2019. Patients were segregated with respect to their genders and into three age groups. Etiology of fracture was noted, and fractures classified according to the anatomical area. Whether the patient received conservative or operative management was also recorded.Results: 43.83% of the fractures occurred in 18-50 years age group. 41.33% in the above 50 group and only 14.73% in the below 18 age group. Overall male to female ratio was 1.4: 1. Vehicular accident was the most common mode of injury (47.07%) followed by fall from height (21.03%). Proximal femur fractures were the most common accounting for 19.57% of all fractures followed by forearm (10.53%), tibia diaphysis (8.10%). Talus was the least common. 81.07% cases were managed operatively and 18.93% conserved.Conclusions: Our study highlights that Indian epidemiology is unique from our Western counterparts. Population affected is much younger, old age males are affected more than females. Lower limb fractures are more prevalent and road traffic accidents are responsible for almost half the fractures

Assessment patient satisfaction after total knee replacement in Indian population

Background: We aim to assess the satisfaction of patients after total Knee replacement in Indian population. Tоtаl knee Аrthrорlаsty is most commonly performed for osteoarthritis, and also for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. Knee reрlасement surgeries helрs tо restоre nоrmаl meсhаniсs during level wаlking аs well аs mоre demanding аnd соmрlex асtivities suсh аs stаir negоtiаtiоn. Раtient sаtisfасtiоn rаtes fоr the рrосedure hаve been reроrted between 81-97%. However, this leаves а signifiсаnt роrtiоn оf the TKR рорulаtiоn аs dissаtisfied with the оutсоmes оf the reрlасed knee. Methods: Patients were assessed at opd visit or with telephonic conversation and scores are calculated and mentioned in excel sheet. Post surgery satisfaction (PSS) score is the score created to measure the satisfaction after total hip replacement. This score contains different questionnaires. These questions include inquiry about relief of pain, ability to do daily routine activities, requirement of walking aids etc. Score contains total 7 questions. Results: Out of 55 patients we found through this study that about 92.7% were classified as satisfied while 7.3% patients were dissatisfied. Satisfaction rate is more as compared to dissatisfaction rate. Conclusions: In present study we have tried to eliminate other factors responsible for dissatisfaction such as hospital ward cleanliness, hospital administration, patient and hospital staff communication. we recommend total knee replacement surgery for end stage arthritis and it is more beneficial to the patients in terms of improvement in post-operative pain and function

Assessment patient satisfaction after total hip replacement in Indian population

Background: We aim to assess the satisfaction of patients after total hip replacement in Indian population. Nоwаdаys tоtаl hiр аrthrорlаsty is the finаl treаtment орtiоn рrоvided tо раtients with unsаlvаgeаble, severely аrthritiс, раinful аnd defоrmed hiрs. Раtient sаtisfасtiоn hаs been meаsured in multiрle оrthораediс рrосedures, inсluding tоtаl hiр аrthrорlаsty. THА is а соmmоn surgiсаl рrосedure thаt imрrоves the lives оf раtients with end-stаge аrthritis by deсreаsing раin, аnd imрrоving mоtоr function and mоbility аs measured by vаlidаted heаlth-relаted оutсоme tооls. Methods: Patients were assessed at OPD visit or with telephonic conversation scores are calculated and mentioned in excel sheet. Post-surgery satisfaction score is the score created to measure the satisfaction after total hip replacement. This score contains different questionnaires. These questions include inquiry about relieve of pain, ability to do daily routine activities, requirement of walking aids etc. Score contains total 7 questions with answers. Results: Out of 95 patients we found through this study that about 92.63% of patients are satisfied after total hip replacement. 7.37% of patients are dissatisfied. Satisfaction rate is more as compared to dissatisfaction rate. Conclusions: In present study we have tried to eliminate other factors responsible for dissatisfaction such as hospital ward cleanliness, hospital administration, patient and hospital staff communication. We recommend total hip replacement surgery for end stage arthritis and is more beneficial to the patients in terms of improvement in post-operative pain and function

Radiological and functional outcome of conservatively managed middle one third clavicle fractures

Background: We aim to assess radiological and functional outcome of conservatively managed middle one third clavicle fractures in Indian population. Clavicle fractures represent 2% to 10% of all fractures. In middle third clavicle fractures, conservative management is the commonest approach. In uncomplicated non displaced midshaft fractures, patients treated non operatively with these conservative measures have fewer complications and a timely recovery as those treated operatively. Conservative management is a simpler yet effective mode of management in middle one third clavicle fractures. Methods: Patients managed conservatively for clavicle fractures were assessed on OPD basis with follow up chest X-ray with bilateral shoulder AP view for radiological signs of union and assessing percent shortening and two questionnaires. Constant shoulder score which assess pain, degree of function, range of motion and muscular force and, simple shoulder test, self administered questionnaire defining one or more affirmative answers to find the satisfaction after treatment modality which were tabulated in Microsoft excel sheets. Results: Out of the 55 patients enrolled in the study 52 showed signs of union at 6 months follow up with mean fracture union time of 13.9 weeks. At 6 months follow up Mean Constant Shoulder score was 87.1 with excellent outcome in 67.67 percent patients and using Simple Shoulder Test satisfaction rate was found to be 78.18 percent. Conclusions: Solid evidence in favour of non-operative treatment for fractures with remaining contact of the bone fragments. Non-surgical management of middle third clavicle fractures yield excellent results. Clear indications for conservative treatment versus surgical fixation of displaced midshaft fractures have not finally been established yet. We recommend conservative management for uncomplicated middle one third clavicle fractures

A prospective randomized trial of trans cervical Foley’s with extra amniotic saline infusion versus intra cervical prostaglandin E2 gel for induction of labour setting

Background: This study evaluated the effectiveness of Extra-amniotic saline infusion (EASI) in comparison with that of intracervical Prostaglandin E2 (PGE2) gel for cervical ripening and induction of labour.Methods: The study conducted in SDM College of Medical College Dharwad, Department of OBG, from December 2012 to November 2013. Consecutive patients with unfavorable cervices requiring pre-induction cervical ripening and induction of labour for various indications were asked to participate in this study. 50 patients (Group A) underwent extra amniotic saline infusion and 50 patients (Group B) underwent PGE2 gel application. Post induction augmentation if required was administered. Labour profile outcomes were compared between the groups.Results: Results were comparable in terms of maternal age, indication for induction in majority of cases, pre-induction Bishop Score, mode of delivery, complications and side effects, neonatal complications, and Apgar Score. The mean post induction Bishop Score was higher in EASI group by an average of 9. The mean duration of augmentation was more in PGE2 group by an average of 2 hrs. The induction delivery interval (IDI) was prolonged by an average of 3.5 hours in PGE2 group.Conclusions: For pre-induction cervical ripening the extra amniotic saline infusion is valid alternative for the PGE2 gel. Both the modes of induction were equally safe and effective in terms of mode of delivery and Apgar Score. EASI, however, had rapid cervical ripening and shorter induction delivery interval

Atomic data from the IRON Project. I. Electron-impact scattering of Fe17+ using <I>R</I>-matrix theory with intermediate coupling

We present results for electron-impact excitation of F-like Fe calculated using R-matrix theory where an intermediate-coupling frame transformation (ICFT) is used to obtain level-resolved collision strengths. Two such calculations are performed, the first expands the target using 2s2 2p5, 2s 2p6, 2s2 2p4 3l, 2s 2p5 3l, and 2p6 3l configurations while the second calculation includes the 2s2 2p4 4l, 2s 2p5 4l, and 2p6 4l configurations as well. The effect of the additional structure in the latter calculation on the n=3 resonances is explored and compared with previous calculations. We find strong resonant enhancement of the effective collision strengths to the 2s2 2p4 3s levels. A comparison with a Chandra X-ray observation of Capella shows that the n=4 R-matrix calculation leads to good agreement with observation</p

Les Houches 2015: Physics at TeV colliders - new physics working group report

We present the activities of the 'New Physics' working group for the 'Physics at TeV Colliders' workshop (Les Houches, France, 1-19 June, 2015). Our report includes new physics studies connected with the Higgs boson and its properties, direct search strategies, reinterpretation of the LHC results in the building of viable models and new computational tool developments. Important signatures for searches for natural new physics at the LHC and new assessments of the interplay between direct dark matter searches and the LHC are also considered.Comment: Proceedings of the New Physics Working Group of the 2015 Les Houches Workshop, Physics at TeV Colliders, Les Houches 1-19 June 2015. 197 page

The challenge of admitting the very elderly to intensive care

The aging of the population has increased the demand for healthcare resources. The number of patients aged 80 years and older admitted to the intensive care unit (ICU) increased during the past decade, as has the intensity of care for such patients. Yet, many physicians remain reluctant to admit the oldest, arguing a "squandering" of societal resources, that ICU care could be deleterious, or that ICU care may not actually be what the patient or family wants in this instance. Other ICU physicians are strong advocates for admission of a selected elderly population. These discrepant opinions may partly be explained by the current lack of validated criteria to select accurately the patients (of any age) who will benefit most from ICU hospitalization. This review describes the epidemiology of the elderly aged 80 years and older admitted in the ICU, their long-term outcomes, and to discuss some of the solutions to cope with the burden of an aging population receiving acute care hospitalization

The effectiveness and efficiency of diabetes screening in Ontario, Canada: a population-based cohort study

<p>Abstract</p> <p>Background</p> <p>Little is known about the efficiency and effectiveness of the current level of diabetes screening activity in Ontario where there is universal access to health services. Our study aims were to: (i) determine how often Ontarians are screened for diabetes; (ii) estimate screening efficiency based on the number needed to screen (NNS) to diagnosis one diabetes case; (iii) examine the population effectiveness of screening as estimated by the number of undiagnosed diabetes cases.</p> <p>Methods</p> <p>Ontario respondents of the Canadian Community Health Survey who agreed to have their responses linked to health care data (n = 37,400) provided the cohort. The five-year probabilities of glucose testing and diabetes diagnoses were estimated using a Cox Proportional Hazards Model. We defined NNS as the ratio of diabetes tests to number of diabetes diagnoses over the study period. We estimated the number of undiagnosed diabetes by dividing the number not tested at the end of study period by the NNS.</p> <p>Results</p> <p>80% of women and 66% of men had a blood glucose test within 5 years. The efficiency of screening was estimated by a NNS of 14 among men and 22 among women. 127,100 cases of undiagnosed diabetes were estimated, representing 1.4% of the Ontario adult population. Increasing age, hypertension, immigrant and non-white ethnicity, and number of general practitioner visits were associated with an increased likelihood of having a glucose test (LR χ2 p < 0.001). Low income men were less likely to be tested.</p> <p>Conclusions</p> <p>Diabetes screening was high in this population-based cohort of Ontarians. Screening efficiency varied considerably in the population. Undiagnosed diabetes continues to be prevalent and remains concentrated in the highest risk groups for diabetes, especially among men.</p