Study of the post operative outcome in orthopeadic management in cases of high HBA1c diabetic patients-a case series

Elderly diabetic patients are at risk of poor fracture healing in post-traumatic fracture seven due to trivial low energy falls and chronic pathological bone involvement. Glycated haemoglobins are haemoglobins with an attached sugar moiety. HbA1c is the predominant fraction of HbA1 and gives an estimate of the blood sugar levels of an individual over the last three months. Here we present a case series of 3 elderly patients who came to us with post traumatic fractures or chronic bone pathologies and very high HBA1C values (>10%) who required operative orthopaedics management. The injuries were adequately managed with splintage and operative procedures after proper control of the patients’ blood sugars levels. Postoperatively mobilization was challenging. Orthopaedic chronic bone pathologies and post traumatic limb fractures with uncontrolled sugar and very high HBa1c are very difficult to treat. Postoperatively patients are at a very high risk of infection, poor suture healing, risk of repeat fracture, osteoporosis, etc which often results into functional outcome being hampered. Proper counselling by operating surgeon, physiotherapy and postoperative rehabilitation with the help of relatives and assisting devices with strict preoperative and post operative sugar control provides good outcome. In cases of trauma in old age, one should always thoroughly examine and screen for comorbidities such as hypertension and diabetes using reliable markers such as HBa1c levels. So that early appropriate treatment and mobilization can be done with good functional outcome

Case series of orthopaedic complications associated with endocrine disorders presented at tertiary care center and review of literature

Endocrine glands affecting skeletal system are parathyroid glands, adrenal glands, pituitary gland, thyroid and gonads. If any abnormality occurs in these glands, they cause structural and functional impairment of the skeletal system. Early diagnosis and treatment of these endocrine problems and ruling out musculoskeletal involvement helps to maintain skeletal integrity and prevent osteoporotic fractures and chronic bone pathologies. Here we present a case series of 4 patients who came to us with chronic bone pathologies or post-traumatic fractures associated with endocrine abnormalities­; such as parathyroid adenoma (hyperparathyroidism), Cushing’s syndrome and thyroid adenocarcinoma. One patient with osteoporotic and pathological fracture was managed operatively and sent for management of endocrine pathology and other three patients after evaluating cause for the bone pathology were referred for primary management of endocrine disease. Osteoclasts and osteoblasts of the bone are affected by the endocrine hormones, such as parathyroid hormone, thyroid, glucocorticoids and gonadotropins. Any abnormality in these hormones leads to alteration of bone mineral density. Hyperthyroidism, glucocorticoid excess, hyperparathyroidism, hypogonadism, and acromegaly decrease bone mineral density and aggravate the osteoporotic tendencies and leading to orthopaedic complications. As an orthopaedic practitioner we should be well aware of endocrine disorders affecting bones. Early diagnosis and treatment of these endocrine problems in older patients helps to maintain their skeletal integrity, prevent osteoporotic fracture and orthopaedic complications

A facile four component one-pot synthesis of polyhydroquinoline derivatives catalyzed by ionic liquid via modified Hantzsch reaction

587-592An efficient and newer Hantzsch reaction for the synthesis of polyhydroquinoline derivatives have been reported via four-component condensation of aldehydes, cyclic 1,3-diketones, -keto esters, NH4OAc and catalytic amount of ionic liquid 1-Vinyl-3-Ethyl imidazolium  iodide [VEim] I. This methodology is operationally simple, economical,rapid and high yielding