Neighbourhood characteristics influence infant mortality above and beyond individual/household factors. In India, there are very few studies discussing the effects of neighbourhood characteristics on infant mortality....Neighbourhood characteristics influence infant mortality above and beyond individual/household factors. In India, there are very few studies discussing the effects of neighbourhood characteristics on infant mortality. This study examined the effect of neighbourhood socioeconomic characteristics on infant mortality using data from the India’s Third District Level Household Survey conducted in 2007-2008. Multilevel analyses applied on the representative sample of 168,625 nested within 14,193 communities using MCMC procedure. Results established that place of residence, neighbourhood socio-economic factors as important determinants of infant mortality. Overall, being born in affluent (OR: 0.79, p < 0.01), more educated (OR: 0.86, p < 0.01) and socially disadvantaged caste (OR: 0.83, p < 0.01) neighbourhood was associated with the significant reduction in hazards of infant death. The finding of this study suggests that effort should be made to reduce infant mortality in these high focus states by including policies which aim at improving infant survival in the neighbourhood that is economically and socially deprived.展开更多
Purpose： The treatment of high-energy tibial condylar fractures which are associated with severe soft tissue injuries remains contentious and challenging. In this study, we assessed the results of Joshi＇s external s...Purpose： The treatment of high-energy tibial condylar fractures which are associated with severe soft tissue injuries remains contentious and challenging. In this study, we assessed the results of Joshi＇s external stabilization system （JESS） by using the principle of ligamentotaxis and percutaneous screw fixation for managing high-energy tibial condylar fractures associated with severe soft tissue injuries. Methods： Between June 2008 and June 2010, 25 consecutive patients who were 17-71 years （mean, 39.7）, underwent the JESS fixation for high-energy tibial condylar fractures associated with severe soft tissue injuries. Out of 25 patients, 2 were lost during follow-up and in 1 case early removal of frame was done, leaving 22 cases for final follow-up. Among them, 11 had poor skin condition with abrasions and blisters and 2 were open injuries （Gustilo-Anderson grade I ＆ 11）. The injury mechanisms were motor vehicle accidents （n - 19）, fall from a height （n = 2） and assault （n - 1）. The fractures were classified according to Schatzker classification system. Results： There were 7 type-V, 14 type-Vl and 1 type-IV Schatzker＇s tibial plateau fractures. The average interval between the injury and surgery was 6.8 days （range 2-13）. The average hospital stay was 13 days （range, 7-22）. The average interval between the surgery and full weight bearing was 13.6 weeks （range 11-20）. The average range of knee flexion was 121° （range 105°-135°）. The normal extension of the knee was observed in 20 patients, and an extensor lag of 5°-8° was noted in 2 patients. The complications included superficial pin tract infections （n 4） with no knee stiffness. Conclusion： JESS with lag screw fixation combines the benefit of traction, external fixation, and limited internal fixation, at the same time as allowing the ease of access to the soft tissue for wound checks, pin care, dressing changes, measurement of compartment pressure, and the monitoring of the neurovascular status. In a nutshell, JESS along with screw fixation offers a promising alternative treatment for high- energy tibial condylar fractures associated with severe soft tissue injuries.展开更多
Purpose: Defects aro und the distal one third of the leg and ankle are difficult to man age by con servative measures or simple split thickness skin graft. Distally based peroneus brevis muscle flap is a well describe...Purpose: Defects aro und the distal one third of the leg and ankle are difficult to man age by con servative measures or simple split thickness skin graft. Distally based peroneus brevis muscle flap is a well described flap for such defects. Methods: This is a retrospective analysis conducted on 25 patients with soft tissue and bony defects of distal third of lower leg and an kle, which were treated using distally based per on eus brevis muscle flap from January 2013 to January 2018. Information regarding patient demographics, etiology, size and location of defects and complications were collected. All patients were followed up for at least 3 months after surgery. Results: There were 21 males and 4 females with the mean age of 39 (5-76) years. The most comm on cause of injuries was road traffic accident, followed by complicated open injury. The average size of defects was 20 (4—50) cm^2. The mean operating time was 75 (60-90) min for flap harvest and inset. We had no patient with complete loss of the flap. Five patients (20%) had marginal necrosis of the flap and two patie nts have graft loss due to un derlyi ng hematoma and required sec on dary split thickness skin grafting. Conclusion: The distally based peroneus brevis muscle flap is a safe optio n w 让h reliable an atomy for small to moderate sized defects following low velocity injury around the ankle. The commonest complication encountered is skin graft loss which can be reduced by primary delayed grafting.展开更多
文摘Neighbourhood characteristics influence infant mortality above and beyond individual/household factors. In India, there are very few studies discussing the effects of neighbourhood characteristics on infant mortality. This study examined the effect of neighbourhood socioeconomic characteristics on infant mortality using data from the India’s Third District Level Household Survey conducted in 2007-2008. Multilevel analyses applied on the representative sample of 168,625 nested within 14,193 communities using MCMC procedure. Results established that place of residence, neighbourhood socio-economic factors as important determinants of infant mortality. Overall, being born in affluent (OR: 0.79, p < 0.01), more educated (OR: 0.86, p < 0.01) and socially disadvantaged caste (OR: 0.83, p < 0.01) neighbourhood was associated with the significant reduction in hazards of infant death. The finding of this study suggests that effort should be made to reduce infant mortality in these high focus states by including policies which aim at improving infant survival in the neighbourhood that is economically and socially deprived.
文摘Purpose： The treatment of high-energy tibial condylar fractures which are associated with severe soft tissue injuries remains contentious and challenging. In this study, we assessed the results of Joshi＇s external stabilization system （JESS） by using the principle of ligamentotaxis and percutaneous screw fixation for managing high-energy tibial condylar fractures associated with severe soft tissue injuries. Methods： Between June 2008 and June 2010, 25 consecutive patients who were 17-71 years （mean, 39.7）, underwent the JESS fixation for high-energy tibial condylar fractures associated with severe soft tissue injuries. Out of 25 patients, 2 were lost during follow-up and in 1 case early removal of frame was done, leaving 22 cases for final follow-up. Among them, 11 had poor skin condition with abrasions and blisters and 2 were open injuries （Gustilo-Anderson grade I ＆ 11）. The injury mechanisms were motor vehicle accidents （n - 19）, fall from a height （n = 2） and assault （n - 1）. The fractures were classified according to Schatzker classification system. Results： There were 7 type-V, 14 type-Vl and 1 type-IV Schatzker＇s tibial plateau fractures. The average interval between the injury and surgery was 6.8 days （range 2-13）. The average hospital stay was 13 days （range, 7-22）. The average interval between the surgery and full weight bearing was 13.6 weeks （range 11-20）. The average range of knee flexion was 121° （range 105°-135°）. The normal extension of the knee was observed in 20 patients, and an extensor lag of 5°-8° was noted in 2 patients. The complications included superficial pin tract infections （n 4） with no knee stiffness. Conclusion： JESS with lag screw fixation combines the benefit of traction, external fixation, and limited internal fixation, at the same time as allowing the ease of access to the soft tissue for wound checks, pin care, dressing changes, measurement of compartment pressure, and the monitoring of the neurovascular status. In a nutshell, JESS along with screw fixation offers a promising alternative treatment for high- energy tibial condylar fractures associated with severe soft tissue injuries.
文摘Purpose: Defects aro und the distal one third of the leg and ankle are difficult to man age by con servative measures or simple split thickness skin graft. Distally based peroneus brevis muscle flap is a well described flap for such defects. Methods: This is a retrospective analysis conducted on 25 patients with soft tissue and bony defects of distal third of lower leg and an kle, which were treated using distally based per on eus brevis muscle flap from January 2013 to January 2018. Information regarding patient demographics, etiology, size and location of defects and complications were collected. All patients were followed up for at least 3 months after surgery. Results: There were 21 males and 4 females with the mean age of 39 (5-76) years. The most comm on cause of injuries was road traffic accident, followed by complicated open injury. The average size of defects was 20 (4—50) cm^2. The mean operating time was 75 (60-90) min for flap harvest and inset. We had no patient with complete loss of the flap. Five patients (20%) had marginal necrosis of the flap and two patie nts have graft loss due to un derlyi ng hematoma and required sec on dary split thickness skin grafting. Conclusion: The distally based peroneus brevis muscle flap is a safe optio n w 让h reliable an atomy for small to moderate sized defects following low velocity injury around the ankle. The commonest complication encountered is skin graft loss which can be reduced by primary delayed grafting.
