Author Archives: pisrt

Abstract:Background: Fractures of the proximal humerus are extremely common, and these are true osteoporotic fractures. Due to rich vascularity and broad cancellous surfaces most of these fractures can be effectively treated nonoperatively as this imparts a high propensity for healing. In addition, many of these fracture patterns result in adequate bone contact and minimal displacement with acceptable alignment. For displaced fractures open reduction and internal fixation can improve outcomes, depending on the pre-injury functional status of the patient. Unique operative treatment challenges include obtaining and maintaining reduction of small bone fragments with strong muscle forces especially in osteoporotic bone. Many options are feasible, including plates, nails, sutures, and other novel devices. Now locking plates are being used more commonly and for a successful result technical details are critical and this minimizes loss of reduction, the risk of implant failure, and reoperation. To our knowledge, very few studies were done on the outcome of operative treatment of these osteoporotic fractures.
Material and Methods: During this observational study, we analyzed all operatively treated proximal humerus fractures between January 2015 and December 2020. Patient selection was on clinical grounds, based on physical, mental, and social criteria. To investigate functional outcome, pain, and ADL limitations we used the DASH Questionnaire. Documented complications were also evaluated.
Results: There were total of 128 patients with displaced proximal humerus fractures treated surgically: 30 two-part, 64 three-part, and 34 four-part fractures. Mean DASH scores were 37.5, 36.9, and 48.6, respectively. Overall good results were obtained with the modern locking plates (mean DASH 34.4). In highly comminuted fractures prosthetic treatment were used and this resulted in poorer function (mean DASH 72.9). Again in this sub group persistent pain and ADL limitations were more present (64 and 50% in patients with 4-part fractures vs. 14% in 2-part fractures). Fracture-related and non-fracture-related complication rates were low (non-union 3%; 2 myocardial infarction) and there were no postoperative deaths within 3 months of surgery.
Conclusion: It is justifiable to consider surgical treatment in selected comminuted dislocated proximal humerus fractures in patients aged 75 and older.

Abstract:The SARS-CoV-2 virus has had a significant impact on a major part of the world, with kidneys being identified as a major target for infection. The incidence of acute kidney injury (AKI) associated with COVID-19 has been reported to range from 5% to 40% worldwide. Pre-existing renal dysfunction has been identified as a risk factor for adverse outcomes. This observational study aimed to analyze the impact of COVID-19 on kidneys in Indian patients hospitalized with various presentations of the disease. A total of 300 adult hospitalized patients with COVID-19 were included, and baseline clinical and laboratory data were analyzed. Follow-up was conducted after 3 months to assess the frequency and outcomes of renal dysfunction in patients with or without previous renal disease. The study found that the mean age of the patients was 37.15 \(\pm\) 9.78 years. The incidence of AKI was 12%, of which 80.6% of patients normalized their renal functions, while 8.30% progressed to chronic kidney disease (CKD). The mortality rate among these patients was 11.1%. Among the patients with pre-existing CKD, 66.6% experienced worsening renal function and 33.3% died. Additionally, 44.4% of these patients required hemodialysis. In conclusion, renal involvement was common among hospitalized COVID-19 patients, and outcomes were worse for patients with pre-existing CKD. The need for hemodialysis increased with disease severity and in patients with pre-existing CKD.

Abstract:David Barker proposed the hypothesis of the “Fetal origin of cardiovascular disease” in 1995, suggesting that the origins of the disease can be traced back to in-utero conditions and adaptations that occur in undernourished fetuses during middle-to-late gestation. The objective of this hospital-based cross-sectional comparative study, conducted from February 2021 to August 2022, was to compare cord blood lipid profiles between Small for Gestational Age (SGA) and Appropriate for Gestational Age (AGA) full-term newborns. A total of 59 SGA babies were enrolled as the study group, while 59 healthy AGA babies were included as the control group. Written informed consent was obtained, and relevant maternal data were collected. Cord blood samples were collected immediately after delivery and sent for lipid profiling. All babies were examined, and anthropometric variables were recorded, and they were classified into SGA or AGA using AIIMS Intrauterine growth charts and Ponderal index. Comparisons of cord blood lipid profile parameters were made between neonatal groups based on gestational age. The study found that Total Cholesterol (TC) and Triglycerides (TG) levels were significantly higher in SGA babies compared to AGA babies. However, the differences in other parameters, such as High-Density Lipoprotein (HDL) and Low-Density Lipoprotein (LDL), were statistically insignificant between the two groups. The findings suggest that SGA neonates have elevated lipid profiles compared to AGA neonates, indicating that maternal changes during gestation may have a significant impact on neonatal lipid metabolism. Therefore, close monitoring for cardiovascular morbidities early in life is recommended for SGA newborns.

Abstract:Background: In pandemic situations, it is essential that the limited resources are used judiciously to achieve most benefits. Prediction of the disease severity at the earliest will help in better allocation, thus, positively affecting prognosis and treatment.
Aim and objective: To investigate patient characteristics and specific biomarker IL 6 as possible early predictors of disease severity of SARS-COV-2 infection.
Material and Methods: Retrospective single-centric record based observational study conducted at intensive care unit of tertiary care hospital in Central , India. 124 consecutive RT-PCR positive coronavirus disease-2019 (COVID-19) adult patients. Demographics, and Inflammatory markers were compared with respect to severity of disease.
Results: The study involved 124 individuals who were affected, out of which 32 patients were categorised as having severe disease, while the remaining 92 patients were categorised as having non-severe disease. Male gender was the predominant demographic in both the severe group. all the symptomps are observed more in frequency among severe group. Immune-inflammatory Markers such as IL-6 The mean value of interleukin-6 in NS-Group patients was 17.6792 27.08 pg/ml, while in S-Group patients it was 97.6515 96.032 pg/ml.
Conclusion: Our study found that high peripheral blood IL-6 levels independently predict COVID-19 severity.IL-6 affected COVID-19 severity and may have been useful for monitoring severe cases. It emphasizes the cytokine storm in COVID-19 progression and suggests IL-6 blockade for severe patients.

Abstract:Gallstone disease is a prevalent condition affecting 3-20% of the global population. While the majority of gallstones are asymptomatic, a small percentage of patients develop symptoms requiring cholecystectomy. The classification of gallstones includes cholesterol, pigment, and mixed types, with ongoing debates regarding the association of hyperlipidemia with gallstone formation. However, there is a lack of information regarding the relationship between abnormal lipid profiles and the biochemical analysis of gallstones. Therefore, this study aimed to assess the association between serum lipid profiles and the biochemical analysis of gallstones in patients with cholelithiasis. A total of 100 patients diagnosed with gallbladder stones were included in the study, and preoperative samples were collected for lipid profile analysis. The patients underwent either open or laparoscopic surgery, and their gallstones were sent for biochemical analysis. The findings revealed that cholesterol stones were the most common type observed. The overall prevalence of hyperlipidemia was 48%, and a significant association was found between hyperlipidemia and the cholesterol content of stones. In particular, the prevalence of hyperlipidemia was 54.3% in pure cholesterol stones, 48.8% in mixed stones, and 23.1% in pigmented stones. Moreover, there was a significant association between blood cholesterol levels and cholesterol stones, with a prevalence of 39.1% in pure cholesterol stones, 19.5% in mixed stones, and 7.7% in pigmented stones. However, no association was observed between triglyceride, LDL, and HDL levels with the composition of stones in cholelithiasis cases. In conclusion, this study highlights a significant association between blood cholesterol levels, hyperlipidemia, and the cholesterol content of gallstones, suggesting that hyperlipidemia, particularly raised cholesterol levels, can be considered a major risk factor in cholelithiasis.

Abstract:Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation and systemic involvement. The management of RA has evolved over the years, with early diagnosis and rapid achievement of remission being the primary goals. In this prospective observational study conducted at the Department of Radio-diagnosis, Baroda Medical College and Hospitals, Vadodara, Gujarat, we aimed to evaluate the pathological involvement of hand and wrist joints in patients with rheumatoid arthritis using ultrasonography (USG) and color Doppler. A total of 32 diagnosed RA patients were included, and their clinico-pathological scores were assessed. The most common ultrasonographic finding in the examined wrist joints was joint synovitis, with the radio-carpal joint being the most frequently involved. Among the small joints of the hand, synovitis and erosions were commonly observed, with the second metacarpophalangeal joint showing the highest involvement. Comparison with clinical disease activity using the Disease Activity Score 28 (DAS-28) revealed that patients with higher DAS-28 scores had a higher incidence of pathological changes in hand and wrist joints on USG. The use of power Doppler ultrasound allowed for the monitoring of disease activity, with increased doppler signals observed in joints of patients with high disease activity. These findings were consistent with previous studies showing correlations between DAS-28 scores and ultrasound findings. Ultrasonography and color Doppler proved to be reliable tools for visualizing pathological processes in RA patients, with synovitis grading and power Doppler grading demonstrating good correlations with disease activity. In conclusion, ultrasonography and color Doppler can be valuable in assessing and monitoring rheumatoid arthritis, enabling early detection and accurate evaluation of joint involvement.

Abstract:Introduction: Congenital Talipes EquinoVarus/Clubfoot is a common structural congenital deformity affecting approximately 1 in 1000 live births. The choice of operative procedures for clubfoot management depends on factors such as patient age, rigidity of deformity, and severity. However, there is a lack of consensus regarding the optimal surgical approach, whether comprehensive release or minimal staged surgery. This study aims to evaluate the outcomes of percutaneous tendon release and posteromedial soft tissue release for the treatment of relapsed, neglected, syndromic, and postural clubfoot. The corrective casts applied are assessed using the Pirani scoring system, podography, radiological imaging, and functional evaluation based on Laaveg Ponseti and Cummings scores.
Material and Methods: This prospective observational study was conducted in the Department of Orthopaedics at Netaji Subhash Chandra Bose Medical College, Jabalpur, over an 18-month period. A total of 27 clubfoot patients with 33 affected feet, ranging from 6 months to 7 years old, were included after meeting the inclusion and exclusion criteria. Detailed history, examination, and required investigations were performed and recorded. Patients were treated accordingly and followed up at regular intervals. Data was collected, compiled, and analyzed using SPSS 22.0.
Results: The majority of participants (37%) were in the age group of 6-11 months, with males constituting the majority (66.7%). The study included patients with relapsed clubfeet (n=18) and neglected clubfeet (n=9). Right foot involvement was more prevalent than left foot involvement. Pre- and post-operative measurements showed significant associations between Pirani scores, talocalcaneal angles, tibiocalcaneal angles, and talocalcaneal indices. The mean change in Pirani score was 4.04, and podographic measurements demonstrated increased foot bimalleolar angles. Functional assessment using Laaveg Ponseti and Cumming’s Functional Score indicated good to excellent outcomes in the majority of participants.
Conclusion: Percutaneous tendon release surgery with corrective cast application is a safe, effective, and low-risk method for correcting relapsed clubfoot. Posteromedial soft tissue release, along with corrective cast application, remains the best option for neglected clubfoot, despite the potential risks of neurovascular and wound complications. These preliminary results, with an average follow-up of 1 year, suggest that soft tissue release surgery for neglected clubfoot and percutaneous tendon release for relapsed clubfoot, along with corrective casting in both methods, yield good to excellent outcomes.