Trivial Trauma Research Articles

To study the incidence of missed Distal Radio-Ulnar Joint (DRUJ) injuries, its’ early diagnosis by dynamic C.T. Scan and Management by modified Kapanji method

Background and Method: All the patients coming to the Department of Orthopaedics of Index Medical College Hospital & Research Centre, Indore, with an aim to Study The Incidence of missed Distal Radio-Ulnar Joint (Druj) Injuries, Its’ Early Diagnosis by Dynamic C.T. Scan and Management by Modified Kapanji Method and diagnosed with distal radio-ulnar joint injuries. All the trauma cases were received in the casualty and primary treatment with detailed examination and required imaging studies were done. The x-ray included antero-posterior and posterio-anterior views with dynamic CT scan and CT scan for head injury patient was donr through all investigation operative procedure were planned. The required consent was taken by the patient beforehand. Result: DRUJ injuries are more prevalent among young males than females. In age group 16 to 30 female (45%) is higher than male (38.8%). DRUJ injuries was seen more in left (55%) than right (45%) hand. Fall on out stretched hand (58%) is the major mechanism of DRUJ injuries followed by trivial trauma in 42%. DRUJ injury was missed in 18.33%, chronic in 20%, acute in 38.33% and sub-acute in 23.33%. Conclusion: Present study conclude that DRUJ injuries are more prevalent among young males than females. DRUJ injuries was seen more in left (55%) than right(45%) hand with fall on out stretched hand is the major mechanism. Physical examination is effective in diagnosis; radiological examination suggested for further investigations. Positive symptoms of DRUJ injuries were in 100%, physical examination was positive in 85% and negative in 15%. Positive CT findings in 66.67% and negative in 33.33%. X-ray findings were positive in 71.67% and negative in 28.33%.

Clinical study, management of diabetic foot and its complications

Background: Diabetic foot infections are frequently polymicrobial. Hyperglycemia, impaired immunologic responses, neuropathy and peripheral arterial disease are the major predisposing factors leading to limb-threatening diabetic foot infections. The aim of the study was to study the benefit and outcome of the different treatment modalities for the diabetic foot.Methods: This study was conducted comprising 100 patients with diabetic foot in the department of general surgery at Rajiv Gandhi government general hospital, MMC from January 2019 to June 2020, over 12 months. Data were collected by detailed history, clinical examination, wound or ulcer and were recorded in the pre-designed proforma. Wagner’s classification, examination findings, blood investigations, renal function test, a swab of the wound, X-ray and treatment provided were collected.Results: Commonest presenting lesion was ulcers (44%), followed by gangrene (24%) and cellulitis (20%). The commonest site of the lesion was the dorsum of the foot (32%), followed by forefoot (28%) and toes (22%). Trivial trauma is the initiating factor in more than half of the cases. More than half of the patients, 82% had an infection. The most common microorganism grown from culture was Staphylococcus aureus (30%).Conclusions: Diabetic patients at risk for foot lesions must be educated about risk factors. The multidisciplinary team approach diabetic foot disorders has been demonstrated as the optimal method to achieve favorable rates of limb salvage in a high-risk diabetic patient. Infection in a diabetic foot is potentially limb-threatening and always requires urgent diagnostic and therapeutic attention.

Giant Cell Tumor (GCT) of Distal Femur with Pathological Fracture - A Case Report

Introduction: Giant cell tumor [GCT] is a relatively common, locally aggressive but most often a benign neoplasm that is associated with a large biological spectrum. The GCT accounts for 4-10% of all bone tumors and approximately 20% of all benign bone tumors. Case Report: We have a 35 year old male patient, who presented with right knee pain after a trivial trauma (history slip and fall while walking) and X ray revealed pathological fracture of the medial condyle of femur along with a lytic lesion. On further investigation with other modalities such as CT scan and MRI was suggestive of giant cell tumor in the distal femur confirmed with a biopsy, and the patient was referred to a higher centre for the management of the same with the pathological fracture of the medial condyle of the femur. Conclusion: The diagnosis of giant cell tumor, as seen, is made based on several factors taken into account including history, clinical examination, imaging techniques and finally the confirmatory biopsy of the lesion. This also helps in grading and staging of the tumor which helps in determining the prognosis and deciding the further treatment modalities.

Recurrent intraparenchymal brain hemorrhage in an infant with factor XIII deficiency

Factor XIII deficiency is an autosomal recessive disorder with an incidence of 1 in 1-5 million. On activation factor XIII stabilizes clot formation by cross-linking fibrin strands. Deficiency is characterized by severe bleeding due to impairment in clot formation. We describe a case of a child presenting with drowsiness following a trivial fall and trauma to the head. An emergency CT scan of the brain was suggestive of acute on chronic (recurrent) hemorrhage. Intraoperatively he was noted to have an intraparenchymal multiloculated cystic cavity with a thinned out cortex in the right frontal region. The child underwent right frontal craniotomy and decompression of an intracerebral hemorrhage. He was subsequently diagnosed to have factor XIII deficiency. He is presently on monthly cryoprecipitate prophylaxis with which he has not experienced a recurrence of a similar episode.

Minimal invasive technique in fixation of fracture phalanx by Intramedullary Herbert screw

Hand fractures are very common fractures in orthopedics injuries, and even one of the most common fractures in the upper extremity fractures.there are many different methods of fixation that can be used in the treatment, .Among these methods is fixation of fractures with a Herbert screw, which are suitable for transverse fractures and oblique fractures, which is the subject of this study This study aimed to analyze the clinical and functional results from patients with a diagnosis of unstable reducible extra-articular fracturing of the phalanx with displacement, who underwent surgical treatment by means of a minimally invasive percutaneous osteosynthesis technique using an Herbert screw in order to avoid interfering with the extensor tendon of this finger.Twenty patients, 15 males and 5 females with a mean age of was 36.25 years, (range, 23-57 years). Direct trauma was predominant cause of injury accounting 65 % followed by RTA and trivial trauma 35 %. Sixteen patients had transverse fracture (80%) and four had oblique fracture (20%). the small finger was the most commonly affected digit (12 patients) and other finger (4 middle, 3 index and 1 ring). the mean radiological union time was 7.7 weeks (range 6-10 weeks). Final QuickDASH score was 4.5.The mean TAF was 249° (range, 245°-270°).The mean TAM was 246.25° (rang, 235°-270°).All the patients follow-up visits were scheduled in the outpatient clinic at 2 weeks, 4 weeks, 6 weeks, 8weeks, 3 months and 6 months .Herbert screw intramedullary fixation is an effective technique for the treatment of transverse and short oblique proximal and middle phalangeal fractures. We found that it can be applied successfully even in peri-articular fractures of the proximal third of the phalanx, and it a safe method for almost of these fracture types giving a higher ROM and less complication.

Evaluation of Patterns of Trauma Reporting to the Emergency Department During the First COVID-19 Lockdown in India.

BackgroundOn March 24, 2020, the Government of India declared a nationwide lockdown and a series of measures aimed at limiting the spread of the coronavirus disease 2019 (COVID-19) infection. This led to dynamic changes in patient inflow and management in the emergency department.This study aims to evaluate the impact of the pre-lockdown and lockdown periods on the demography of trauma in a tertiary care teaching hospitaland to compare it with the homologous period of 2019.MethodsThe trauma caseloads between March 25, 2020, and April 14, 2020, and that of the homologous period of 2019 were thoroughly analyzed and compared retrospectively.ResultsThere was an overall decrease in trauma patients. Elderly male patients had an increased incidence of injury during the lockdown period with a significant p-value (0.0009). There was a significant increase in the number of minor orthopedic procedures while there was a significant decrease in the number of major orthopedic procedures. Fractures of the proximal femur were significantly increased during the lockdown period (p-value0.011) and fractures of the femur and tibia shaft were significantly decreased during the lockdown period (p-value0.002). Fractures of the distal radius were significantly increased during the lockdown period (p-value0.005) and fractures of the shaft of humerus, radius, and ulna were significantly decreased during the lockdown period (p-value0.028). Injuries following fall, trivial trauma, and animal-induced trauma were significantly increased (p-values <0.0001, <0.0001, 0.014, respectively), whereas injuries following sports and motor vehicle accidents were significantly decreased (p-value 0.006, <0.0001, respectively). The number of patients reaching within the golden hour (<1 hour) was significantly increased (p-value 0.0003). The total number of patients presenting under the influence of alcohol during the lockdown period was significantly decreased (p-value- <0.0001). The use of government-sponsored ambulances for transport to the hospital was significantly increased during the lockdown period (p <0.0001).ConclusionStrict administrative measures had a high impact on the number and epidemiology of trauma with remarkable changes. There was a decreased number of trauma cases but the mechanism, type, and management of these cases were significantly altered from the homologous period of the previous year.

Profile of fungal keratitis in a Sub-Himalayan territory of north India

Aim: To study the microbiological and epidemiological profile of patients with suppurative corneal ulcer presenting in a rural referral center situated in a Sub-Himalayan territory of north India. The study was conducted to evaluate the epidemiology and frequency of mycotic keratitis among the patients of suppurative corneal ulcer and to identify various fungal species as etiological agents.&#x0D; Methods: Corneal scrapings from 56 patients of suppurative corneal ulcers were subjected to direct microscopy and culture.&#x0D; Results: Of the 56 cases of suppurative corneal ulcer investigated, fungal etiology was identified in 18 (32%) cases. Most of the patients (82.1%) worked in agriculture. Trivial trauma with vegetative matter was the most common predisposing factor. Fusarium and Acremonium species were the most common fungi isolated, followed by Aspergillus. Four cases of rare mycotic keratitis caused by Paecilomyces lilacinus, Scedosporium apiospermum, Monilia sitophila, and Ulocladium species were detected. Four cases were smear positive (10% KOH wet mount) but culture negative. Analysis of KOH wet mount was done using culture as gold standard. The sensitivity and specificity of KOH wet mount was 71.43% and 90.48%, respectively.&#x0D; Conclusion: Direct microscopy and culture has a greater diagnostic value in the management of suppurative corneal ulcer. The authors have observed changes in the pattern of organisms identified as cause of fungal keratitis in the region. Rare species of fungi may also be detected if corneal scrapings are collected for direct microscopy and culture from all the cases of suppurative corneal ulcers greater than 2 mm.

Surgical outcome of tibial condyle fracture with MIPPO technique

Background: Tibial condylar fractures are very common in road traffic accidents; however, sports injury, fall and other trivial trauma can frequently produce these fractures. These are unstable fractures and quite challenging to manage. This study was undertaken to evaluate locking compression plate (LCP) fixation in proximal intra articular tibia fractures by MIPPO (minimally invasive percutaneous plate osteosynthesis) technique. Materials and Methods: The study was conducted from 0ctober 2016 to 2018. 20 cases who had sustained tibial plateau fractures (Schatzker type 1- VI) and operated with LCP fixation using MIPPO technique were included in this study after obtaining informed consent. Follow-up was done at 6 weeks, 12 weeks, 18 weeks and 24 weeks after the surgery and they were evaluated in accordance with modified Rasmussen knee scoring system. Results: Modified Rasmussen functional knee scoring system and modified Rasmussen criteria for radiological assessment was used to analyse the functional outcome among the cases. After evaluation it was observed that 90% of the patients had good to excellent performance. Conclusion: MIPPO technique enables soft tissue stripping via a small surgical incision and provides a rigid fracture reduction. There is also a reduced chance of post traumatic soft tissue injury. Proximal Tibial locking plate is a good device to stabilize the fractures of Tibial plateau (intra articular), especially when used in conjunction with meticulous intraoperative handling of the soft tissues and active participation of the patients in the rehabilitation programme is ensured. Keywords: Proximal tibia, MIPPO, Intra – articular, Tibia plateau, Locking compression plate.

KTP 532 laser excision of lingual schwannoma: a case report

&lt;p class="abstract"&gt;Schwannoma is a benign slow-growing tumour that arises from Schwann cells of the peripheral nerve sheath. The head and neck are common locations of this neoplasm. Intraoral schwannoma is uncommon, with the tongue being the most common site. The tumor can remain asymptomatic for a long period of time. The patient may present with symptoms such as a lump, swallowing difficulty, pain or discomfort, voice change, paresthesia, snoring, bleeding or ulceration. The tumor is usually slow-growing, solitary and well-encapsulated and malignant transformation is very rare. Sudden enlargement of the tumor can occur even from trivial trauma. Only approximately 50% of these tumors have a close relationship with a nerve. Transoral resection is the treatment modality of choice. Histopathological examination and immunohistochemistry help in confirmation of the diagnosis. Recurrence of the tumor is very rare. This is a case report of a 26-years-old lady with schwannoma in the ventral surface of the tongue successfully treated by transoral resection with the KTP-532 Laser. &lt;/p&gt;

Esophageal Stricture and Dermal Pathology Related to Compound Heterozygous Mutations in the TNXB Gene.

The Ehlers-Danlos' syndrome (EDS) constitutes a group of connective tissue disorders that are clinically and genetically heterogeneous. Mutations in the TNXB gene have been recognized as pathogenic causing classical-like EDS due to tenascin-X deficiency. Here, we have reported a unique case of compound heterozygous mutation in TNXB gene leading to esophageal stricture and scarred skin in a 7-year-old boy who presented to us with impacted foreign body in esophagus. The child was also having tendency to atrophic skin scarring secondary to trivial trauma.

Assessment of Vitamin D Levels and Its Correlation With Osteoporosis and Fracture Site Comminution in Osteoporotic Hip Fractures in Tertiary Care Hospital

Introduction: A global concern is vitamin D deficiency and insufficiency. There is a particularly high risk for pregnant women, people of color (Blacks, Hispanics, and those with increased skin melanin pigmentation), obese children and adults, and children and adults who are abstinent from direct sun exposure. The goal of this study was to understand the incidence of vitamin D deficiency in patients with osteoporotic hip fractures in our rural population and also to know its association with osteoporosis and osteoporotic hip fractures in a tertiary care trauma center.Methods: This prospective research was performed at our tertiary trauma treatment center in Kolar, Karnataka, India by the Department of Orthopedics from September 2019 and July 2020. The age category was 45-90 years, intertrochanteric fractures were graded using the Boyd and Griffin classification and femoral neck fractures the Garden's staging. The research included all patients with fractures after a trivial trauma such as slip and fall while standing/walking and excluded patients with a serious history of trauma such as road traffic accidents/falls from height and pathological fractures. This study involved 30 patients. Age and gender, type of fracture, vitamin D levels, Singh’s index, and comminution of fracture site were reported in patient demographics.Results: Thirty patients comprised the study population. Most of them were female. Females comprised 18 out of the 30. There were twelve, thirteen, and five persons in our sample population between the ages of 45-60, 61-75, and >75 years. The Singh's index was tabulated. Mean vitamin D levels were 9.64+/-3.23 in the femur fracture group and 13.42+/-5.31 in the intertrochanteric fracture group. Mean levels of vitamin D are included as a graphical representation. The comminution of the fracture site in groups of the femur and intertrochanteric fractures was eight and six, respectively.Conclusion: Early diagnosis and treatment of these patients with vitamin D for osteomalacia and anti-osteoporotic osteoporosis regimens will hopefully enhance bone, muscle, and general health, minimizing falls and fractures.

Clinical Presentation and Surgical Outcomes of Chronic Subdural Hematoma

Objective: The aim of this study was to access clinical presentation of chronic subdural hematoma and to evaluate the surgical outcome of evacuation of chronic subdural hematoma after single burrhole craniotomy with a close drainage system under local anesthesia.&#x0D; Material &amp; Methods: A descriptive study conducted in the Neurosurgery Department of Khairpur Medical College Sindh. 30 patients of chronic subdural hematoma were included. Patients prepared for evacuation of chronic subdural hematoma through single burr hole followed by closed drainage system for two days.&#x0D; Results: The most common feature was gait disturbance followed by Hemiparesis and headache. Coexisting diseases were hypertension, Diabetes mellitus and Chronic Liver Disease, etc. and causes of CSDH were head injury (trivial trauma) and anticoagulant. Surgical decisions were taken on the bases of clinical presentation and radiological findings of patients. Surgical procedure single burrhole craniotomy followed by irrigation with normal saline and close drainage system for two days. On post-operative follow-up, a recurrence of CSDH occurred in two patients.&#x0D; Conclusion: Single burrhole craniotomy with close drainage system is a simple and safe procedure under local anesthesia for treatment of chronic subdural hematoma.&#x0D; Keywords: CSDH (chronic subdural hematoma), GCS (Glasgow coma score), Burrhole craniotomy, Neurosurgery &amp; Subdural drain.

Indirect carotico-cavernous fistula following trivial trauma causing secondary glaucoma

Indirect carotico-cavernous fistula following trivial trauma causing secondary glaucoma

Mineralising Angiopathy of Lenticulostriate Vessels in Childhood: Series of Four Cases

Mineralising lenticulostriate vessels’ angiopathy is becoming an important recognisable cause of ischaemic stroke in healthy children post trauma or fall. The usual presentation is a focal neuro-deficit of acute onset following trivial trauma in infancy with or without seizures/dystonia. The authors conducted a retrospective chart review of children diagnosed with stroke in a tertiary care paediatric hospital. Based on clinical and radiological features, children diagnosed with mineralising angiopathy with basal ganglia stroke in the last two years were identified, data was retrieved from the hospital’s electronic database and included in the study. Also, the patients were contacted telephonically in case of missing data. Out of the four cases, three were less than 18-month-old, and one was 52- month-old. All were normal before illness and had a history of trivial trauma {except one who had Road Traffic Accident (RTA)} followed by hemiparesis. Investigations for other aetiologies of stroke were non contributory. With antiplatelet therapy and iron supplements, most did well with an excellent functional outcome at follow-up. None of the children had recurrence during follow-up. In a typical case, an extensive work-up is not required.

Clinical triad of chronic subdural haematoma

Background: Chronic subdural haematoma (CSDH) is one of the common intracranial haemorrhages mostly affecting the elderly population. It has a great role in morbidity and mortality, yet it is treatable by relatively simple technique and the majority of patients improve rapidly following surgical intervention but mortality rate is still 13%. The incidence of CSDHs in over 65 years is 58.1 per 100,000 per year compared to 3.4 per 100,000 per year in those under 65 years of age. Most of the population in developing country like Bangladesh resides in rural area; and there is less opportunity to do Computed Tomography (CT) scan brain. So better to diagnose clinically and then confirmed by CT scan to provide necessary treatment timely to reduce suffering of the patient.The purpose of this present study was to take details history, analysis symptoms and meticulous examination to diagnose CSDHs clinically, so that further CT scan of very diagnostic cases could be done to treat properly. Materials and Method: This study was conducted in the Department of Combined Military Hospital (CMH), Dhaka from March 2018 to February 2019 and it is a prospective study. The patients more than 20 years who were admitted and diagnosed clinically and all confirmed as CSDH by non-contrast CT scan head. A total 50 patients randomly allocated and sampling was done as per inclusion and exclusion criteria but must exclude who were not CT scan positive findings. Details history, meticulous symptom imprinting, keen physical examination including neurological examination and finally data collection with CT scan-head was done. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 26 for Windows (SPSS). Results: In this study 50 cases were finally selected as &lsquo;Chronic Subdural Haematoma&rsquo; and all were diagnosed clinically and radiologically confirmed. It was observed that most of the patients 39 (78%), 51-80 years age group. Regarding distribution of gender male were 41 &amp; female were 9 in number. In our study subjects, it was noticed that 43(86%) subjects had trivial head trauma, on anti-platelet and anti-coagulant medication. Regarding clinical picture of these CSDHs, it was observed that less number of patients only 5 (10%) patients had hemiparesis &amp; vomiting but 45(90%) subjects had Headache, Dysphasia and Altered level of consciousness. Conclusion: Diagnosis of CSDH by details history and meticulous clinical tests is easily accessible, less costly and effective in dubious mass population. Much suspected cases by clinical means can be confirmed by CT scan head and at least on time treatment could reduce morbidity as well as mortality of developing to poor country.

Posttraumatic True Aneurysm of the Superficial Temporal Artery

Most superficial temporal artery (STA) aneurysms are pseudoaneurysms that occur following a trivial trauma to the temporal region. True aneurysms of the STA are very rare. They occur usually due to congenital defects in vessel wall or atherosclerotic degeneration. We report a case of true aneurysm of the STA following trauma which is exceedingly rare. A 23-year-old male presented with painless swelling in front of the right ear for 4 months with a history of trauma to the right temporal region. Examination revealed a painless pulsatile mass of 4 cm × 3 cm size, and the diagnosis was supported by Doppler ultrasound and magnetic resonance imaging. Surgical excision was done. Histological examination showed all the three layers of the arterial wall to be intact, confirming a diagnosis of true aneurysm of the STA.

Functional outcome of hemiarthoplasty as a treatment option for trochanteric fractures

Objectives: Management of unstable intertrochanteric fractures in elderly patients is challenging due to osteoporosis. Comminuted unstable intertrochanteric fractures require early postoperative immobilization. Most of the recent reports have recommended Hemiarthroplasty for treatment of unstable intertrochanteric fractures to avoid various immobilization-associated complications like bed sore, pneumonia, urinary infection. The purpose of this study was to evaluate the functional and clinical outcomes of bipolar hemiarthroplasty for intertrochanteric fractures. Methods: Fifteen patients aged over 60 years underwent hemiarthroplasty to treat unstable intertrochanteric fractures and were followed up over 12 months. All surgeries were performed by the same surgical team using the Hardinge (lateral) approach. Wires, cables, and plates were used as required. Use of cemented protheses was considered when the lesser trochanter had been displaced. All patients were allowed full weight-bearing as tolerated as soon as possible. Clinical evaluation was based on Harris Hip Scores. Results: In our study, there were 6 male and 9 female patients with mean age of 70.26 years. 86.67% of the cases admitted were due to trivial trauma, 13.33% due to RTA with right side being more common side affected. In all patient partial weight bearing was started within 5 days. Good to excellent results were seen in 92.85% cases & Fair results were seen in 7.15% of cases in our study according to Harris Hip Score.Conclusions: Primary bipolar hemiarthroplasty for treating unstable intertrochanteric fractures provide a stable, pain free and mobile joint. It also eliminates the need for prolonged immobilization and permits early ambulation. As reported by others, hip hemiarthroplasty is an effective treatment choice for unstable intertrochanteric femoral fracture in older patients.

Is Dynamic Condylar Screw Better Than (95°) Blade Plate in Management of Subtrochanteric Fracture of Femur?

Background: Subtrochanteric fractures account for approximately 10-30% of all hip fractures, affecting persons of all ages and should be internally fixed to reduce the morbidity and mortality by early rehabilitation and mobilization. A dynamic condylar screw (DCS) and a 95° angle blade plate (BP) provide a good choice for fixation of subtrochanteric fractures so it is a matter of debate that which one is the best fixation in such fractures. Objective: To evaluate the surgical treatment of subtrochanteric fracture of femur using DCS versus a 95° BP. Methods: Prospective comparative study of 40 patients conducted in Al-Imamein Al-Kadhimein Medical City from November 2015 to November 2017. Twenty patients treated with open reduction and internal fixation by using DCS and other twenty patients treated with open reduction and internal fixation by using a 95° BP. The mode of injury, site and type of fracture, age of patients, operating time, and blood loss, union rate, complication of implants, functional results were compared between the groups. Results: Out of 40 patients, there were 26 (65%) male, right side affected in 24 (60%) patients. Mechanism of injury was trivial trauma observed in 28 (70%) patients. According to a Russell-Taylors classification, majority of fractures are type IB that observed in 16 (40%) patients. Majority of the patients, 27 (67.5%), started full weight bearing at 14 weeks. There was no significant mean age difference between the two groups (p=0.7). The mean operation time of DCS (83±4.3 min) was lower significantly than of 95° BP (p&lt;0.001). Mean blood loss from DCS variety (365±63 cc) was lower significantly than of 95° BP (p=0007). Infection occurred less frequently significantly in patients who treated by DCS than those treated by 95° BP (p=0.03). There was no association between types of open reduction and internal fixation treatment variety and functional result according to the modified Harris hip score (p=0.52). Conclusion: DCS better than 95ᵒ BP because of its technically easier, possibility to correct reduction even after insertion, less perioperative complication and earlier weight bearing. Keywords: Subtrochanteric fractures of femur, dynamic condylar screw, 95ᵒ BP Citation: Joda AI, Chhaily ZA, Abd Ali AS, Rahee LS. Is dynamic condylar screw better than (95°) blade plate in management of subtrochanteric fracture of femur? Iraqi JMS. 2020; 18(2): 123-129. doi: 10.22578/IJMS.18.2.6

Congenital hypertrophy of retinal pigment epithelium presenting as incidental finding in a middle aged woman

Introduction: Retinal Pigment epithelial hypertrophy are uncommon benign, epithelial malformation characterised by typical fundus findings, which is almost always congenital in nature. RPE hypertrophy occurs in three varieties: unifocal, unilateral lesion; multifocal unilateral lesion; and atypical multifocal, bilateral lesion. While the atypical multifocal, bilateral lesions are associated with familial adenomatous polyposis syndrome & requires systemic evaluation the other two varieties have benign coarse & doesnot require any intervention. Case Report: A 42yr Female noticed diminished vision in R/E following trivial trauma with fingernail 14 days back, it was not associated with pain, redness or any other symptoms. On evaluation, BCVA was 6/18p, N6 R/E & 6/6, N6 L/E; rest anterior segment evaluation was normal. R/E fundus showed focal, 1 DD sized, well-demarcated, hyperpigmented lesion just temporal to fovea with blocked fluorescence in all phase of FFA. OCT & B-scan showed slightly elevated retinal lesion with optical shadowing. Diagnosis of Retinal pigment epithelial hamartoma (RPEH) was made. Lesion was documented & followed. Discussion and Conclusion: RPE hypertrophy are presumed congenital stationary retinal malformation with characteristic ophthalmic, fluorescerin angiographic & OCT features. These lesions present as asympotomatic incidental findings in childhood or adults with good visual prognosis if located at extrafoveal sites. Gass et al & shields et al had described various types of RPE malformations & their characteristic features in FFA & OCT. In present case, we have reported a rare case of RPEH & also demonstrated the role of ancillary tests for diagnosis & followup. Keywords: Congenital retinal pigment epithelial hypertrophy, RPE hypertrophy, Congenital retinal malformation.

Serum osteocalcin: A potential biomarker for primary osteoporosis

Osteoporosis is a silent killer usually asymptomatic and noticed only after a fracture. Women irrespective of their origin and social strata show an accelerated phase of bone loss, for about 10 yrs after the cessation of ovarian function due to hormonal imbalance. Until now for the diagnosis of osteoporosis Bone mineral density (BMD) and DEXA was used, which is costly hence bone turns over markers have come to vogue in suggesting the risk of osteoporotic fractures. Objectives of the Study: To assess the potentiality of serum osteocalcin as a diagnostic tool for osteoporosis in post menopausal women and thus overcome the risk of fractures. Materials and Methods: This study was conducted on 50 apparently healthy pre menopausal women and 50 postmenopausal women with immediate fractures sustained as a result of trivial trauma. Results: The mean serum osteocalcin level was (2.63 ± 1.76) in the post menopausal women with fractures as compared to the pre menopausal women (5.55 ± 2.92) which was statistically significant. (p value Conclusion: Osteocalcin is a highly sensitive bone formation marker and can be used as a diagnostic or screening tool in post menopausal women for Osteoporosis. The decreased serum osteocalcin levels after menopause could hence predict and prevent the risk of fractures. Keywords: Osteocalcin, Pre-menopausal women, Postmenopausal women with fractures, Calcium, Phosphorous, Alkaline phosphatase, Total protein, Albumin and osteoporosis.