BJ Medical College Research Articles

Effect of Sildenafil in Neonates with Persistent Pulmonary Hypertension: An Interventional Study

Introduction: Persistent Pulmonary Hypertension of the Newborn (PPHN) reflects a disruption of the normal perinatal circulatory transition and is characterised by high pulmonary artery pressure. Inhaled Nitric Oxide (iNO) is considered the mainstay of treatment for PPHN. However, many developing and resource limited countries do not have access to such expensive therapy. Therefore, sildenafil, due to its easy availability and low cost, becomes the most commonly used drug in the management of PPHN in such settings. Aim: To study the treatment response and outcomes of neonates who received sildenafil for the management of PPHN. Materials and Methods: The present hospital-based prospective interventional study was conducted in the Neonatal Intensive Care Unit (NICU), BJ Medical College, Civil Hospital, Ahmedabad, Gujarat, between May 1, 2020, and April 30, 2021. Study was conducted on neonates with meconium aspiration syndrome and/or severe birth asphyxia admitted to the NICU. A total of 48 neonates with Two Dimensional (2D) echocardiography-proven PPHN were enrolled. Baseline clinical parameters including heart rate, respiratory rate, preductal and postductal Saturation of Peripheral Oxygen (SpO2), Oxygenation Index (OI), Saturation Oxygen Distending Pressure Index (SOPI), and Non Invasive Blood Pressure (NIBP) were monitored every six hours. Neonates who were on invasive/ non invasive ventilation had their Fraction of Inspired Oxygen (FiO2), Positive End Expiratory Pressure (PEEP), Peak Inspiratory Pressure (PIP), respiratory rate and flow rate monitored every six hours. Data were statistically analysed using Analysis of Variance (ANOVA) test. Results: During the study period, a total of 1080 neonates were admitted with meconium aspiration syndrome and/or severe birth asphyxia, out of which 48 neonates showed findings suggestive of PPHN on 2D echocardiography. A statistically significant improvement in oxygenation after sildenafil treatment was indicated by a significant reduction in OI from 35.3±8.6 to 13.2±2.1 (p-value<0.001), a reduction in SOPI from 3.6±0.3 to 1.5±0.2 (p-value<0.001), a reduction in FiO2 (%) from 94.6±8.19 to 24.2±4.5 (p-value<0.001), an increase in Partial pressure of oxygen (PaO2) (mmHg) from 52±5.6 to 72±3.4 (p-value<0.001), and an increase in SpO2 (%) from 83.5±8.6 to 93.5±5.1 (p-value<0.001). Conclusion: The findings of the present study suggest that oral sildenafil can be successfully used to improve oxygenation in patients with PPHN, especially in a resource limited setting where facilities like Extracorporeal Membrane Oxygenation (ECMO) and iNO are not available, as demonstrated in the present study.

COVID-19 associated mucormycosis: A bibliometric analysis of Indian research based on Scopus

Objective. Invasive fungal infections, specifically mucormycosis, showed a massive surge during the COVID-19 pandemic, forcing the global medical fraternity to research this highly fatal co-infection. India has contributed significantly to COVID-19-associated mucormycosis (CAM) research, but a bibliometric analysis of this research topic is scarce. Using established bibliometric methods, we aimed to provide the yield and impact of CAM research in India. Design/Methodology/Approach. The publication data on CAM was extracted from Scopus. Data was analyzed using quality indices such as citations per paper (CPP), relative citation index (RCI), and total linkage strength (TLS). Results/Discussion. India contributed 640 (61.2%) to 1045 global publications on CAM research involving 548 authors from 247 organizations. Only 62 (9.8%) and 96 (15.0%) publications were funded and collaborative. The CAM research was focused on clinical features (36.5%), complications (21.7%), risk factors (19.2%), epidemiology (12.3%), diagnostics & imaging (6.8%), treatment outcomes (4.5%), prognosis (3.4%) and pathophysiology (3.1%). The average CPP of Indian publications was 7.8 compared to 28.2 CPP in France, 17.8 CPP in the USA, 8.7 CPP in Saudi Arabia, 8.3 CPP in Bangladesh, and 8.1 CPP in Iran. The major collaborations were with the USA, Bangladesh, Saudi Arabia, the UK, Pakistan, Malaysia, and UAE. The most productive organizations were PGIMER-Chandigarh (n=47), AIIMS-New Delhi (n=44), and AIIIMS-Jodhpur (n=17), whereas the most impactful organizations were SMS Medical College, Jaipur, SGPGIMS, Lucknow and BJ Medical College, Ahmedabad. The most productive authors were A. Chakrabarti, V. Muthu, and R. Agarwal, and the most impactful were I.S. Sehgal, R. Agarwal, and V. Muthu. The most preferred journals were the Indian Journal of Ophthalmology, the Indian Journal of Otolaryngology and Head & Neck Surgery, and BMJ Case Reports. Conclusions. Even though India is the topmost contributor to global CAM research, the quality of its publications is lower than those from France and the USA. The CAM research is largely non-funded. There is a need to improve international collaboration and increase focus on pathophysiology, epidemiology, and pediatric aspects. This may lead to an improved understanding of CAM and increase survival in affected patients.

Comparative Study of Clinical and Audiological Outcome between Autologus and Prosthesis in Ossicular Chain Reconstruction

Abstract Introduction: Ossiculoplasty is one of the commonly done and challenging surgery in otology and has been done using various graft materials. Materials such as autologous cartilage (tragal or conchal) or allograft (homograft) of the same tissue and synthetic materials like polyethylene TORP, ceramic and hydroxyapatite PORP or Titanium prosthesis have been used. But the latter synthetic materials are expensive and have high extrusion rates. Autologous cartilage grafts are selected for Ossiculoplasty as they are easy to harvest at the same site of operation, non-toxic, has less extrusion rate, minimum shrinkage and lateralization. Aims and Objective: The aim of this study is to know the efficacy of autologous graft and prosthesis in ossicular reconstruction and to evaluate hearing outcome along with extrusion rate among them. Methodology: It is a prospective study done on patients attending ENT outpatient department in civil hospital Ahmedabad affiliated to BJ medical college Ahmedabad. 60 patients were included in the study who underwent ossicular reconstruction either with canal wall up or down mastoidectomy with tympanoplasty. Conclusion: On follow up of 60 patients over six month we followed there is significant air bone gap reduction with prosthesis but there is risk of extrusion which cancel out beneficial effect of prosthesis. Whereas cartilage and incus remodelling give good result in air bone reduction and better take up compare to prosthesis with less extrusion rate. Also, autologous grafting in ossicular chain reconstruction is economical in developing countries like India with disease prevalent among low socioeconomic group. Keywords: PORP/TORP, Ossicular chain reconstruction, incus remodelling, CSOM, Mastoidectomy

Clinical profile of low-birth-weight neonates admitted in NICU: a tertiary care hospital-based study

Background: LBW is defined as weight at birth less than 2.5kg irrespective of gestational age. LBW neonate remains at much higher risk of morbidity and mortality than normal birth weight baby. Morbidity and mortality among LBW babies are a major health problem in our country, so it’s important to identify risk factors. Methods: A prospective observational study was conducted on 153 extramural LBW neonates admitted in Neonatal intensive care unit of civil hospital, BJ medical college Ahmedabad from April 2021 to January 2022. Results: Out of 153 neonates, 94 (61.4%) were preterm, appropriate for gestational age and 59 (38.6%) were small for gestational age including 41 (26.8%) term and 18 (11.8%) preterm. 16 (10%) were extremely LBW neonates and 28 (18%) were very low birth weight neonates. 77 (53%) neonates were late preterm and term gestational age. Most common indication of NICU admission was respiratory distress syndrome in 53 (27.8%) followed by sepsis 35 (18.4%), neonatal hyperbilirubinemia 22 (11.6%), birth asphyxia 15 (7.8%) and prematurity+LBW 16 (8.4%). Conclusions: Majority of LBW babies were preterm AGA babies. Respiratory distress syndrome, sepsis, birth asphyxia, prematurity and neonatal hyperbilirubinemia are major causes of admission. While, Respiratory distress syndrome, sepsis and birth asphyxia were common causes of expires. Respiratory distress syndrome is most common cause of morbidity and mortality in low-birth-weight babies. Appropriate and effective use of oxygen delivery system, surfactant, safe, early and effective transportation of neonates should be advised.

Results of tibial defect in TKR managed with bone cuts and cement without tibial stem augmentation

Introduction: Osteoarthritis of the knee is one of the most common causes of disability among elderly population. OA clinically presents as flexion with varus deformity. Various methods to manage bone defects during TKR surgery have been described like use of Bone cement, Bone grafts, metal wedges and augment and Extension of tibial stem in various permutations and combinations. In this study we are evaluating the results of tibial bone defect.Aims and Objectives: To study the Result of Tibial defect in TKR managed with Bone cuts and Cement.Materials and Methods: A Prospective study of 55 total knee replacements performed over 42 patients for osteoarthritis knee by trained surgeons at a tertiary care centre in the Department of Orthopaedics, BJ medical college, Civil hospital Ahmedabad between May 2019 to September 2021. The mean follow-up study time was 3 years. Observation and Results: All the operated patients were followed up for mean period of 3 years. The defects in our study were solely managed with bone cuts and cement with or without screw augmentation. Conclusion: Tibial bone defect even more than 5 mm but less than 10 mm can be effectively managed with bone cuts and cement alone or screw fixation without any bone grafts or tibial augmentation.

Comparative study in patients treated by negative pressure wound therapy versus conventional wound treatment for abdominal wounds

Background: The use of negative pressure to enhance wound healing is a well-known notion. If excess fluid is not effectively evacuated from a wound during surgery, its constituents may act as both physical and chemical impediments to wound healing. Furthermore, mechanical stresses can alter tissue form and growth. A buried drain tube has little mechanical impact on the surrounding tissue. Aims and Objectives: The aim of the study was to compare the effectiveness of negative pressure wound therapy (NPWT) versus conventional wound treatment (CWT) in abdominal wounds after surgery in clinical practice. Materials and Methods: The present and prospective study was conducted among 60 patients taking treatment for abdominal wounds after surgery at General surgery Department at BJ Medical College, Ahmedabad, Gujarat, India, during June 2022–May 2023. The cases divided in two groups: Group A: Patients treated with NPWT (n = 30), Group B: Patients treated with CWT (n = 30). Results: Cases treated by NPWT had faster reduction of surface area, higher rate of granulation achieved in lesser time and had better outcome with wound closure by delayed primary suturing. Conclusion: NPWT is the safe and effective compare to CWT in term of duration of wound closure, faster reduction in surface area, and faster proliferation of granulation tissue.

Evaluation of Laboratory Performance in Consideration with Pre analytical and Post analytical Quality Indicators.

Implementation of Quality indicators (QIs) plays an imperative role in improving the total testing process, as it provides a quantitative basis for evaluating the laboratory performance. Besides monitoring of analytical quality specifications, several lines of experimental and clinical evidence have alluded a pivotal role of extra-analytical phases in improving the quality of laboratory services and therefore a relevance of pre- and post-analytical steps have been speculated on the overall quality in the total testing process and consequently on clinical decision-making. This was a retrospective study designed to evaluate and review different extra-analytical quality indicators in NABL accredited clinical biochemistry laboratory at BJ Medical College and Civil Hospital, Ahmedabad, Gujarat in an endeavour to ameliorate the performance of the laboratory. All Clinical Chemistry Laboratory test requests with their respective samples from January 2018 to December 2021 were included in the study. A total of 1,439,011samples were processed, and were evaluated for seven QIs [(% of number of suitable samples not received; QI-8), (% of number of samples received in inappropriate container; QI-9), (% of number of samples hemolysed; QI-10), (% of number of samples with inadequate sample volume; QI 12) (% of number of samples received mismatched; QI 15), (% of number of samples reported after turnaround time; QI 21) and (% of number of samples with critical values informed; QI 22)] based on defined criteria of Quality Specification given by International Federation of Clinical Chemistry. Total number of preanalytical errors was 53,669 (3.72%). Among the preanalytical errors, inadequate sample volume (2.37% of total samples; 63.49% of total pre-analytical errors) was the most common anomaly followed by Not received samples (24.18%) hemolysis (8.26%) mismatched (3.91%) and 0.14% samples were received in Inappropriate container; manifesting that the error frequency was unacceptable for QI 21 and QI 8, acceptable for QI 10, minimally acceptable for QI 15 and optimum for QI QI 9. Furthermore, there was year-wise progressive decline in error rate of inadequate sample volume, hemolysed sample received and mismatched samples. Total number of post analytical errors were 19,002 (1.32%). TAT outlier and critical values communicated were the two QIs evaluated for this phase and results of both QI were within acceptable limits. Quality indicators serve as a tool to monitor process performance and consequently derived error rates warrant active intervention to improve the laboratory services and patient health care. Dissemination of certified documents, regular staff training and evaluation needs to be conducted.

Histopathological study of pediatric solid malignant tumors in a tertiary care hospital

Background: Pediatric malignancies are extremely heterogeneous yet account for only approximately 1% of all tumor diagnosis. These entities are important to recognize because their clinical features are non-specific and may mimic common disorders of childhood .Pediatric solid malignant tumors are clinico-biologically distinct. They are more aggressive but usually respond satisfactorily to chemotherapy. The advanced multidisciplinary approach results in improved overall survival and a better quality of life for majority of the patients [1].Aims & Objectives: To study the incidence, age and sex distribution of Pediatric solid malignant tumors. To study the histopathological appearances of various Pediatric solid malignant tumors.Materials and Methods: A retrospective observational cohort study over a period of 5 years (January 2017 to September 2021) in the age group of 0-14 years was conducted in civil hospital, BJ Medical College, Ahmedabad. The data was retrieved from LIS (laboratory information system).The data consisted of information about the surgical pathology specimens received in histopathology laboratory from surgical departments. All specimen were examined macroscopically, processed by routine paraffin processing method and haematoxylin and eosin stained sections were studied microscopically.Results: In our study of 170 malignant cases, patients were stratified in 3 age groups; 0-5 years, 6-9 years, 10-14 years. Total of 110 cases were observed among males and 60 cases among females. Most of the malignancies 67(39.4%) were observed among 0-5 years age group. Central Nervous System (CNS) malignancies 123(72.35%) was most common followed by soft tissue sarcoma, lymphoma, germ cell tumors, renal malignant tumors, bone tumors and miscellaneous malignant tumors.

Clinical Study of Surge of Mucormycosis in COVID-19 Pandemic: A Tertiary Care Center Study

The aim of this study is to evaluate the prevalence, pathogenesis and management of mucormycosis in post covid 19 patients in our tertiary care covid dedicated hospital. A prospective cross sectional study was done in 70 patients who were admitted in the covid department of BJ Medical College, Civil hospital Ahmedabad and presented with mucormycosis during admission or after discharge over a period of 10 months from March 2020 to December 2020. Middle aged to elderly population were found to be most commonly affected with mucormycosis. It was found that majority of the affected population was uncontrolled diabeteic and had a delayed presentation to hospital due to ongoing covid pandemic crisis. Covid infection had major effect on the hormonal balance of the body as evident from the uncontrolled blood glucose levels of affected patients. In patients with mucormycosis, early detection, surgical debridement, suitable antifungal therapy, and control of risk factors like diabetes mellitus are the main parameters of successful management of this lethal infection. Early diagnosis and treatment of mucormycosis can be life saving as it is a rapidly progressing disease and have been proven fatal.

Study of Pregnancy with COVID-19 and its Clinical Outcomes in a Tertiary Care Teaching Hospital in Western India

Objectives: To study cases of pregnancy with coronavirus disease-2019 (COVID-19) and its clinical outcome. To study evidence of the vertical transmission in pregnant women infected with COVID-19. Materials and methods: A prospective study was performed in BJ Medical College and Civil Hospital, Ahmedabad, one of the biggest designated (1200 beds) COVID hospitals in India. It was carried out from June 2020 to mid-October 2020. A total of 50 pregnant patients who were COVID-19 positive and admitted to the labor room were studied. Results: The mean age of the mothers was 27.40 ± 4.76 years (range: 19–36 years) and mean gravidity was 1.67 ± 1.41 (range: 1–4). The mean gestational age was 38.31 ± 1.67 weeks. The main complaint was fever in 22 (44%), followed by dry cough in 9 (18%), sore throat in 4 (8%), headache in 2 (4%), malaise in 7 (14%), and diarrhea in 2 (4%) patients. Twenty-two (44%) patients showed an elevated C-reactive protein level, 17 (34%) had lymphopenia, 19 (38%) had mild elevation of the D-dimer level, and 16% of the patients had increased interleukin 6 levels. Most of the patients had normal renal function test (RFT) and liver function test (LFT) results. A majority of them (86%) had normal chest X-ray, whereas rest of them (14%) had haziness in bilateral lung fields. Twenty-six (52%) patients underwent C-section, and 23 (46%) delivered vaginally. Four (8%) babies required the admission in the newborn intensive care unit for mild birth asphyxia but were discharged well. Five babies developed physiological jaundice and required single surface phototherapy (SSPT). Forty-eight (96%) out of 50 had negative vaginal swab by reverse transcription polymerase chain reaction (RT-PCR), 48 (96%) did not show any evidence of the virus in the expressed breast milk by RT-PCR. We collected the cord blood sample of 35 patients after delivery which was found to be negative in all (100%). The nasopharyngeal swab of all the babies was negative on the very first day. Day 7 repeat swab was found positive only in one baby. This transmission was mostly via respiratory droplets during intermittent assisted breastfeeding. Most of the cases were having mild disease without acute respiratory distress syndrome (ARDS), which responded to the supportive treatment. Four patients (8%) had severe anemia and required blood transfusion. Conclusion: Most of the cases were having mild disease without ARDS, which responded to supportive treatment. Reassuringly, there was no evidence of poor fetal outcome, intrauterine fetal deaths, or premature deliveries. We did not find any evidence of the virus in the vaginal fluid, cord blood, or breast milk supporting vertical transmission of COVID-19 in the third trimester of pregnancy, even if patient delivered vaginally. © Jaypee Brothers Medical Publishers. 2021.

Histopathological and cytological correlation of thyroid lesions

Introduction: Fine needle aspiration cytology (FNAC) has become the dominant method in the Evaluation of thyroid nodules, being the fast, reliable, safe and minimally invasive, cost Effective and reaching high sensitivity and Specificity.Aims and Objectives: The Study was undertaken with the main aim of evaluating the utility and efficacy of FNAC and to study the histopathological pattern of various diseases of thyroid gland. Materials and Methods: The study was conducted in the Department of Pathology of B.J. Medical College and Civil Hospital, Ahmedabad, during the period between June 2018 to October 2020. Data for study is obtained from departmental records and tissue specimens received in the histopathology and cytology sections section in the specified period of study.Results: In the present study, 225 cases of Thyroidectomy were received at the Histopathology Section of Pathology Department, BJ Medical College and Civil Hospital, Ahmedabad, during the period between June 2018 to October 2020. Out of these, 190 were non-neoplastic and 35 were neoplastic. Among 35 neoplastic lesions, 28 were benign and 7 were malignant, 120 cases were correlated with FNAC findings. In correlation study, FNAC had 100% accuracy for malignant lesions.

Comparison of outcome of shaft humerus fracture: Anterior bridge plating versus posterior plating vs humerus intramedullary nailing

Introduction: Shaft humerus fractures are complex injuries as their management requires stable fixation and adequate reduction. Management includes conservative cast application, intramedullary nailing, open reduction and internal fixation or MIPPO plating in form of Anterior Bridge plating.Aims and Objectives: Comparison of outcome of shaft humerus fracture treated by: Anterior bridge plating versus posterior plating versus intramedullary humerus nailing. Materials and Methods: A retrospective clinical study was done on 40 patients with shaft humerus fractures treated with Anterior bridge plating and posterior plating and intramedullary nailing by trained surgeons at a tertiary trauma care centre in the Department of Orthopaedics, BJ medical college, Civil hospital Ahmedabad between Nov 2019 to Nov 2020. The mean follow-up study time was approximately 6 months. (1-12 months).Observation and Results: All the operated patients were followed up for mean period of 6 months months (range from 01 to 12 months). Clinical, physiological and ortho-radiological assessment was performed to observe and evaluate fracture stabilization and reduction and fracture healing and callus formation and range of movements.Conclusion: Adequate reduction with less operative time and less soft tissue damage and preservation of neurovascular with increased rate of union and early mobilization was seen with ABP plating. Nailing had same benefits except the decreased range of movement at shoulder.

Comparison of outcome of distal humerus fracture: Single extra articular humerus plating versus bipillar plating

Introduction: Distal humerus fractures are complex injuries as their management requires stable fixation and properly working adjoining joints. Management includes open reduction and internal fixation of distal humerus fractures with the use of available implants and their modification. Dual lock plating still has disadvantages of less hardware availability, their cost and also long surgical time wiht extensive soft tissue damage. The mainstay objective of this study is to evaluate the effectiveness and benefits of distal humerus fractures operated by using a single extra articular humerus plating versus bipillar plating. Aims and Objectives: 1: Evaluation of Clinical and radiological Outcome of single extra articular humerus plating planned for distal humerus fractures. 2: Comparison of clinical outcome of single extra articular humerus plating than the bipillar plating planned for distal humerus fractures. Materials and Methods: A retrospective clinical study was done on 40 patients with distal humerus fractures treated with single extra articular humerus plating and bipillar plating by trained single surgeon at a tertiary trauma care centre in the Department of Orthopaedics, BJ medical college, Civil hospital Ahmedabad between August 2016 and march 2018. The mean follow-up study time was approximately 13 months. Observation and Results: All the operated patients were followed up for a mean time of about 13 months (range from 06 to 20 months). Clinical, physiological and ortho-radiological assessment was performed to observe and evaluate fracture stabilization and reduction and fracture healing and callus formation and range of movements. The Mayo Elbow Performance Score and visual analogue scale were used to asses functional outcome. Conclusion: Proper Reduction with internal fixation still being considered the gold standard for treatment of distal humerus fractures. Extra articular plating however has better good prognostic results than bipillar plating. Early p

Operative Management of closed fracture shaft humerus: comparative study between MIPPO anterior bridge platting Vs conventional ORIF

Aim: Operative treatment of shaft humerus fracture continues to evolve. MIPPO is one of such emerging operative procedure which does give excellent results over conventional ORIF platting. We are comparing overall functional outcome and surgical complexity of MIPPO (Minimal Invasive Percutaneous Plate Osteosynthesis) vs conventional ORIF (Open Reduction and Internal Fixation) by posterior approach in this study. Materials and Methods: A retrospective clinical study was done on 50 patients with shaft humerus fractures treated with MIPPO anterior bridge plating and posterior platting by trained single surgeon at a tertiary trauma care centre in the Department of Orthopaedics, BJ medical college, Civil hospital Ahmedabad between October 2016 and May 2018. Follow up data was collected and patients were called for clinical and radiological evaluation. Results: 24 of the 25 (96%) MIPPO patients and 22 of the 25 (88%) ORIF patients achieved union. Average union times for the MIPPO and ORIF groups were 19.3 and 16.1 weeks respectively. At the end functional outcome of both the technique is as follows: the Mayo Elbow Performance Score (MEPS; range 95–100) were 90% in 20 cases (n = 20) operated with conventional ORIF posterior plating and 20 cases operated with MIPPO plating which is excellent scores. Two cases operated with ORIF posterior plating and three cases with MIPPO plating are showing a good MEPS score. Conclusions: Even though MIPPO is surgically demanding, fracture hematoma is not disturbed in it therefore it gives better and fast union than conventional ORIF. Keywords: Conventional ORIF, MIPPO platting, Fracture, Humerus.

Extra-Articular Proximal Tibia fractures: Proximal tibia plate versus intramedullary nailing

Introduction: Extra-articular promixal tibial fracture make up to around 10%(1) of all shaft tibia fractures which are most commonly due to high velocity injury. Both conservative and operative management options are available, but conservative management has resulted in many complications. Intramedullary nailing and minial invasive plating are the preferred techniques of the available modalities of operative management. There is not enough evidence regarding the superiority of one of the two techniques. The purpose of this study is to compare these different approaches based on hospital stay, blood loss, union rates, mal/non-union, post-operative range of motion of knee ,period of non-weight bearing , infection rates and implant removal rate. Material and Methods:This is a randomized prospective study conducted on 50 osteoporotic patients with extra-articular proximal tibia fractures treated with minimally invasive proximal tibial plating vs intramedullary nailing at Department of Orthopedics, BJ medical college, Civil hospital Ahmedabad between June 2016 and May 2017. Observation and Results:Patients with intramedullary nailing had lesser duration of stay, lower cost, less infection rate, less implamt removal rate but higher malunion and union rates compared to plating patients. Operative time, time to full weight bearing and range of motion was found to be similar in both. Conclusion:Intramedullary nailing is preferred operative modality over plating because of decreased hospital stay, faster union, decreased operative time and decreased infective rate. However there was no significant difference in range of motion of knee, rate of malunion and nonunion Keywords: Proximal tibia fracture, Intramedullary nailing, Plating

Association of Vegetable and Animal Flesh Intake with Inflammation in Pregnant Women from India.

In pregnant women, studies are lacking on the relationship of vegetable and animal flesh (poultry, red meat and seafood) intake with inflammation, especially in low- and middle-income countries. We conducted a cohort study of pregnant women receiving antenatal care at BJ Medical College in Pune, India. The dietary intake of pregnant women was queried in the third trimester using a validated food frequency questionnaire. Twelve inflammatory markers were measured in plasma samples using immunoassays. Only 12% of the study population were vegetarians, although animal flesh intake levels were lower compared to Western populations. In multivariable models, higher intakes of total vegetables were associated with lower levels of the T-helper (Th) 17 cytokine interleukin (IL)-17a (p = 0.03) and the monocyte/macrophage activation marker soluble CD163 (sCD163) (p = 0.02). Additionally, higher intakes of poultry were negatively associated with intestinal fatty-acid binding protein (I-FABP) levels (p = 0.01), a marker of intestinal barrier dysfunction and Th2 cytokine IL-13 (p = 0.03), and higher seafood was associated with lower IL-13 (p = 0.005). Our data from pregnant women in India suggest that a higher quality diet emphasizing vegetables and with some animal flesh is associated with lower inflammation. Future studies should confirm these findings and test if modulating vegetables and animal flesh intake could impact specific aspects of immunity and perinatal health.

Endoscopic Modified Denker's Approach for the Treatment of Juvenile Nasopharyngeal Angiofibroma.

Juvenile nasopharyngeal angiofibroma is a benign vascular lesion with propensity of bony erosion leading to skull base involvement and intracranial extension. It involves multiple compartments which are difficult to access surgically. With surgical expertise endoscopic resection of angiofibroma has become the preferred choice of surgical management. This article presents our experience with endoscopic approach for angiofibroma and establishes the modified Denker's procedure as a effective approach for removal of tumor. A prospective case study was done on 25 cases of juvenile nasopharyngeal angiofibroma treated surgically by endonasal endoscopic modified Denker's approach in the department of ENT at BJ Medical College, Ahmedabad over a period of 4years from January 2015 to January 2019. This technique was used up to Fisch stage 3b with extension up to infratemporal fossa. Using this technique no major recurrence or major morbidity was observed and did not produce any late serious complications. The endoscopic technique allows the surgeon to achieve an extensive exposure of the sinuses and control of the sphenopalatine and internal maxillary arteries without the risk of palatal dysfunction, oronasal fistula, or facial scarring. In addition, the modified Denkers approach can be an effective and less mutilating technique in managing recurrences.

Ten minutes with Mrs Katya Tambe, Joint Head of Service, Ophthalmology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK

![Graphic][1] ### Biography Katya Tambe is the Joint Head of Service (HoS) for the ophthalmology department at Nottingham University Hospitals NHS Trust (NUH). She was appointed as a consultant ophthalmologist...

Arginase and Procalcitonin: Promising Biomarkers for Early Diagnosis of Sepsis

Introduction: Sepsis remains a major cause of death in critically ill patients in Indian population because of high susceptibility towards infectious diseases in the world. Procalcitonin (PCT) is a well-studied marker in foreign countries but needs to be established in Indian population. In the last few years, importance of Arginase as a marker of immunity has also increased exceptionally, because this enzyme is essentially involved in different inflammatory processes. Keeping these facts in mind PCT and Arginase were evaluated for their utility as markers to diagnose sepsis. Aim: To evaluate Arginase and PCT as biomarkers for early diagnosis of sepsis. Materials and Methods: Hundred adult patients (age >18 years) with Systemic Inflammatory Response Syndrome (SIRS) attending BJ Medical College which is affiliated with Sassoon General Hospital (Pune, Maharashtra, India) during May 2012-July 2015 were incorporated in the study. Age n sex-matched of 100 samples healthy controls were also collected. Arginase was estimated by Roman and Ray method and PCT by Enzyme-linked Immunosorbent Assay Kit (ELISA) method. Unpaired t-test was done to compare the mean biomarker levels between the cases and controls. The Area Under Curve (AUC) was calculated using Receiver Operating Curve (ROC). All the data analysis was set at 95% Confidence Interval (CI) and value p<0.05 are statistically significant. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Results: In the study, a significant increase was observed in the levels of arginase (p<0.01) and PCT (p<0.01) in cases as compared to controls. ROC curves were plotted to find out the cut-offs of arginase (4.6 IU/L) and PCT (0.04 ng/mL) to check the diagnostic efficacy of both the biomarkers. Conclusion: Serum PCT and arginase offers a high level of accuracy than other currently available tests and hence can be helpful in the management of sepsis. In addition to this apart from high sensitivity and specificity arginase estimation is cost effective as compared to PCT.

Endoscopic cerebrospinal fluid leak repair: how we do it

<p class="abstract"><strong>Background:</strong> Cerebrospinal fluid (CSF) rhinorrhoea is characterized by a defect in the barriers which separate the subarachnoid space from sinonasal tract resulting in the leakage of watery fluid from the nose. Management of CSF rhinorrhoea is by both conservative and/or surgical approach. Transnasal endoscopic method has become the preferred surgical method for the repair of CSF leak because of less complication as compared to the open approach. To evaluate the results of patients who underwent endoscopic repair of CSF rhinorrhoea over a period of 5 years at BJ Medical College, Civil Hospital, Ahmedabad.</p><p class="abstract"><strong>Methods:</strong> 118 patients were included in this retrospective study who underwent CSF leak repair by nasal endoscopy over a period of 5 years between 2011-2016 in the department of ENT at BJ Medical College, Civil Hospital, Ahmedabad. As per review of the records, these patients were diagnosed with CSF leak on the basis of their history, clinical examination, and radiological investigations. Materials used for the repair were fat, fascia lata, fibrin sealant, and/or vascular flap. </p><p class="abstract"><strong>Results:</strong> Primary surgery was successful in 110 (93%) of cases. In 8 (7%) cases, there was a recurrence of leak which was managed by either conservative management (5 cases, 4%) or by re-exploration (3 cases, 3%).</p><p class="abstract"><strong>Conclusions:</strong> Transnasal endoscope is an important tool for the evaluation and subsequent treatment of CSF rhinorrhoea. Endoscopic repair of CSF rhinorrhoea is safe, effective, has a low complication rate and has almost completely replaced the open technique.</p>