A review of upper limb injuries in bear maul victims: Consistent pattern and inverse relation in severity with facial and scalp injuries.

PURPOSE: Bear maul injuries are the most common wild animal inflicted injuries in India. More than 300 bear maul injuries report to our hospital per year. METHODS: Twenty-one consecutive patients over a period of 1 year reported to our department for orthopaedic management of bear maul injuries. All the patients were referred either from peripheral hospitals or from other surgical departments of our hospital. RESULTS: All the patients had facial/scalp injuries of variable severity. In all the patients the severity of limb and facial trauma was inversely proportional to each other. Pattern of upper limb trauma in most of the patients was similar. Fifteen patients had either fractures of distal humerus or mid shaft/proximal forearm bone fracture. Two had distal forearm bone fracture, 2 had carpal/metacarpal fractures and 1 had clavicle fracture. Only 1 had lower limb fracture. Thirteen out of 21 patients had associated neurovascular injury of the involved limb. The characteristic feature was extensive soft tissue involvement of the affected limb. CONCLUSION: Upper limb injuries in bear maul patients usually have similar pattern. The severity of upper limb and facial/scalp trauma is inversely proportional to each other. Multistage orthopaedic surgeries are needed for such complex limb injuries.

Impending gangrene of fingers by constriction bands of mother's hair mistaken as pernio by parents: A case series of 10 infants.

BACKGROUND: Long harsh winter in Kashmir Valley increase the incidence of pernio in children so much that common people consider every hand swelling as pernio. METHODS: 10 Infants over two years were brought to our hospital as cases of pernio involving fingers. RESULTS: All the infants came out to be cases of impending gangrene due to mother's hair as constriction bands around fingers. CONCLUSION: Impending gangrene of fingers in infants due to mother hair as constriction band is very rare. However its symptoms overlap with symptoms of peripheral cold injuries and can be easily mistaken for each other by people.

Management of humeral fracture nonunion in severe osteoporosis by a combination of locking plating and intramedullary fibular grafting.

Nonunion of the humerus in a severely osteoporotic bone is a likely event especially if the fracture is transverse. The management of such a combination is a challenge. Most of the conventional fixation methods are unlikely to succeed as the bone failure precedes implant failure in osteoporosis. The challenge is further compounded in severe osteoporosis when the cortical thickness is affected more severely. We used a combination of an intramedullary fibula with a locking plate in 5 cases. The results show that it may be a good combination in such situations as the bone strength is augmented and the plate pullout is less likely.

Prevalence of hepatitis B virus in the Kurram Agency, Pakistan: A 5-year observational study in a war-affected region.

BACKGROUND: Hepatitis B is an inflammatory liver illness caused by the hepatitis B virus. The exact magnitude and extent of the hepatitis B virus in Pakistan is still unknown, but at least 10 million people are estimated to be infected with chronic hepatitis B virus. OBJECTIVES: The objective of this study was to determine the seroprevalence of hepatitis B surface antigen (HBsAg) in the war-affected area since 2009. STUDY DESIGN: Observational study. RESULTS: A total of 4922 healthy subjects were tested for the detection of HBsAg during 2009-2013, and 14.95% subjects were found to be reactive for HBsAg. The highest seroprevalence (26.0%) of HBsAg was found in those individuals who were less than 35 years of age. Male subjects were more affected (16.6%) than females. The seroprevalence of HBsAg was significantly associated with <35 years of age and male gender (P<0.005 for both). Moreover, an increasing trend over 5 years was observed, as 8.6% subjects were positive for HBsAg in 2009 and subsequently 10.4% in 2010, 14.6% in 2011, 18.9% in 2012, and 21.7% were reactive for HBsAg in 2013. CONCLUSION: This study concluded that HBsAg was more prevalent in the war-affected region. The prevalence rate was increasing with time as the highest rate was found in 2013. Present observations will help to provide the background for awareness and bring the increasing levels of hepatitis B to the attention of health professionals and government authorities in order to increase the capacity of the health systems in such troubled areas.

Evaluation of low-cost custom made VAC therapy compared with conventional wound dressings in the treatment of non-healing lower limb ulcers in lower socio-economic group patients of Kashmir valley.

BACKGROUND: Negative-pressure wound therapy is a technique to achieve wound healing in patients with non-healing wounds of the lower limb; vacuum-assisted closure (VAC) therapy is a technique to accelerate the healing of non-healing ulcers that fail to heal on their own (primary healing) (Plast Reconstr Surg 117:193-209S, 2006). Delayed wound healing or non-healing of ulcers is a significant health problem, particularly in older adults. The efficacy of VAC dressings has been demonstrated in several randomized controlled studies, which have shown significantly faster wound healing rates compared to conventional wound therapy (Lancet 366:1704-10, 2005; J Wound Care 17:426-32, 2008). However, commercially available VAC is costly. The aim of using custom made VAC was decided by our team due to lower socio-economic status of patients taken for study who could not have afforded charges of commercially available VAC unit. OBJECTIVE: Objective was to evaluate VAC therapy compared with conventional dressings in the treatment of non-healing lower limb ulcers in lower socio-economic patients. METHODS: Sixty patients of lower socio-economic status aged between 40 and 70 were prospectively studied for non-healing ulcers Wagner grade 2 or 3 and randomized into 2 groups. VAC dressing was kept for over a period of 2-7 weeks. Ulcers were treated until the wound closed spontaneously, surgically or until completion of the 50-day period, whichever was earlier. RESULTS: By seventh week, discharge disappeared in 96 % in VAC and only 54 % in conventional dressing group. Granulation tissue appeared in 100 % of patients in VAC group and only 63 % in conventional dressing group. The patients treated with VAC dressing in our study showed comparable wound reduction capabilities with an average wound size reduction of 56 % in comparison to conventional dressing group which had average wound size reduction of 29 %. Majority of wounds in VAC group got closed in 7 weeks. Patient satisfaction was excellent in the majority of patients in VAC group compared to those in conventional dressing group. CONCLUSION: The application of VAC™ had shown good results in our study.

Analytical variables influencing the HCV RNA determination by TaqMan real-time PCR in routine clinical laboratory practice.

Hepatitis C virus (HCV) quantification is used as a prognostic marker for treatment success. In a routine clinical laboratory some infinitesimal sample handling factors can contribute to variability and loss of precision in HCV quantification. This may include blood collection tubes, blood drawing procedure, sample processing and storage temperatures. In current study blood was collected in tubes with different anticoagulant type (spray vs. liquid), group 1, blood was drawn with possible suck of methylated spirit through needle (experimental group) while avoiding the methylated spirit suck (control group) group 2, plasma separation was delayed from 0 to 60 min for group 3, plasma storage at different temperatures group 4. All samples were analyzed using Corbett research real time PCR system using AJ Roboscreen Kit. Mean viral load difference between spray vs. liquid was found 3.6 × 10(5) IU/ml (p < 0.001). Methylated spirit inhibited the viral load quantification with a value of 4.8 × 10(5) IU/ml (p < 0.001). Mean viral load difference was found 1.2 × 10(5) IU/ml (p < 0.05). Delay in centrifugation from 0 to 60 min and plasma placement at 25 °C for 15 min before freezing had no effect (p = 0.5996). Plasma storage temperature at -80 and -20 °C did not affect significantly on RNA levels (p > 0.05). In conclusion blood collection tubes and procedures can be a key factor in variability of results, that might affect the treatment response decision.