Urine Specific Gravity Measurement for Fluid Balance in Neonates on Intravenous Fluids in a Neonatal Intensive Care Unit: An Open Label Randomized Controlled Trial.

Background: Urine specific gravity reflects hydration status and correlates well with urine osmolality. OBJECTIVE: To compare intravenous fluid therapy guided with and without inclusion of urine specific gravity to the standard parameters for maintaining postnatal weight loss within permissible limits in neonates admitted to the intensive care unit. METHODS: An open-label randomized controlled trial was conducted, including neonates requiring intravenous fluids for ≥72 hours, randomized into the study (urine specific gravity guided fluids) and control arms. The outcomes of the study were to determine proportion of neonates with weight loss within permissible limits, mean percentage weight loss and number of days to reach maximum weight loss. RESULTS: 80 preterm and term neonates (40 in each arm) were enrolled. A comparable proportion of neonates had weight loss within permissible limits in study arm and in control arms [39 (97.5%) vs 36 (90%); P=0.165]. The (mean (SD) percentage weight loss was significantly less in the study arm compared to control arm [All neonates: 7.2(2.6) vs 9.3(3.5); P=0.004); preterm neonates: 7.7 (2.8) vs 11 (3.9); P=0.008)]. Preterm neonates in the study arm attained nadir weight significantly earlier than in the controls (P=0.03) and attained complete enteral feeding earlier. Urine specific gravity showed a moderate negative correlation with the percentage weight loss. CONCLUSION: Using urine specific gravity to regulate intravenous fluids in neonates resulted in a significant reduction in postnatal weight loss, especially in preterm neonates.

Prospective randomised comparison of ring versus rail fixator in infected gap nonunion of tibia treated with distraction osteogenesis.

AIMS: This is a prospective randomised study which compares the radiological and functional outcomes of ring and rail fixators in patients with an infected gap (> 3 cm) nonunion of the tibia. PATIENTS AND METHODS: Between May 2008 and February 2013, 70 patients were treated at our Institute for a posttraumatic osseocutaneous defect of the tibia measuring at least 3 cm. These were randomised into two groups of 35 patients using the lottery method. Group I patients were treated with a ring fixator and group II patients with a rail fixator. The mean age was 33.2 years (18 to 64) in group I and 29.3 years (18 to 65) in group II. The mean bone gap was 5.84 cm in group I and 5.78 cm in group II. The mean followup was 33.8 months in group I and 32.6 months in group II. Bone and functional results were assessed using the classification of the Association for the Study and Application of the Method of Ilizarov (ASAMI). Functional results were also assessed at six months using the short musculoskeletal functional assessment (SMFA) score. RESULTS: The bone result was excellent, good, fair and poor in 21, 12, 0 and 2 in group I; and 14, 15, 3, and 3 in group II, respectively. The functional results were excellent, good, fair, poor and failure in 16, 17, 1, 0 and 1 in group I; and 22, 10, 0, 3 and 0 in group II, respectively. Both fixator systems achieved comparable rates of union and functional outcomes. The rate of deep pintract infection was significantly higher in the rail fixator group but patients found it more comfortable. CONCLUSION: We recommend the use of a ring fixator in patients with a bone gap of more than 6 cm. Patients with a bone gap up to 6 cm can be managed with either a ring or rail fixator. Cite this article: Bone Joint J 2016;98B:1399-1405.

Compressive peroneal neuropathy during harvesting season in Indian farmers.

Thirty patients (34 limbs) with compressive peroneal neuropathy induced by prolonged squatting of more than 5 h during harvesting season were treated conservatively and followed-up to an average of 28.2 months. A marked preponderance of involvement of the left side was noticed. We attribute this to the intermittent extension of the right lower limb habitually used by Indian farmers to propel themselves forwards while squatting during harvesting. All but two lesions recovered fully within 3 to 9 weeks: one patient took 16 and another 20 weeks. We recommend non-operative treatment for this benign lesion.

Medial opening wedge high tibial osteotomy for osteoarthritis of knee: long-term results in 50 knees.

To retrospectively study the long term results of high tibial valgus osteotomy in management of primary medial compartment osteoarthritis, with special reference to patient satisfaction and functional assessment, we conducted this study in radiologically established 50 knees of patients with primary osteoarthrosis of knee. In these patients with medial compartment disease (varus knee), medial open wedge osteotomy was performed using full thickness iliac crest grafts. These were called for follow-up after average 7.5 years and clinico-radiological assessment was done. Although many surgeons of the west do not favour this osteotomy, we found the procedure to be quite acceptable to our patients in whom the primary concerns of cost and squatting habits are well taken care of. The authors feel that this osteotomy is still relevant in the third world. Results do deteriorate with time but most patients consider the surgery satisfactory.

Critical evaluation of compartment pressure measurement by saline manometer in peripheral hospital setup.

A hundred limbs of patients suffering limb trauma were assessed by at least two different reviewers for symptoms of compartment syndrome, both clinically, and by a simple, locally devised apparatus for pressure measurement. We have found the apparatus to be very effective, safe, reproducible and simple. Orthopaedic surgeons working in peripheral hospitals in the developing world can make use of this apparatus which costs less than 5 dollars to assemble. This technique may assist an early decision regarding surgical decompression at a peripheral hospital or referral to specialist unit, thus saving valuable time and expense.

Cubitus varus--correction by distraction osteogenesis.

Cubitus varus deformity in thirty children was corrected by gradual medial opening wedge osteotomy. The osteotomy was stabilized and distracted by simple external fixator-cum-distractor. The patients of both sexes and age from 6 to 14 years, had varus deformity from 17 degrees to 43 degrees. We achieved good to excellent results in 28 cases as regards to correction of deformity and range of motion at elbow joint. None of the cases had neurological deficit or permanent stiffness. One case had fair result due to under-correction and another case had a poor result as osteotomy united before correction. The main complication faced was superficial pin-site infection particularly in summer season and a in fatty children but was managed by good pinsite dressing and care. The technique has been found to be quite effective, technically simple, cosmetically acceptable and with little, if any, lazy S deformity.

External fixator in the management of trochanteric fractures in high risk geriatric patients--a friend to the elderly.

The best treatment option for trochanteric fracture in a geriatric high risk patient with all associated medical and surgical problems remains debatable. Conservative methods of treatment are associated with dangerous complications of prolonged recumbency while open reduction and internal fixation under anaesthesia significantly increases the mortality and morbidity rates. We treated 110 elderly patients who were unfit or high risk cases for anaesthesia and major surgery for internal fixation due to associated medical and surgical conditions, by external fixation under local anaesthesia. The average age was 65 years and mean follow up was 18 months. 83.3% were ambulatory with support and 97.2% were able to manage activities of daily living at the time of discharge. At 18 months post surgery, 74% were ambulatory with a stick or better. The fracture united in an average of 16.4 weeks. Overall satisfaction rate was 80% at end follow up. The mortality rates were comparable to series of open reduction and internal fixation. Pin tract infection and knee stiffness were the major complications. External fixation done under local anaesthesia offers advantages in the form of a quick, simple relatively inexpensive procedure with negligible blood loss, preserves fracture haematoma, can be easily removed as an out patient procedure, besides it provides earliest possible ambulation and day care to the elderly high risk patient.

Functional restoration by excision arthroplasty in temporomandibular joint ankylosis--a report of 35 cases.

OBJECTIVE: To evaluate the long term functional results of excision arthroplasty in treatment of temporomandibular joint (TMJ) ankylosis. MATERIAL AND METHODS: This retrospective study includes 35 patients of TMJ ankylosis who were treated by excision arthroplasty and followed for a maximum period of eight years after surgery. Past trauma was documented as a major etiological factor in 63% cases. Fibrous ankylosis & unilateral involvement was found to be more common. Peroperatively a gap of 1 1/2 to 2 cm was created. The results were assessed according to a criteria based on inter-incial month opening, deviation of jaw and complications. They were satisfactory in 29 cases and there were 3 recurrences. CONCLUSION: Childhood trauma is a major cause of TMJ ankylosis in India. Long term results of excision arthroplasty are satisfactory & comparable to other surgical modalities that are in vogue, provided the patients are operated when young, the ankylosis is in early stage, gap created is adequate and post operative exercise regimen is followed diligently.

On the effects of family planning communication.

PIP: The results of family planning communication efforts are examined in order to ascertain whether they have succeeded in creating an awareness, motivation, and practice of family planning among the people. Awareness comparisons from the early 1950s when programs first started to the late 1960s shows a vast increase in awareness. The awareness picture was further improved by the use of a national symbol and motto for family planning. However, although many know about family planning few utilize it. For creating interest and making evaluation studies personal contact has been the most effective. Good motivation effects also come from group meetings. It is thus necessary to provide social acceptance to take people from awareness to motivation. Taking action in family planning involves another step and can be improved through communication with contraceptive users and through the use of mass media to create an impression of mass interest. It is concluded that the presence of a favorable climate facilitates definite steps. Leaders can play a useful role by legitimatizing family planning. This effect from leaders has been found to be more often associated with leaders of small groups and communities than national leaders.^ieng

A study in family planning communication-Direct mailing.

It is sometimes stated that direct mailing to individuals in developing countries like India may be wasteful due to the low literacy rate among village people. Direct mailing is a relatively new development in India and comparatively a newer channel of communication. An exploratory study was carried out by the Central Family Planning Institute to test this hypothesis. The observations made showed that direct mailing is practical, controllable, inexpensive, and useful.The information provided by direct mailing seems to cross the barriers of illiteracy. Based on this experience, the Central Family Planning Institute has initiated a large-scale communication action research project in Meerut district in North India where the impact of direct mailing on specific groups is being studied further. It is hoped that such studies would help in developing prototype information material and would provide a methodology to supplement the available channels of communication in a nation-wide family planning program.