Study on role of fibular graft in non-union and complex fractures of long bone

Background: Road traffic injuries are the seventh most common cause of long bone fractures. Following high velocity limb trauma, the defects in the long bone are usually associated with appreciable soft-tissue losses. These open long bone injuries always require multidisciplinary managements to reconstruct the composite defects of bone and soft tissue. Aims and Objectives: The aim of the study was to find out radiological and clinical outcome, complications, and union time in complex and non-union fractures of long bone managed by fibular graft. Materials and Methods: Out of 50 cases, 40 cases were of complex fractures and ten cases were of non-union. We used Fibular strut grafts in reconstruction of bone defects and soft tissue injury. Results: Thirty (60.0%) had excellent functional outcome, 10 (20.0%) had good, 6 (12.0%) had satisfactory, and 4 (8.0%) patients had poor outcome. Main complications were non-union 2 cases and 3 cases of superficial wound infection, which subsided by wound dressing and intravenous antibiotic treatment. Conclusion: Free fibular grafting has been proven to be an ideal choice in the management of large segmental bone defects as well as in situations of biological failure of bone healing

First report on the occurrence of Avicennia marina (Forssk.) Vierh. (Acanthaceae) in the Nicobar archipelago

The 2004 Sumatra-Andaman earthquake (9.2 Mw) and tsunami that followed it resulted in uplift and subsidence across the Andaman and Nicobar archipelago. This unusual natural event severely affected the mangrove and coastal ecosystems across the Andaman and Nicobar Islands. The tsunami and land drowning of 1.1-2.85 m resulted in considerable loss of mangrove habitats in the Nicobar archipelago. Meanwhile, the land drowning also created new intertidal habitats in the earlier terrestrial zones that are now providing suitable conditions for the colonization of mangroves. During the long-term monitoring of mangrove colonization in these new inter-tidal zones, we identified the first occurrence of the Avicennia marina (Forssk.) Vierh. in the Nicobar archipelago. The distribution of A. marina and the characteristics of its colonizing sites are discussed herein

Intubating conditions following rapid sequence induction with three doses of succinylcholine

Background: The aim of this prospective, randomized, double-blind study was to compare tracheal intubating conditions and the duration of apnoea following administration of 0.4, 0.6 and 1.0 mg/kg of succinylcholine during simulated rapid sequence induction of anaesthesia. Methods: Anaesthesia was induced with fentanyl 2 μg/kg and propofol 2 mg/kg followed by application of cricoid pressure. Patients were randomly allocated to three groups according to the dose of succinylcholine administered (0.4, 0.6 or 1.0 mg/kg). Intubating conditions were assessed at 60 s after succinylcholine administration. Time to first diaphragmatic contraction (apnoea time) and time to resumption of regular spontaneous breathing were noted. Results: Excellent intubating conditions were obtained in 52.4%, 95.7% and 100% of the patients after 0.4, 0.6 and 1.0 mg/kg succinylcholine, respectively; P<0.001. Acceptable intubating conditions (excellent and good grade combined) were obtained in 66.7%, 100% and 100% of the patients after 0.4, 0.6 and 1.0 mg/ kg succinylcholine, respectively; P<0.001. Apnoea time and resumption of regular spontaneous breathing were dose-dependent. Apnoea time was 3.8±1.1 min, 4.3±0.9 min and 8.2±3.4 min in groups 0.4, 0.6 and 1.0 mg/kg, respectively; P<0.001. Time to regular spontaneous breathing was 5.3±1.2 min, 5.5±1.1 min and 8.9±3.5 min in groups 0.4, 0.6 and 1.0 mg/kg, respectively; P<0.001. Conclusion: A dose of 0.6 mg/kg succinylcholine can be used for rapid sequence induction of anaesthesia as it provides acceptable intubating conditions with a shorter apnoea time compared with a dose of 1 mg/kg

Sternomental distance and sternomental displacement as predictors of difficult laryngoscopy and intubation in adult patients

Background: Several morphometric airway measurements have been used to predict difficult laryngoscopy (DL). This study evaluated sternomental distance (SMD) and sternomental displacement (SMDD, difference between SMD measured in neutral and extended head position), as predictors of DL and difficult intubation (DI). Materials and Methods: We studied 610 adult patients scheduled to receive general anesthesia with tracheal intubation. SMD, SMDD, physical, and airway characteristics were measured. DL (Cormack-Lehane grade 3/4) and DI (assessed by Intubation Difficulty Scale) were evaluated. The optimal cut-off points for SMD and SMDD were identified by using receiver operating characteristic (ROC) analysis. Multivariate logistic regression was used to predict DL and ROC curve was used to assess accuracy on developed regression model. Results: The incidence of DL and DI was 15.4% and 8.3%, respectively. The cut-off values for SMD and SMDD were ≤14.75 cm (sensitivity 66%, specificity 60%) and ≤5.25 cm (sensitivity 70%, specificity 53%), respectively, for predicting DL. The area under the curve (AUC) with 95% confidence interval (CI) for SMD was 0.66 (0.60–0.72) and that for SMDD was 0.687 (0.63–0.74). Multivariate analysis with logistic regression identified inter-incisor distance, neck movement <80°, SMD, SMDD, short neck and history of snoring as predictors and the predictive model so obtained exhibited a higher diagnostic accuracy (AUC: 0.82; 95% CI 0.77–0.86). SMDD, but not SMD, correlated with DI. Conclusions: Both SMD and SMDD provide a rapid, simple, objective test that may help identifying patients at risk of DL. Their predictive value improves considerably when combined with the other predictors identified by logistic regression