Orthopaedic aspect of anatomy and radiology of proximal femur

Femoral pathology is common in relation to the orthopedic. There is complex anatomy of the proximal femur and hip joint. So, its knowledge regarding anatomy and radiological correlation is necessary to the well-known fact for the orthopedics for the routine day to day practice. This review article briefly illustrates important anatomical and radiological aspect of the proximal femur

A study on the onset of thermally modulated Darcy–Bénard convection

A stability analysis of linearized Rayleigh–Bénard convection in a densely packed porous layer was performed using a matrix differential operator theory. The boundary temperatures were assumed to vary periodically with time in a sinusoidal manner. The correction in the critical Darcy–Rayleigh number was computed and depicted graphically. It was shown that the phase difference between the boundary temperatures rather than the frequency of modulated temperatures decides the nature of influence of modulation on the onset of convection. Conclusions were drawn regarding the possible transitions from harmonic to subharmonic solutions. The results on the onset of thermally modulated convection in a rectangular porous enclosure were obtained using those on the modulated Darcy–Bénard convection

Weakly Nonlinear Stability Analysis of Temperature/Gravity-Modulated Stationary Rayleigh–Bénard Convection in a Rotating Porous Medium

The effect of time-periodic temperature/gravity modulation on thermal instability in a fluid-saturated rotating porous layer has been investigated by performing a weakly nonlinear stability analysis. The disturbances are expanded in terms of power series of amplitude of convection. The Ginzburg–Landau equation for the stationary mode of convection is obtained and consequently the individual effect of temperature/gravity modulation on heat transport has been investigated. Further, the effect of various parameters on heat transport has been analyzed and depicted graphically

Rasmussen’s encephalitis in an Indian child

A 5 year old boy with history of recurrent seizures and progressive weakness in left upper & lower limb. On MRI scan atrophy of right cerebral hemisphere with prominent right sided sulci & sylvian fissure. Temporal horn of right lateral ventricle appears prominent. Body and genu of corpus callosum appears hypo plastic. Electroencephalography revealed moderate voltage record showing mixed activity comprising ill-defined 8-10 Hz alpha rhythm plus 4-7Hz waves and random background delta components at 3Hz frequency. A clinical diagnosis of focal tonic-clonic epilepsy was made secondary to Rasmussen’s encephalitis, based on the features MRI scan findings of the brain

EVALUATION OF PRESCRIBING PATTERN OF FIXED DOSE COMBINATIONS OF ANTIHYPERTENSIVES AND ANTIDIABETIC AGENTS

  Objective: The objective of this research was to evaluate prescribing pattern of fixed dose combinations (FDCs) of antihypertensives and antidiabetic agents among patients of private hospitals.Methods: An observational study was carried out in the outpatient department of two hospitals. Data of patients being diagnosed with the symptoms of hypertension and diabetes were enrolled which mainly included information related to prescribe FDCs, i.e., antihypertensives and antidiabetics, respectively. Descriptive analysis of collected information was done which involved representation of demographical data, number of comorbidities, number of FDCs prescribed, and type of FDCs consequently.Results: Combination drug therapy was prescribed in maximum patients, which was enumerated as 93% among hypertensive patients and about 91% in diabetics. Average age of patients suffering more from hypertension was 64.5±18 years and that in case of diabetes sufferers was 54.5±18 years. The most frequent combination prescribed in hypertensive patients was of angiotensin receptor blocker (ARB) and calcium channel blocker (CCB) which were about 53%, and in diabetic patients, it was of biguanides and sulfonylureas about 63%. Comorbidity too was notified, and its estimation was 61% in hypertensive patients and 72% in diabetic patients, respectively.Conclusion: The study here demonstrates that the most often prescribed antihypertensive combination is of ARB and CCB, and subsequently for diabetes, the oral hypoglycemic combination is of biguanides and sulfonylureas. Most of FDCs contained medications of these two classes. Positive results were also observed in levels of blood pressure and glucose within the normal range

Presier’s disease: idiopathic avascular necrosis of scaphoid in a case presenting with wrist pain in young male

A 25-years-old male presented with complain of pain in right wrist and difficulty in gripping objects. No history of trauma to the right wrist joint. On local examination, tenderness was present in right anatomical snuff box. Tenderness was elicited by axial compression on right first metacarpal with decreased range of the motion at the right wrist compare to the left side. Routine blood investigation was within normal limits. X-ray of the right wrist joint showed minimal sclerotic in right scaphoid. On MRI right wrist joint, low intensity signal was seen involving the whole right scaphoid bone on T1 weighted, T2 weighted and STIR images with loss of normal marrow signal intensity. So according to the Herbert and Lanzetta it was stage 4 and Kalainov et al, type 1 avascular necrosis.  Diagnosis of idiopathic avascular necrosis of the right scaphoid bone was postulated based on clinical and radiological findings. Patient was treated with vascularised pedicle bone graft from the right distal radius. The patient was gradually improved clinically with subsidence of pain and improvement in the grip strength over 1 year

Unusual presentation: fracture neck femur in 18 months old child

An 18 months old child was brought to the emergency department with alleged history of trauma due to hit by two wheeler and sustained injury over right hip. Child was not able to move the right lower limb. Physical examination of child revealed contusion over right hip region and injury over perineal region. There was no active vaginal bleeding. Rest of the systemic examination was normal. Routine blood was normal. On X-ray of pelvis with both hip showed fracture of neck femur on right side without any pelvic injury. Patient was treated with hip spica cast and complete bed rest for 1 month. After 1 month of the treatment, on follow-up the patient was able to weight bear and fractured was united on X-ray

Utility of MRI in diagnosis of empty Sella syndrome in a young female with amenorrhoea and bilateral nipple discharge

Empty sella syndrome is a rare disease in which sella turcica appears empty. It can be asymptomatic or may have symptoms due to hormonal disturbances. Here we report a case of 35-years-old female who presented with amenorrhoea and bilateral nipple discharge.

Hepatocellular carcinoma in a case of hepatitis C

Hepatocellular carcinoma has incidence of 90% of all liver cancers. HCC is the second most common hepatic malignancy in children after the hepatoblastomas. Patients with hepatocellular carcinoma presents with symptoms like pruritus, splenomegaly, bleeding oesophageal varices etc. Computed Tomography of the liver can look for local spread and thorax can look for metastases. Our case was a 49-year- old hepatitis C positive female came with vague right upper quadrant abdominal discomfort with weight loss of 7 lbs in last 2 months. Mild icterus was present on examination. CT scan revealed a well-defined iso-dense lesion in the segment V of right lobe of the liver, which shows enhancement in the hepatic arterial phase and rapid washout in the portal venous phase. Laboratory investigations showed abnormal liver function test. The HCV RNA levels were 1.45×105 IU/ml by real time PCR. Histopathology examination of biopsy specimen shows characteristic morphological features of steatohepatitic variant of hepatocellular carcinoma. Then the patient was referred to the higher center for the further management

Routine versus early nasogastric decompression in gastrointestinal surgeries: a randomized controlled trial

Background: Traditionally nasogastric decompression is carried out in post operatively in patients undergoing gastrointestinal surgery. The purpose of the study is to assess the benefits of nasogastric decompression in the early postoperative period as compared to routine nasogastric decompression in patients undergoing gastrointestinal surgeries. Objectives: To assess the benefits of nasogastric decompression in the early postoperative period as compared to routine nasogastric decompression in patients undergoing gastrointestinal surgeries, to assess the complications associated with nasogastric tube insertion, and to assess the effect of early nasogastric tube removal on the patients’ postoperative morbidity and comfort level.Methods: This was a randomized control trial done in the Shree Sayajirao General Hospital, Vadodara.  According to patient flow and previous study details the estimated sample size was 300 patients. Patient allotment was 150 patients in each group. Patients admitted on odd dates will be followed for routine nasogastric decompression, and patients admitted on even dates will be followed for early nasogastric decompression. Inclusion criteria for the study include laparotomies performed by any abdominal incisions on emergency as well as elective bases. Variables to be studied were patient comfort (according to patient’s opinion), vomiting (episodes, type, amount, content, on which post-operative day), abdominal distension, appearance of normal bowel sounds, passage of flatus and/or stools (according to patient’s history), incidence of aspiration pneumonia and total duration of the hospital stay with wound complications. Data will be processed and analyzed by chi square test and t-test.Results: In the study total 300 patients were included. No significant difference between both the groups in case of postoperative vomiting with p- value of 0.6028 (i.e. p > 0.05) and abdominal distension with p- value of 0.5183 (i.e. p > 0.05). Significant difference seen in the appearance of the bowel sound in post-operative period with p- value of 0.0002 (i.e. p < 0.05) and passage of flatus or stool with p-value of <0.0001. In case of early decompression group mean postoperative day for the suture removal was 11.9 days and for routine decompression group it was 12.3 days, the difference was statistically significant with p- value of 0.0006 (i.e. p < 0.05). The mean for the total hospital stay for early decompressed group was 10.04 days and for routine decompression group it was 10.47 days which was highly statically significant with p- value of 0.0001 (i.e. p < 0.05). Post-operative wound complication which was statically significance with p-value of 0.0394 (i.e. p < 0.05) and respiratory complications was also significant with p-value of 0.0367 (i.e. p < 0.05). In case of early decompression post-operative nausea, vomiting and abdominal distention were higher but not significant statistically.Conclusions: Early removal of Ryle’s tube leads to less incidence of respiratory complications and wound complications ultimately early suture removal and less hospital stay. Early removal of Ryle’s tube leads to early resolution of postoperative paralytic ileus indicated by early appearance of bowel sounds and early passage of flatus and stool.