Randomized controlled trial comparing outcome of hybrid Ilizarov versus distal tibial metaphyseal locking plate (P) for treatment of distal tibial fractures in adults

Background: Distal tibia fractures include extra-articular fractures of the metaphysis and the more severe intra-articular tibial plafond or pilon fractures.Several treatment methods have been recommended for the treatment of these injuries, with a recent emphasis on minimally invasive techniques and Ilizarov technique also. Several studies regarding distal tibial fracture treatment are available. Few of them are only randomized controlled trial. So, we conducted this research comparing distal tibial plating (P) versus hybrid Ilizarov (HI) for treatment of distal tibial fractures.Methods: The randomized controlled trial was conducted in B.P. Koirala Institute of Health Sciences, a tertiary care hospital in Eastern Nepal, over a period of fifteen months from June 2015 to August 2016. Patient in group A underwent HI fixation, and group B underwent P.Results: Gender ratio for male: female was 2.63 in HI, 1.35 in P group. Mean age was 47.03±15.93 and 42.1±12.788 for HI and P respectively. Most fractures in both group belonged to AO A3 type. Most surgeries were done at interval of 1 day to 1 week. Mean hospital stay was 6.43±4.545 and 4.93±4.676 for HI and P respectively. Mean Lower extremity functional score (LEFS) was 66.55 in HI and 67.15 in P group. Mean Percentage of maximal function (LEFS/80 *100) was 83.56. Three cases among 40 cases in P had infection but no infection in HI group was seen at the end of 12th week follow up.Conclusions: Our study showed that there is no significant difference in terms of LEFS criteria, union, fracture alignment, ROM (knee, ankle), infection and other outcome measures between HI fixation and P in the treatment of distal tibia fracture in adults

Effect of gender preference on fertility: cross-sectional study among women of Tharu community from rural area of eastern region of Nepal

BACKGROUND: Son preference is predominant in developing countries especially South Asian countries and its effect is most visible when the fertility is on transition. Nepal is a country in South Asia where the fertility has declined and son is valued highly. This study examines the parent’s gender preference for children and its effect on fertility and reproductive behaviors. METHODS: Study was conducted in Sonapur village development committee of Sunsari district among women of Tharu community of reproductive age (15–49) currently in union and having at least one child. Data was collected by house to house survey. Data was analyzed with IBM SPSS 20 version. Multinomial and binary logistic regression were used to analyze the relationship among variables. RESULTS: Three hundred women of reproductive age were included in the study. Current average age of the respondents was 31.97 years and mean age at marriage was 18.87 (SD +/-2.615). Child Sex ratio (male: female) of the respondents who didn’t want any more children was 1.41. The birth spacing following male baby was 3.09 years whereas the average birth spacing following female baby was 2.71 years. Age of the respondents and education status of the respondents were also significantly associated with contraceptive practice. Presence of only female children in family significantly increased the desire of other children (AOR = 10.153, 95% CI = 2.357-43.732). CONCLUSION: This study finds that the gender preference affects the fertility and reproductive behavior of the respondents and it is necessary to reduce son preference for the health and well being of children and women

Randomized controlled trial comparing outcome of hybrid Ilizarov versus distal tibial metaphyseal locking plate (P) for treatment of distal tibial fractures in adults

Background: Distal tibia fractures include extra-articular fractures of the metaphysis and the more severe intra-articular tibial plafond or pilon fractures.Several treatment methods have been recommended for the treatment of these injuries, with a recent emphasis on minimally invasive techniques and Ilizarov technique also. Several studies regarding distal tibial fracture treatment are available. Few of them are only randomized controlled trial. So, we conducted this research comparing distal tibial plating (P) versus hybrid Ilizarov (HI) for treatment of distal tibial fractures.Methods: The randomized controlled trial was conducted in B.P. Koirala Institute of Health Sciences, a tertiary care hospital in Eastern Nepal, over a period of fifteen months from June 2015 to August 2016. Patient in group A underwent HI fixation, and group B underwent P.Results: Gender ratio for male: female was 2.63 in HI, 1.35 in P group. Mean age was 47.03±15.93 and 42.1±12.788 for HI and P respectively. Most fractures in both group belonged to AO A3 type. Most surgeries were done at interval of 1 day to 1 week. Mean hospital stay was 6.43±4.545 and 4.93±4.676 for HI and P respectively. Mean Lower extremity functional score (LEFS) was 66.55 in HI and 67.15 in P group. Mean Percentage of maximal function (LEFS/80 *100) was 83.56. Three cases among 40 cases in P had infection but no infection in HI group was seen at the end of 12th week follow up.Conclusions: Our study showed that there is no significant difference in terms of LEFS criteria, union, fracture alignment, ROM (knee, ankle), infection and other outcome measures between HI fixation and P in the treatment of distal tibia fracture in adults

Squat and Smile Assessment in Predicting Healing of Lower Limb Fractures Fixed with a SIGN Nail

BACKGROUND: Irrespective of the treatment method, union is the ultimate goal of any fracture treatment. However, nowadays, rather than the physician-based clinico-radiological methods, the patient-reported outcome measurements assessing their quality of life and function are gaining much popularity. This is specifically true in the part of the world where the patient needs almost complete degree of hip/knee flexion – for social, cultural, religious or occupational reason(s). The ability to squat can assess the mobility and stability of joints and thus the quality of squatting is a proxy reflection of the functional outcome after fixation of lower limb fracture. Thus, we studied to determine the inter-observer and intra-observer reliability of Radiographic Union Score for Tibia (RUST) and Squat and Smile (S & S) test in clinical photograph. We further calculated the sensitivity and specificity of S & S test in predicting healing of lower limb fracture fixed by intramedullary interlocking nail considering RUST as the gold standard. METHODS: This was a retrospective study of prospectively collected data of solid Surgical Implant Generation Network (SIGN) intramedullary interlocking nailing from a single, university-based, high volume tertiary center where 56 consecutive adults with either tibial or femoral shaft fractures fixed with a SIGN nail within one year and not requiring any surgery till minimum of eighteen-month follow-up were included. Cases without either Anterior-Posterior (AP) view and/or Lateral (Lat.) view follow-up x-ray(s) or proper S & S clinical photograph (at least 1.5-year post fixation) were excluded. The x-rays (RUST criteria) and clinical photograph (S & S grading) were scored by two independent and blinded observers each and repeated after 1 month. RESULTS: The overall intra-observer reliability was from 0.773 to 0.825 and inter-observer reliability from 0.635 to 0.757 for RUST scoring which was from 0.687 to 0.785 and from 0.301 to 0.650 respectively for S & S scoring. The sensitivity and specificity of S & S in predicting fracture healing were up to 82.22% and 63.64% respectively. CONCLUSION: The S & S test is reliable to predict the healing of lower limb fracture fixed with an intramedullary nail. The test is more useful to determine healed fractures than to determine non-healed ones. (sensitivity being higher than specificity

Multilocus microsatellite typing (MLMT) reveals genetic homogeneity of Leishmania donovani strains in the Indian subcontinent

In this population genetic study of Leishmania donovani parasites in the Indian subcontinent, 132 isolates obtained from patients in Bangladesh, India, Nepal and Sri Lanka suffering from Kala-azar (100), post-Kala-azar dermal leishmaniasis (PKDL) (25) and cutaneous leishmaniasis (CL) (2), and from 5 patients whose clinical patterns were not defined, were analysed by using 15 hyper-variable microsatellite loci. Multilocus microsatellite typing (MLMT) data were analysed by using a Bayesian model-based clustering algorithm and constructing phylogenic tree based on genetic distances. In total, 125 strains from Bangladesh, Bihar (India) and Nepal formed a very homogeneous population regardless of geographical origin, clinical manifestation, and whether they presented in vitro or in vivo susceptibility to antimonial drugs. Identical multilocus microsatellite profiles were found for 108 strains, other strains differed in only one marker. Considerably different microsatellite profiles were identified for three Indian strains most closely related to L. donovani from Kenya, and for four strains from Indian and Sri Lankan CL cases. The circulation of a single homogeneous population of L. donovani in Bihar (India), Bangladesh and Nepal is, most probably, related to the epidemic spread of visceral leishmaniasis in this area