Outcome Analysis of Neglected Musculoskeletal Injuries

INTRODUCTION: Musculoskeletal injuries, as a non-communicable disease has become a major epidemic. Neglect of such injuries has become a major burden in our society due to the preference for native treatment. Especially in injuries involving the joints, this neglect has lead to severe disability and is affecting the productivity of our population. AIMS AND OBJECTIVES: To analyse the outcome of neglected periarticular injuries and to calculate the sample proportion of these injuries. MATERIALS AND METHODS: Out of 615 patients admitted in Rajiv Gandhi Government General Hospital in the age group of 14-60 years with injuries involving the major joints, 160 were neglected cases, 11 cases in shoulder, 13 cases in elbow, 7 cases in wrist, 96 cases in hip, 17 cases in knee, 13 cases in ankle were studied. Pre op X rays were taken, CT scan in selected cases were taken. The cases were evaluated for pre-procedure Visual Analogue Scale, Functional capacity. Patient tailored procedure was done based on findings during pre-interventional and interventional period. All patients were followed up for maximum 1 year. Protocol based physical therapy was done. Functional evaluation scoring was done exclusive for each joint. RESULTS: Sample proportion of neglected cases in our study was 26%. In 80% of the cases the neglect was due to native treatment. In rural areas 18% of the cases in our study presented untreated due to poor accessibility. The Sample proportion for neglected upper extremity cases was 19% and the sample proportion for neglected lower extremity cases was 28%. The sample proportion of shoulder, elbow, wrist, hip, knee and ankle cases were, 15%, 25%, 16%, 36%, 17%, and 16% respectively. The average outcomes were good in shoulder, elbow, hip, and knee cases and Excellent in wrist and ankle cases. CONCLUSION: The complications and outcome in all the cases depended on many factors as even in some cases with longer neglect duration excellent outcome was possible but in some cases with shorter neglect duration also fair outcome was only possible. Hence the commonly found factors that can influence the outcome of the neglected musculoskeletal injuries in pre intervention stage were: Age of patient, Type of native treatment availed, Duration of native treatment methods, Quality of native treatment methods, Associated co morbidities, Associated fractures. The factors which influence the outcome in intervention and post intervention stage were: Intraoperative findings of soft tissue distortion and loss of anatomical configuration; Type of procedure selected; Aseptic precautions taken; Patients’ will for functional betterment; Expertise of the surgeons; Regularity in visiting the hospital for physiotherapy. In our study all the patients had a common will for betterment and they cooperated in all the steps and thereby had a successful outcome at the end of follow up. Hence patients’ cooperation and perseverance is the foremost quality that defined success for them

Composition of primary cosmic rays near the knee

The size dependence of high energy muons and the size spectrum obtained in the air shower experiment suggest that the mean mass of cosmic rays remains nearly constant at approx 15 up to 5 x 1000,000 GeV and becomes one beyond. The composition model in which nuclei are removed spectrum steepens at 6.7 x 10 power GeV due to leakage from the galaxy, which explains the data which are consistent with data from other experiments

Loose shell syndrome (LSS) of cultured Penaeus monodon - microbiological and histopathological investigations

Investigations were undertaken on loose shell syndrome (LSS) of cultured Penaeus monodon during the period 2009 - 2010. The infected shrimps were collected from culture ponds of east and west Godavari districts in Andhra Pradesh, India and were subjected to microbiological and histopathological studies. Four species of Vibrio were isolated from the diseased shrimps and were identified as V. harveyi, V. alginolyticus, V. metschnikovii and V. fluvialis based on morphological characteristics and biochemical tests. Histopathological studies revealed the presence of occlusion and inclusion bodies of monodon baculovirus (MBV), hepatopancreatic parvo-like virus (HPV), and white spot syndrome virus (WSSV) in hepatopancreatic and gill tissues. All the LSS affected shrimps collected during the present study were found infected with V. harveyi and concurrent infections of other Vibrio species were observed in 40% of the samples. Prevalence of infection with WSSV, MBV and HPV was less compared to Vibrio infections. Granuloma formation was observed in the affected tissues due to bacterial invasions. Multiple viral infections in association with Vibrio sp. were also observed in 2% of LSS affected shrimp

The composition of cosmic rays near the Bend (10 to the 15th power eV) from a study of muons in air showers at sea level

The distribution of muons near shower cores was studied at sea level at Fermilab using the E594 neutrino detector to sample the muon with E testing 3 GeV. These data are compared with detailed Monte Carlo simulations to derive conclusions about the composition of cosmic rays near the bend in the all particle spectrum. Monte Carlo simulations generating extensive air showers (EAS) with primary energy in excess of 50 TeV are described. Each shower record contains details of the electron lateral distribution and the muon and hadron lateral distributions as a function of energy, at the observation level of 100g/cm. The number of detected electrons and muons in each case was determined by a Poisson fluctuation of the number incident. The resultant predicted distribution of muons, electrons, the rate events are compared to those observed. Preliminary results on the rate favor a heavy primary dominated cosmic ray spectrum in energy range 50 to 1000 TeV

Study of muons near shower cores at sea level using the E594 neutrino detector

The E594 neutrino detector has been used to study the lateral distribution of muons of energy 3 GeV near shower cores. The detector consists of a 340 ton fine grain calorimeter with 400,000 cells of flash chamber and dimensions of 3.7 m x 20 m x 3.7 m (height). The average density in the calorimeter is 1.4 gm/sq cm, and the average Z is 21. The detector was triggered by four 0.6 sq m scintillators placed immediately on the top of the calorimeter. The trigger required at least two of these four counters. The accompanying extensive air showers (EAS) was sampled by 14 scintillation counters located up to 15 m from the calorimeter. Several off line cuts have been applied to the data. Demanding five particles in at least two of the trigger detectors, a total of 20 particles in all of them together, and an arrival angle for the shower 450 deg reduced the data sample to 11053 events. Of these in 4869 cases, a computer algorithm found at least three muons in the calorimeter

Fatigue studies on stainless steel piping materials and components: Indian AHWR

As a part of component integrity test program at Bhabha Atomic Research Centre, fatigue tests on full scale pipe and pipe welds were conducted in addition to CT and TPB specimens. In this paper the outcome of this program is discussed. Specimen testing was conducted to determine the basic cyclic stress strain curve, LCF and FCGR properties. FCGR tests were conducted on CT and TPB specimens to understand the effect of different conditions: Specimen level tests result show that, for the present grade of material, the FCGR is not significantly affected by specimen type (CT and TPB), specimen thickness and notch orientation. FCGR resistance of the hot wire GTAW is superior compared to that of conventional SMAW. The effects of stress ratio are mildly significant at lower R-values for base metal but are significant for weld metal. Component tests were conducted to understand the effect of the following variables:(a)Component type and size: pipe and pipe weld, Pipe diameters 170 mm and 324 mm,(b)Pipe and pipe weld: initial notch in pipe base, and girth welded pipe, (c) Pipe welds: Conventional GTAW/SMAW and hot wire narrow gap GTAW, (d)Environment: Air and water, (e) Type of loading: Constant amplitude cyclic, vibration, Block, overload and underload. Results indicated that the fatigue life of the component is reduced under water environment compared to air environment. Fatigue life of the pipe subjected to block loading (increasing stress ratio followed by decreasing stress ratio), intermittent overloading and underloading is also decreased compared to that of constant amplitude loading. Vibration loading reduces fatigue life significantly. Crack growth in thickness direction is more compared to circumferential direction for all types of loading which is desirable for demonstration of LBB criteria. Fatigue life of the notched component has also been predicted using the Paris constants data from the specimen level tests. Fatigue crack growth and the crack shape of the growing crack have been evaluated for regular interval of loading cycles. The predictions compares well with those of experiments

Histopathological and bacteriological studies of monodon slow growth syndrome (MSGS) affected shrimps

Shrimps affected by monodon slow growth syndrome (MSGS) were sampled from culture ponds in Amalapuram and Bhimavaram areas of Andhra Pradesh during 2005-2010 and subjected to bacteriological as well as histopathological investigations. Three species of Vibrios were identified in the bacterial isolates from haemolymph viz., V. alginolyticus, V. fluvialis and V. harveyi. Histopathological studies revealed major changes in the hepatopancreas as well as gill tissue and the presence of monodon baculovirus (MBV), heptopancreatic parvo virus (HPV) and Infectious hypodermal and hepatopancreatic necrosis virus (IHHNV). Fifty percent of the MSGS affected shrimps showed single infections with MBV, 20% with HPV and 30% had dual infections of HPV and MB

Association of Climatic Factors on Population Dynamics of Leaf Roller, Diaphania pulverulentalis

The production of quality mulberry leaf and subsequent production of quality silk is hampered due to the incidence of various insect pests. The present study analyses the population dynamics of Diaphania pulverulentalis (leaf roller), a serious pest of mulberry in a sericulture seed farm. The results indicated that maximum population buildup of the pest was recorded during rainy season. High humidity coinciding with low temperature because of southwest and northeast monsoon was conducive for breeding and multiplication of the pest. Correlation studies revealed that there was a significant negative correlation between increase in temperature and pest infestation. All other weather factors recorded from the study location have a positive correlation with incidence of the pest. The regression model developed also supported the relationship between the pest population buildup and weather factors

High energy hadrons in EAS at mountain altitude

An extensive simulation has been carried out to estimate the physical interpretation of dynamical factors such as , in terms of high energy interaction features, concentrated in the present analysis on the average transverse momentum. It appears that the large enhancement observed for versus primary energy, suggesting in earliest analysis a significant rise of with energy, is only the result of the limited resolution of the detectors and remains in agreement with a wide range of models used in simulations.Comment: 13 pages, 6 PostScript figures, LaTeX Subm. to JPhys

Early detection of neovascular age-related macular degeneration : an economic evaluation based on data from the EDNA study

Funding: The project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme (grant number: 12/142/07) and will be published in full in Health Technology Assessment. The funder was not involved in the study design; in the collection, analysis and interpretation of the data; in the writing of the report; and in the decision to submit the paper for publication. The Health Services Research Unit (HSRU) and the Health Economics Research Unit (HERU) are core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate (HSRU/2021-2024, HERU/2021-2024).Peer reviewedPostprin