Political Leadership and the Indian Armed Forces in Diplomacy and War: by Brigadier (Dr.) M. P. Singh

Publisher: Greenfield Publishers (2019) Location: Dehradun, India. ISBN: 978-93-81089-39-

Gradual distraction for treatment of severe knee flexion contractures using the Ilizarov’s apparatus

Background: Knee flexion contractures result in a significant amount of functional disability due to reduced mobility and limb length discrepancy. Treatment options include non-surgical methods like serial casting, dynamic splinting and traction or surgical methods like osteotomies and soft tissue procedures. External fixation has emerged as a highly successful means of achieving controlled gradual correction of joint contractures with low rates of complications including recurrence. The aim of this study is to evaluate the functional outcome in terms of residual deformity and change in ambulatory status following correction using the Ilizarov’s apparatus.Methods: 12 patients with knee flexion contractures ranging from 20°-70° underwent correction using the Ilizarov’s external fixator (IEF). The use of simple mathematic formulae enabled us to calculate and estimate the rate and duration of distraction. End results were assessed at one year by the residual contracture as: Excellent: 0-5°, Good: 6-15°, Fair: 16-30° and Poor: >30°.Results: The functional assessment was graded as excellent in 7, good in 4 and fair in 1 out of 12 patients. All patients were independent ambulators and only 1 out of 12 patients required an additional orthosis for maintenance of the correction.Conclusions: The IEF is a safe and precise modality even for the most complex contractures of the knee. Accurate placement of the hinges along the center of rotation of the knee avoids undue subluxation of the tibia during correction. In order to ensure a low rate of complications, it is imperative to have a detailed pre-operative plan and all principles of fixation should be meticulously adhered to.

A comparative study of functional outcome of external fixation and volar plating in unstable distal radius fractures

Background: Distal radius fractures are amongst the most common injuries seen in the emergency department. It is imperative to restore the anatomy as much as possible in order to restore wrist function. Identifying a fracture as ‘unstable’ is critical in predicting the final outcome of treatment. The present study compares two primary modalities of treatment: external fixation and volar plating in terms of the functional outcome post-surgery.  Aim of the study was to compare the functional outcome of fixation of unstable distal radius fractures by external fixation to that of volar plating by the Disabilities of the Arm, Shoulder and Hand (DASH) scoring system and analysis of recovery of grip strength and range of motion. Settings and design: Hospital-based; randomized control trial.Methods: 80 patients presenting with unstable distal radius fractures were randomized into two groups of 40 each. One group received external fixation and the second received open reduction with volar plate fixation as the primary intervention. DASH scores were obtained and compared at specified time intervals following surgery.Results: The results of our study show a better improvement in the mean DASH scores at 3, 6 and 12 months in the volar plating group as compared to the external fixation group.Conclusions: Volar plating, with its definitive advantage of direct fracture visualization, has an overall better functional outcome with greater postoperative wrist motion and a lower incidence of complications.

Altered Bioenergetics of Blood Cell Sub-Populations in Acute Pancreatitis Patients.

Acute pancreatitis (AP) is a debilitating, sometimes fatal disease, marked by local injury and systemic inflammation. Mitochondrial dysfunction is a central feature of pancreatic damage in AP, however, its involvement in circulating blood cell subtypes is unknown. This study compared mitochondrial bioenergetics in circulating leukocytes from AP patients and healthy volunteers: 15 patients with mild to severe AP were compared to 10 healthy controls. Monocytes, lymphocytes and neutrophils were isolated using magnetic activated cell sorting and mitochondrial bioenergetics profiles of the cell populations determined using a Seahorse XF24 flux analyser. Rates of oxygen consumption (OCR) and extracellular acidification (ECAR) under conditions of electron transport chain (ETC) inhibition ("stress" test) informed respiratory and glycolytic parameters, respectively. Phorbol ester stimulation was used to trigger the oxidative burst. Basal OCR in all blood cell subtypes was similar in AP patients and controls. However, maximal respiration and spare respiratory capacity of AP patient lymphocytes were decreased, indicating impairment of functional capacity. A diminished oxidative burst occurred in neutrophils from AP patients, compared to controls, whereas this was enhanced in both monocytes and lymphocytes. The data demonstrate important early alterations of bioenergetics in blood cell sub-populations from AP patients, which imply functional alterations linked to clinical disease progression

UAVs and Counter UAVs Technologies in the World and the Indigenous Capability

At any time in history, the concepts of waging a war keep changing by the centuries. It adapts its hue to the socio-political environment and the current military capabilities prevalent in the zone of conflict. Modern wars are characterised by swift and intense conflicts unlike the long-enduring battles of the past. The battles are unlikely to be openly declared wars on another nation or entity but border on small intrusions and incursions. The present-day environment has witnessed the concept of multi-state armies fighting under one umbrella as happened in the Gulf War and Global War on Terror (GWOT) in Afghanistan. Moreover, the emerging hybrid nature of warfare beckons the use of innovative ways of fighting in conventional as well as unconventional conflicts, as we witness on the Northern borders of our country

"Effect of topical timolol on intraocular pressure in the presence of systemic indomethacin in normal subjects"

In the present study on 60 normal subjects, the effect of 0.5% timolol eye drops on intraocular tension was assessed in the presence of oral indomethacin. The subjects were categorized in four groups for comparing the results. Also the side effects of timolol maleate were noted. The following conclusions were made:- 1. In cases in whom indomethacin was given along with timolol drops, average fall in intraocular tension was almost identical with those in whom timolol alone was used. 2. The ocular hypotensive effect of timolol maleate eve drops is not attenuated by indomethacin given orally; but before we can conclude that the simultaneous administration of timolol maleate eye drops and indomethacin is entirely without risk of attenuation. We must study the effect of combined administration in patients with glaucoma

Efficacy and safety of viscosupplementation in symptomatic knee osteoarthritis: An experience from a Tertiary Care Center in Mumbai

Objective: To report on our clinical experience (safety and efficacy) of intraarticular injection of high molecular weight hyaluronic acid in symptomatic knee osteoarthritis. Methods: In this prospective, experimental pre post efficacy, non-comparative study, 39 patients with symptomatic knee osteoarthritis (OA) were treated with single intra-articular injection of high molecular weight (HMW) hyaluronic acid (Hylan G-F20). Pain visual analogue scale (VAS) and WOMAC scores were evaluated at baseline, after three and six months. The study as completed over one year. The change in VAS and WOMAC score from baseline was calculated for patients who completed all three visits. Results: The mean age of participants was 55.5 (+10.9) years; mean duration of OA was 4.8 (+3.1) years. Of the 39 patients, 12 patientshad grade 2 OA, 26 patients had grade 3 OA and one patient had grade 4 OA. Thirteen patients completed all three visits, and seven patients completed baseline and three month evaluation. The median VAS score reduced from 6.5 (+2.1) at baseline to 3.5 (+2.1) at 3 months and 4.5 (+2.2) at 6 months, P = 0.01 (vs Baseline). The median WOMAC score reduced from 52.5 (+18.5) baseline to 23 (+13.5) at 3 months and 33 (+17.5) at 6 months, P = 0.0004 (vs baseline). Study medication was well tolerated. None of the patients reported any adverse event. Conclusion: In our experience intra-articular HMW hyaluronic acid (Hylan G-F20) is a good and safe therapeutic option for patients with mild to moderate knee OA to reduce pain

Is CT scan a predictor of instability in recurrent dislocation shoulder?

Purpose: Glenoid bone defect and the defect on the posterior-superior surface of the humerus “Hill-Sachs lesion” are the commonly seen bony lesions in patients with recurrent dislocation shoulder. Computed tomography (CT) scan is considered as the best option in assessing the bony defects in the recurrent dislocation shoulder. The aim of this study was to assess the clinical and radiological co-relation in the patients with recurrent dislocation shoulder. Methods: Forty-four patients of recurrent dislocation shoulder who were evaluated between January 2015 and December 2017 at a tertiary care center, clinically and radiologically using CT scan and meeting the inclusion criteria, were included. The correlation between the clinical history of the number of dislocations and the bone loss using CT scan was evaluated. Two sided statistical tests were performed at a significance level of α = 0.05. The analysis was conducted using IBM SPSS STATISTICS (version 22.0). Results: All the patients were male with mean age of 25.95 (SD ± 4.2) years were evaluated. Twenty-four patients sustained injury in sporting activities while 20 patients sustained injury in training. There were an average of 4.68 (SD ± 3.1, range 2–15, median 3) episodes of dislocation. Forty-one patients had the glenoid bone loss while 40 had the Hill-Sachs lesions. The mean glenoid width defect was 10.80% (range 0–27%) while the mean Hill-Sachs defect was 14.27 mm (range 0–26.6 mm). The mean area of bone loss of the glenoid surface was 10.81% (range 0–22.4%). The lesions were on track in 34 patients and off track in 10 patients. Conclusions: CT scan of the shoulder joint is an effective method for assessing the amount of bone loss. The number of dislocations are correlated significantly with off-track lesions and the amount of bone loss on the glenoid and Hill-Sachs lesion. The glenoid width bone loss of more than 9.80% or Hill-Sachs defect of more than 14.80 mm are the critical defects after which the frequency of dislocations increases. Keywords: Shoulder joint, Recurrent dislocation, Hill-Sachs lesio