A study of surgical management of idiopathic congenital talipes equinovarus by posteromedial soft tissue release

Background: Idiopathic congenital talipes equinovarus is a complex deformity that is difficult to correct. The treatment of club foot is controversial and continues to be one of the biggest challenges in paediatric orthopaedics. Most orthopaedicians agree that the initial treatment should be non-surgical but if it fails, advise surgical treatment in the form soft tissue release for better results. The study was done with the aim to study a short term follow up of 14 patients treated to assess the efficacy of the treatment modality.Methods: 14 patients underwent the posteromedial soft tissue release (PMSTR) at Department of Orthopaedics, S. V. S. Medical College during the period from October 2013 to September 2015. Patients were followed up regularly up to one and half year. Severity of foot deformities were graded according to Denis-Brown classification.Results: Out of 14 cases there were 10 males (71.4%) and 4 females (28.6%) for the sex ratio of 2.5:1 male to female. The youngest child was 6 months old and oldest child was 3 years old. In bilateral cases both feet were operated at an interval of 7 to 10 days. Good results were seen in 15 feet (71%), fair: in 04 feet (19%) and poor: in 02 feet (10%).Conclusions: The PMSTR method is a safe and cost-effective treatment for congenital idiopathic clubfoot and radically decreases the need for extensive corrective surgery. Non-compliance with orthotics after surgery and surgery at late age are causes for failure of technique

A case report of synchronous primary malignancy: Papillary thyroid carcinoma and non-Hodgkin’s lymphoma

Multiple primary malignancies involving papillary thyroid carcinoma and non-Hodgkin’s lymphoma (NHL) is an extremely unusual event. Here, we report the case of a 70-year-old man presented with high-grade fevers and abdominal discomfort and were found to have pancytopenia. He had generalized lymphadenopathy, hepatosplenomegaly, goiter, and tracheal shift. Biopsy of the left cervical lymph node was positive for papillary carcinoma of the thyroid. He underwent excision biopsy of axillary lymph node which was suggestive of high-grade NHL. The patient was started on chemotherapy (R-CHOP) and his fevers resolved promptly. He then underwent total thyroidectomy and the histopathology of the thyroid gland post-operative showed papillary carcinoma. The second primary malignancy is a second malignant neoplasm occurring in a patient with known cancer. This case highlights the unusual synchronous occurrence of the papillary carcinoma of thyroid and NHL and the diagnostic challenges involved in such cases

Increasing Proton Exchange Membrane Fuel Cell Catalyst Effectiveness Through Sputter Deposition

Sputter deposition has been investigated as a tool for manufacturing proton-exchange membrane fuel cell (PEMFC) electrodes with improved performance and catalyst utilization vs. ink-based electrodes. Sputter-depositing a single layer of Pt on the gas diffusion layer provided better performance (0.28 A/cm2 at 0.6 V) than sputtering the Pt directly onto a Nafion membrane (0.065 A/cm2 at 0.6 V) and equaled the performance of the baseline for an equivalent Pt loading. Sputter-depositing alternating layers of Pt and Nafion-carbon ink (NCI) onto the membrane did not increase the performance over the baseline as measured in amperes per centimeter squared due to the excessive thickness of the NCI (the NCI accounted for 99.9% of the electrode thickness). However, three and six layer Pt/NCI membrane electrode assemblies (MEAs) resulted in Pt activities double that of the 905 A/g at 0.6 V achieved by the ink-based baseline. Decreasing the thickness of each NCI layer increased the performance of the six-layered Pt/NCI MEA from 0.132 to 0.170 A/cm2 at 0.6 V, providing an activity of 2650 A/g at 0.6 V. It is likely that by further decreasing the ratio of NCI to Pt in these electrodes, Pt activity, and PEMFC electrode performance can be increase

Using Sputter Deposition to Increase CO Tolerance in a Proton-Exchange Membrane Fuel Cell

Placing a layer of Ru atop a Pt anode increases the carbon monoxide tolerance of proton-exchange membrane fuel cells when oxygen is added to the fuel stream. Sputter-deposited Ru filter anodes composed of a single Ru layer and three Ru layers separated by Nafion-carbon ink, respectively, were compared to Pt, Pt:Ru alloy, and an ink-based Ru filter anodes. The amount of Pt in each anode was 0.15 mg/cm2 and the amount of Ru in each Ru-containing anode was 0.080 mg/cm2. For an anode feed consisting of hydrogen, 200 ppm CO, and 2% O2 (in the form of an air bleed), all Ru filter anodes outperformed the Pt:Ru alloy. The performance of the Pt + single-layer sputtered Ru filter was double that of the Pt:Ru alloy (0.205 vs. 0.103 A/cm2 at 0.6 V). The performance was also significantly greater than that of the ink-based Ru filter (0.149 A/cm2 at 0.6 V). Within the filter region of the anode, it is likely that the decreased hydrogen kinetics of the Ru (compared to Pt) allow for more of the OHads formed from oxygen in the fuel stream to oxidize adsorbed CO to CO2

SYNTHESIS OF (E)-N'-(5-bromo-SYNTHESIS OF (E)-N'-(5-bromo-2-hydroxybenzylidene)nicotinohydrazide) AND ITS Pt(II), Zn(II), Mn(II), Ni(II) AND Mo(V) COMPLEXES AS POTENTIAL ANTI-TUBERCULAR AGENT AGENT

The cold condensation reaction of nicotinic acid hydrazide and 5-bromo-2-hydoxylbenzaldehyde to form a tridentate Schiff base hydrazone ligand {H2L3 ) was studied. The prepared ligand was characterized using CHN analyzer, ESI mass spectrometry, IR, 1H NMR, 13C NMR and 2D NMR such as COSY and HSQC. Thereafter, five novel metal complexes [Pt(Il), Zn(ll), Mn{ll), Ni(JJ) and Mo(V)] of the hydrazone ligand were synthesized and characterized based on conductivity measurements, CHN analysis, AAS, magnetic measurement, UV/ Vis, IR, ESR and TGAIDTA study. The proposed structures of the metal complexes were further supported with the use of powder X-ray analysis. Antitubercular activity study of the compounds was evaluated against Mycobac/erium Juberculosis H37Rv by using microdiluted method. The study revealed that H2L3 exhibited promising anti-tubercular activity with MlC value of 0.82 j.igfmL. Also, metal complexes {(Pt(H2L3)Cl]- 0.88 IJg/mL, [Mn{H2L3)(CH3C00)2]- 0.78 JJ.g/mL, [Zn(H2e)(CH3C00)2H20]- 0.62 J.Lg/mL and [Ni{H2L3)(CI)2]H20- 1.19 J.Lg/mL) exhibited significant inhibition as compared to the standard drug (isoniazid- 0.91 j.ig/mL). Complex 2 and 3 with coordinated acetates showed two folds inhibition than standard isoniazid drug. However, complex 5 with coordinated chlorine atom displayed lower inhibition when compared to isoniazid

Efficacy of the 1-year (13-cycle) segesterone acetate and ethinylestradiol contraceptive vaginal system : results of two multicentre, open-label, single-arm, phase 3 trials

A ring-shaped, contraceptive vaginal system designed to last 1 year (13 cycles) delivers an average of 0.15 mg segesterone acetate and 0.013 mg ethinylestradiol per day. We evaluated the efficacy of this contraceptive vaginal system and return to menses or pregnancy after use. In two identically designed, multicentre, open-label, single-arm, phase 3 trials (one at 15 US academic and community sites and one at 12 US and international academic and community sites), participants followed a 21-days-in, 7-days-out segesterone acetate and ethinylestradiol contraceptive vaginal system schedule for up to 13 cycles. Participants were healthy, sexually active, non-pregnant, non-sterilised women aged 18-40 years. Women were cautioned that any removals during the 21 days of cyclic use should not exceed 2 h, and used daily paper diaries to record vaginal system use. Consistent with regulatory requirements for contraceptives, we calculated the Pearl Index for women aged 35 years and younger, excluding adjunctive contraception cycles, as the primary efficacy outcome measure. We also did intention-to-treat Kaplan-Meier life table analyses and followed up women who did not use hormonal contraceptives or desired pregnancy after study completion for 6 months for return to menses or pregnancy. The trials are registered with ClinicalTrials.gov, numbers NCT00455156 and NCT00263341. Between Dec 19, 2006, and Oct 9, 2009, at the 15 US sites, and between Nov 1, 2006, and July 2, 2009, at the 12 US and international sites we enrolled 2278 women. Our overall efficacy analysis included 2265 participants (1130 in the US study and 1135 in the international study) and 1303 (57.5%) participants completed up to 13 cycles. The Pearl Index for the primary efficacy group was 2.98 (95% CI 2.13-4.06) per 100 woman-years, and was well within the range indicative of efficacy for a contraceptive under a woman's control. The Kaplan-Meier analysis revealed the contraceptive vaginal system was 97.5% effective, which provided further evidence of efficacy. Pregnancy occurrence was similar across cycles. All 290 follow-up participants reported return to menses or became pregnant (24 [63%] of 38 women who desired pregnancy) within 6 months. Interpretation The segesterone acetate and ethinylestradiol contraceptive vaginal system is an effective contraceptive for 13 consecutive cycles of use. This new product adds to the contraceptive method mix and the 1-year duration of use means that women do not need to return to the clinic or pharmacy for refills every few months78e1054e1064We thank The Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (NICHD), the US Agency for International Development (USAID), and WHO for funding the phase 3 studies. We also acknowledge all participating study investigators (appendix p 1) and coordinators at the 27 clinical sites for conduct of the two phase 3 clinical trials and the over 2200 women participants from eight countries. We further acknowledge the medical writing assistance of Kathleen Ohleth (Precise Publications; Bedminster. NJ, USA) supported by TherapeuticsMD (Boca Raton, FL, USA). The NICHD (contract no HHSN27500403372) funded and conducted the US study and USAID (grant no GPO-A-00-04-00019-00) funded the international study, which was conducted by the Population Council. WHO Department of Reproductive Health and Research funded two international study sites. Medical writing support for manuscript submission and resubmission was supported by TherapeuticsMD. The authors acknowledge the major contribution of Daniel R Mishell Jr (deceased), from the Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine (Los Angeles, CA, USA) who invented the concept of the vaginal system to deliver contraceptive steroids, did many of the clinical studies for the segesterone acetate and ethinylestradiol contraceptive vaginal system, and was a principle investigator for the 300 B phase 3 study analysed in this Article while a member of the International Committee for Contraceptive Research (ICCR) of the Population Council. The authors also gratefully acknowledge the contribution of Horacio B Croxatto, from the University of Chile (Santiago, Chile), who established the clinical centre in Chile, participated in all pivotal clinical studies for this ring, and provided guidance for the full development of this new contraceptive while a member of the ICC