Long-term follow-up result of short metaphyseal femoral stem in primary total hip arthroplasty:A retrospective study

BACKGROUND Total hip arthroplasty(THA)has increased along with an increasing demand for improved quality of life.Combined with prolonged life expectancy,the number of revision surgeries is expected to increase.Stress shielding is a significant issue with traditional femoral stems used in THA,making revision surgeries particularly challenging in younger patients.This has sparked renewed interest in studying safety and functional outcomes of short metaphyseal femoral stems,which have the potential to alleviate these challenges and simplify revision surgeries.AIM To evaluate the long-term outcomes of short-stem THA.METHODS A total of 124 hips that underwent THA using the short femoral stem(TRILOCK®Depuy)between May 2006 and November 2008 were included in this study.Patients were followed for a period of 15 years.Outcomes were assessed in terms of pain relief,hip joint range of motion,improvement in mobility,and functional outcomes using the modified Harris Hip Score,Oxford hip score,and Western Ontario and McMaster Universities Osteoarthritis index score.RESULTS A total of 124 hips in 98 patients were evaluated.Significant improvements in functional outcomes were observed over the 15-year follow-up period,with no cases of subsidence,implant loosening,or complications necessitating revision surgery.The only complication reported was heterotopic ossification in 1 patient.CONCLUSION Short metaphyseal stems provide better functional outcomes with early mobilization,and its long-term follow-up without subsidence,implant loosening,or proximal femoral bone loss simplifies revision surgery in younger patients.

Dupuytren’s disease:A review

Dupuytren’s disease is a well-known benign fibroproliferative disorder that affects the palmar and digital fasciae of the hands.This spectrum includes nodule formation,cord formation,and flexion contracture of the digits,which may result in functional limitations.These deformities are often progressive and irreversible.Surgery is a cornerstone therapy.This review discusses the epidemiology,pathophysiology,risk factors,clinical manifestations,and management of Dupuytren’s disease.

COVID-19 mutations:An overview

The severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)belongs to the genus Beta coronavirus and the family of Coronaviridae.It is a positive-sense,non-segmented single-strand RNA virus.Four common types of human coronaviruses circulate globally,particularly in the fall and winter seasons.They are responsible for 10%-30% of all mild upper respiratory tract infections in adults.These are 229E,NL63 of the Alfacoronaviridae family,OC43,and HKU1 of the Betacoronaviridae family.However,there are three highly pathogenic human coronaviruses:SARS-CoV-2,Middle East respiratory syndrome coronavirus,and the latest pandemic caused by the SARS-CoV-2 infection.All viruses,including SARS-CoV-2,have the inherent tendency to evolve.SARS-CoV-2 is still evolving in humans.Additionally,due to the development of herd immunity,prior infection,use of medication,vaccination,and antibodies,the viruses are facing immune pressure.During the replication process and due to immune pressure,the virus may undergo mutations.Several SARS-CoV-2 variants,including the variants of concern(VOCs),such as B.1.1.7(Alpha),B.1.351(Beta),B.1.617/B.1.617.2(Delta),P.1(Gamma),and B.1.1.529(Omicron)have been reported from various parts of the world.These VOCs contain several important mutations;some of them are on the spike proteins.These mutations may lead to enhanced infectivity,transmissibility,and decreased neutralization efficacy by monoclonal antibodies,convalescent sera,or vaccines.Mutations may also lead to a failure of detection by molecular diagnostic tests,leading to a delayed diagnosis,increased community spread,and delayed treatment.We searched PubMed,EMBASE,Covariant,the Stanford variant Database,and the CINAHL from December 2019 to February 2023 using the following search terms:VOC,SARS-CoV-2,Omicron,mutations in SARS-CoV-2,etc.This review discusses the various mutations and their impact on infectivity,transmissibility,and neutralization efficacy.

Clinicopathological spectrum of snake bite-induced acute kidney injury from India

AIM To study the clinico-pathological spectrum of snake bite-induced acute kidney injury(AKI).METHODS A retrospective study of patients admitted at Indira Gandhi Medical College Hospital,Shimla with snake bite-induced AKI from July 2003 to June 2016.Medical records were evaluated for patient's information on demographic,clinical characteristics,complications and outcome.Outcomes of duration of hospital stay,requirement for intensive care unit support,treatment with dialysis,survival and mortality were analyzed.The survival and non survival groups were compared to see the difference in the demographic factors,clinical characteristics,laboratory results,and complications.In patients subjected to kidney biopsy,the findings of histopathological examination of the kidney biopsies were also analyzed.RESULTS One hundred and twenty-one patients were diagnosed with snake bite-induced AKI.Mean age was 42.2 ± 15.1 years and majority(58%) were women.Clinical details were available in 88 patients.The mean duration of arrival at hospital was 3.4 ± 3.7 d with a range of 1 to30 d.Eighty percent had oliguria and 55% had history of having passed red or brown colored urine.Coagulation defect was seen in 89% patients.The hematological and biochemical laboratory abnormalities were:Anemia(80.7%),leukocytosis(75%),thrombocytopenia(47.7%),hyperkalemia(25%),severe metabolic acidosis(39.8%),hepatic dysfunction(40.9%),hemolysis(85.2%) and rhabdomyolysis(68.2%).Main complications were:Gastrointestinal bleed(12.5%),seizure/encephalopathy(10.2%),hypertension,pneumonia/acute respiratory distress syndrome(ARDS) and disseminated intravascular coagulation(9.1% each),hypotension and multi organ failure(MOF)(4.5% each).Eighty-two percent patients required renal replacement therapy.One hundred and ten(90.9%) patient survived and 11(9.1%) patients died.As compared to the survival group,the white blood cell count(P = 0.023) and bilirubin levels(P = 0.006) were significant higher and albumin levels were significantly lower(0.005) in patients who died.The proportion of patients with pneumonia/ARDS(P = 0.001),seizure/encephalopathy(P = 0.005),MOF(P = 0.05) and need for intensive care unit support(0.001) was significantly higher and duration of hospital stay was significantly shorter(P = 0.012) in patients who died.Kidney biopsy was done in total of 22 patients.Predominant lesion on kidney biopsy was acute tubular necrosis(ATN) in 20(91%) cases.In 11 cases had severe ATN and in other nine(41%) cases kidney biopsy showed features of ATN associated with mild to moderate acute interstitial nephritis(AIN).One patient only had moderate AIN and one had patchy renal cortical necrosis(RCN).CONCLUSION AKI due to snake bite is severe and a high proportion requires renal replacement therapy.On renal histology ATN and AIN are common,RCN is rare.

Autologous bone marrow derived stem cell therapy in patients with type 2 diabetes mellitus-defining adequate administration methods

AIM To carry out randomized trial for evaluating effects of autologous bone marrow derived stem cell therapy(ABMSCT) through different routes.METHODS Bone marrow aspirate was taken from the iliac crest of patients. Bone marrow mononuclear cells were separatedand purified using centrifugation. These cells were then infused in a total of 21 patients comprising three groups of 7 patients each. Cells were infused into the superior pancreaticoduodenal artery(Group Ⅰ), splenic artery(Group Ⅱ) and through the peripheral intravenous route(Group Ⅲ). Another group of 7 patients acted as controls and a sham procedure was carried out on them(Group Ⅳ). The cells were labelled with the PET tracer F18-FDG to see their homing and in vivo distribution. Data for clinical outcome was expressed as mean ± SE. All other data was expressed as mean ± SD. Baseline and post treatment data was compared at the end of six months, using paired t-test. Cases and controls data were analyzed using independent t-test. A probability(P) value of < 0.05 was regarded as statistically significant. Measures of clinical outcome were taken as the change or improvement in the following parameters:(1) C-peptide assay;(2) HOMA-IR and HOMA-B;(3) reduction in Insulin dose; subjects who showed reduction of insulin requirement of more than 50% from baseline requirement were regarded as responders; and(4) reduction in HbA 1c. RESULTS All the patients, after being advised for healthy lifestyle changes, were evaluated at periodical intervals and at the end of 6 mo. The changes in body weight, body mass index, waist circumference and percentage of body fat in all groups were not significantly different at the end of this period. The results of intra-group comparison before and after ABMSCT at the end of six months duration was as follows:(1) the area under C-peptide response curve was increased at the end of 6 mo however the difference remained statistically non-significant(P values for fasting C-peptide were 0.973, 0.103, 0.263 and 0.287 respectively and the P values for stimulated C-peptide were 0.989, 0.395, 0.325 and 0.408 respectively for groups Ⅰ?to Ⅳ);(2) the Insulin sensitivity indices of HOMA IR and HOMA B also did not show any significant differences(P values for HOMA IR were 0.368, 0.223, 0.918 and 0.895 respectively and P values for HOMA B were 0.183, 0.664, 0.206 and 0.618 respectively for groups Ⅰto Ⅳ);(3) Group Ⅰshowed a significant reduction in Insulin dose requirement(P < 0.01). Group Ⅱ patients also achieved a significant reduction in Insulin dosages(P = 0.01). The Group Ⅰand Group Ⅱ patients together constituted the targeted group wherein the feeding arteries to pancreas were used for infusing stem cells. Group Ⅲ, which was the intravenous group, showed a non-significant reduction in Insulin dose requirement(P = 0.137). Group Ⅳ patients which comprised the control arm also showed a significant reduction in Insulin dosages at the end of six months(P < 0.05); and(4) there was a non-significant change in the Hb A1 c levels at the end of 6 mo across all groups(P = 0.355, P = 0.351, P = 0.999 and P = 0.408 respectively for groups Ⅰto Ⅳ). CONCLUSION Targeted route showed a significant reduction in Insulin requirement at the end of six months of study period whereas the intravenous group failed to show reduction.

Synthesis and Characterization of Polymeric Composites Embeded with Silver Nanoparticles

Silver nanoparticles were synthesized by chemical reduction method. The Ag nanoparticles (AgNP) were characterized using UV-Vis spectroscopy which shows an absorption band at 420 nm confirming the formation of nanoparticles. For any practical application of the silver nanoparticles it is necessary to stabilize it which can be done by making a composite. In the present studies three polymers were chosen such that AgNP could be put to some practical use. Polyvinyl Alcohol (PVA), Polypyrrole (Ppy) and Carboxymethyl cellulose (CMC) are important for use in textiles, electronics and food/drug technologies respectively. Polymeric composites of PVA, PPy, and CMC were prepared by mixing the aqueous solutions of the respective polymers and the colloidal suspension of preformed silver nanoparticles. Various compositions containing 1% to 5% of Ag nanoparticles were prepared. Thin films of these composites were characterized by UV-Vis spectroscopy, X-ray diffraction and Scanning electron microscopy. X-ray diffraction showed the presence of the peaks at 2θ values of 38.1°, 44.2°, 64.4 and 78.2° corresponding to cubic phase of silver metal. SEM photographs revealed the presence of Ag nanoparticles of sizes varying from 40 to 80 nm. The electrical conductivity of these materials was studied using the four probe method. The conductivity was found to increase from 10–6 for control samples to 10–3 S/cm after the formation of the nanocomposites.

Hodgkin's lymphoma involving extranodal sites:potential association with HIV infection and the implications for clinical management

We commend Li et al.[1]for their article "Clinical characteristics of the patients with Hodgkin’s lymphoma involving extranodal sites" (published in the Chinese Journal of Cancer in July 2012). We agree that in comparison with extranodal non-Hodgkin’s lymphoma(NHL), the incidence of extranodal Hodgkin’s lymphoma(HL) is much rarer and thus described much

Impact of geographical and seasonal temperature on sperm parameters in Indian men who were partners in subfertile couples-A retrospective analysis

Objective:To evaluate the impact of seasonal and geographical temperature on sperm parameters in Indian men who were partners in subfertile couples.Methods:A retrospective review of the records of semen analysis from January 2009 to December 2017 that was performed as part of primary evaluation of infertile couple was undertaken.Mean values of various semen parameters were compared between seasons using one-way analysis of variance test followed by Bonferroni pair wise post-hoc comparison test.Bivariate Pearson correlation coefficient was applied to measure the correlation between age,sperm parameters and annual temperature/seasons.The logistic regression analysis was further carried out to identify significant variables contributing to normal progressive motility of sperm.Results:A total of 3433 reports of semen samples were analysed.There was no significant seasonal variation in the mean volume,concentration,and total motility levels(P>0.05)except the mean values of progressive motility(P<0.001).The mean values of progressive motility during pre-monsoon were significantly higher compared to the corresponding values during monsoon and autumn seasons(P<0.01).In all the seasons,total motility had significant positive correlation with sperm concentration and progressive motility(P<0.05).Pre-monsoon emerged as the significant favourable season to get normal progressive motility level(OR 1.32,95%CI 1.04-1.68)compared to winter.The chances of getting normal progressive motility reduced due to longer abstinence period(OR 0.87,95%CI 0.80-0.93).When the temperature was more than 28℃,the likelihood of getting normal progressive motility decreased(OR 0.70,95%CI 0.51-0.95).Conclusions:The progressive motility of sperms significantly decreases from pre-monsoon to autumn with recovery towards winter,which substantiates the effect of rising temperature on the progressive motility of sperm.This is clinically important to counsel infertile patients,so that they can plan their treatment accordingly.

On the Pair of Equations x+y=z+w,y+z=(x-w)^2

The system of double equations given by x+y=z+w,y+z=(x-w)^2,is studied for obtaining its non-zero distinct solutions in integers.

Isolated gonadotropin deficiency with primary empty sella: Causal or casual association?

Empty sella is a radiological-anatomical entity characterised by a sella turcica filled partially or completely with cerebrospinal fluid, leading to varying degrees of pituitary flattening. Literature reports a 5% - 20% incidence of empty sella in unselected autopsies leading many to argue that its an extreme normal variant. Endocrine dysfunction varies from 8% - 25% with primary empty sella with growth hormone deficiency being most common. However isolated gonadotropin deficiency with normal sized primary empty sella are rare if any. We are reporting a case of isolated gonadotropin deficiency with primary empty sella unable to confirm or refute the association as causal or casual.

Knowledge,attitude,and practices related to medication errors among nursing professionals:a questionnaire-based study in a tertiary care hospital

Objective:To evaluate the level of understanding(knowledge),beliefs(attitude),and behavior(practice)of staff nurses toward medication errors(MEs).Methods:Self-administered questionnaires were distributed to nursing professionals who had at least 1 year of work experience.Each questionnaire contained 19 items assessing“knowledge,”“attitude,”and“practice”attributes toward MEs.Results:Responses from 47 nursing respondents were included for the final analysis.The mean knowledge score was 3.8±1.1(out of 6);66%and 79%of the respondents had awareness of medication repor ting systems and interventions in preventing MEs,respectively.Lack of adequate knowledge in recognizing MEs(P=0.003),or presuming MEs are not as important enough to be reported(P=0.002),was considered as the major reason for under-repor ting of MEs.Nurses with higher knowledge score were against administration of medication through a different route than that prescribed by the physician(P=0.023),and tried to rectify an ME(P=0.020)and stayed with the patient until an oral medication had been swallowed(P=0.037).Conclusions:The nursing professionals were aware of the ME repor ting system and methods to prevent the occurrence of MEs.They also exhibited a positive attitude and followed optimal practices in controlling MEs.

对天疱疮的12年临床治疗经验:54例病例的回顾性研究

Background: Pemphigus, a common immunobullous disease of skin and mucous membranes affecting both sexes of all ages, was almost fatal before the advent of corticosteroids. Better strategies to avoid their side-effects and recent introduc tion of adjuvant therapy has further improved its prognosis. As the treatment re mains need-based and patient-specific, different regimens and strategies have evolved, each with its own merits and demerits. This retrospective hospital-bas ed study was carried out to understand the clinico-therapeutic aspects of pemph igus in our clinic. Methods: Medical records of all new patients admitted to our hospital with the diagnosis of pemphigus from 1990 to 2002 were analyzed. The d iagnosis was mainly clinical and confirmed by positive Tzanck’s test and histopathology. All patients were assessed clinically on a severity score of 1 +to 4+. These patients had received treatment with dexamethasone-cyclophospha mide pulse (DCP) therapy, oral mini-pulse (OMP) with betamethasone, or intramus cular triamcinolone acetonide alone or with azathioprine, dapsone or cyclophosph amide. They were followed up for clinical remission and side-effects of therapy . Results: There were a total of 54 new patients comprising 53.7%females and 46 .3%males, and 12.9%of these were < 18 years of age. Pemphigus vulgaris was the commonest clinical type seen in 81.48%and mucosal involvementwas seen in 63.63 %of cases. The severity of mucosal lesions was not proportionate to that of cut aneous lesions. Associated diseases seen were seropositive rheumatoid arthritis, hypertension, diabetes mellitus and hyperthyroidism in one case each. Dexametha sone-cyclophosphamide pulse therapy was given to 75%of the pemphigus vulgaris patients while those having less severe disease were treated with other regimens . In general, clinical remission was seen after 2-16 (mean 6.5) DCP doses. Two patients have been in complete remission for the last 5 and 7 years of completio n of DCP therapy, respectively. Addition of other adjuvants to corticosteroids w as also helpful. However, azathioprine 50 mg/day was not as effective as cycloph osphamide 50 mg/day. Menstrual irregularities, amenorrhoea, azoospermia, rise in blood pressure and glycosuria were the major side-effects seen during DCP puls e therapy. Drop out rate was unacceptably high with all modes of treatment, alth ough with DCP therapy it appears to be partly owing to early disease control. Th ere was no mortality in this series. Conclusions: Pemphigus vulgaris is the comm onest clinical type. Mucosal surfaces other than the oral cavity are uncommonly involved, it may herald the onset of disease and takes longer to heal. Dexametha sone-cyclophosphamide pulse therapy seems to have a definite advantage over tre atment with steroids alone, especially in terms of better control of disease act ivity, near absence of steroid side-effects and significantly reduced hospital stay. However, ways and means to reduce gonadal toxicity of adjuvants need to be explored as DCP therapy is likely to stay as a treatment of choice.

继发于皮肤型肥大细胞增生症的皮肤松弛症

A female child, a product of a nonconsanguineous parentage and normal pregnancy, was seen first at the age of 4 years. She had suffered from recurrent episodes of multiple, erythematous, confluent plaques and a few bullous lesions all over the body since infancy. The child was irritable but had no history of flushing, dyspnea, wheezing, or frequent diarrhea. Darier’s sign was strongly positive and systemic examination did not reveal any abnormality. Routine laboratory investigations were normal and a skin biopsy specimen revealed an unremarkable epidermis and dense proliferation of round to spindle-shaped mast cells which stained positive for metachromatic granules (Fig. 1). With the diagnosis of urticaria pigmentosa, she was managed with antihistaminic drugs and the parents were advised to handle the child gently. She did not report for further follow-up. Recently, the child, now 8 years of age, was brought again with finely wrinkled, lax, and redundant skin, especially of the face, giving her a senile appearance (Fig. 2). Systemic examination did not show any abnormality. History revealed that the child had been asymptomatic during the last 4 years even without treatment, but developed slowly progressive lax and pendulous skin. A repeat biopsy from the lax facial skin revealed sparse and fragmented elastic fibres, normal collagen, and a perivascular and intradermal cellular infiltrate composed of metachromatic mast cells. Her serum α1-antitrypsin levels were 190.0 mg/dL (normal, 93-224 mg/dL) and a pulmonary function test showed no abnormality. Treatment with antihistaminic drugs was started again and she was advised to have a cosmetic facial uplift at a later stage.

银胶菊皮炎:内吸收性接触性皮炎还是空气传播性接触性皮炎?

We describe here a Parthenium hysterophorus patch-test-positive patient with widespread dermatitis of non-airborne contact dermatitispattern,improving whil e staying in Shimla(a parthenium-free area) and rapidly worsening while visitin g his native place, where there was exuberant parthenium growth. After recovery, inhalation of fresh plant material from a polythene bag resulted in exacerbatio n of dermatitis and pruritus within 8-10 hr, without any respiratory symptoms. The possible pathomechanism of such a phenomenon is discussed.

Success Story of a Low Cost Intra-Dermal Rabies Vaccination (IDRV) Clinic-Lessons Learnt over Five Years of 12,000 Patient Vaccinations “Without Failure” at DDU Hospital Shimla, Himachal Pradesh, India <br/>—“Saving a Drop of Rabies Vaccine and Immunoglobulins” 12 Innovations to Make Himachal Pradesh Rabies Free State by 2020

Background: Rabies is a dreaded disease and an estimated 55,000 people die of rabies every year. Himachal Pradesh is in the North bordering China and is predominantly rural and hilly. Villages are near forests, where wild reservoirs of rabies exist. Since health facilities are not accessible easily, we need to innovate on existing schedules of rabies vaccination keeping in view the compliance of the patients and affordability so as to give them the best possible option of treatment. In the year 2006 and 2007, we, at DDU Hospital Shimla, experienced a severe shortage of rabies vaccine and patients were running from pillar to post to fetch rabies vaccine. At the same time, we learnt that some of the patients died because either they were not able to purchase the vaccine, mostly because of its high cost, $35, or they ignored the animal bites and did not seek the treatment. Since last year, we have been experiencing non-availability of rabies immunoglobulins (RIGs) in the market and have to innovate new schedules and techniques to save lives of the patients. Methods: During shortage of rabies vaccine in 2008, we contemplated to start a low cost intra-dermal (ID) clinic so as to make rabies vaccine affordable as intramuscular (IM) vaccination cost five times more than ID vaccination. But, there were three main hurdles. One hurdle was the non-availability of rabies vaccine vials having written on them “For IM/ID use” and another hurdle was only fewer animal bite patients attending the DDU Hospital, sometimes only one or two per day, which was insufficient to open a vaccine vial and distribute among them. The third problem being faced was reluctance of the hospital doctors to prescribe ID vaccine as this was not the practice at higher teaching institutions, including medical colleges. We contacted a vaccine company and few vials labeled as “For IM/ID use” were sourced from Mumbai (1200 km away from here). We asked the Chief Medical Officer, Shimla district to write a letter to all health facilities around our Hospital to give first aid to animal bite patients and then refer them to DDU Hospital for vaccination. Now we were able to pool the patients and divide a single 1 ml vaccine vial among four patients. After continuous advocacy, our stress that WHO has given its approval for ID use of rabies vaccine and that subsequent approval has been granted by Government of India was enough for doctors to prescribe the vaccine as ID. Last Year, we got ethical approval to inject rabies Immunoglobulins (RIGs) only locally in and around the wound at times of scarcity of RIGs in the market. The subsequent follow up of patients proved life saving in crisis of shortage of RIGs. Due to shortage of RIGs we innovatively vaccinated people bitten by rabid dogs or people who had consumed rabid cow’s milk and followed them for outcome, apart from having Rabies Fluorescent Focus Inhibition Test (RFFIT) was done for few of the patiens for verification of protective titers. We innovated a technique of extraction of last drop of vaccine from the vial and also saved a drop of RIGs being used for test dose before giving RIGs to the patients. Results: The first low cost anti-rabies clinic was started on August 2, 2008 after long advocacy sessions with the authorities and the doctors. Since then, we have done many innovations based on local requirements and patients’ feedback and accessibility to treatment. We have given pre and post-exposure prophylaxis to more than 12,000 animal bite victims over more than five years period in this single clinic, saving lives as well as money without any failure even in difficult rabid animal bite cases. Our innovation helped us save the vaccine and immunoglobulins till the last drop. Conclusions: Innovative ways by health providers backed by extensive literature review and scientific evidence can help patients get low cost health deliverables that increase their compliance as medicines/vaccines become affordable to them. Third world countries need to innovate their own ways to solve their problems of scanty resources and find innovative solutions to conquer them, rather than looking elsewhere for solutions.

Designing of tragacanth gum-poly [2-(methacryloyloxy) ethyl] dimethyl-(3-sulfopropyl) ammonium hydroxide and poly(acrylamide) based hydrogels for drug delivery and wound dressing applications

Bioactive tragacanth gum(TG)was functionalized by covalent crosslinking of poly[2-(methacryloyloxy)ethyl]dimethyl-(3-sulfopropyl)ammonium hydroxide(PMEDSAH)to design network structure in form of hydrogel wound dressings(HWD).These copolymers were encapsulated with antibiotic drug vancomycin to enhance wound healing potential of the dressings.The copolymers were characterized by SEM,AFM,FTIR,13C NMR,XRD,and TGA-DSC analysis.SEM demonstrated uneven heterogeneous morphology and AFM revealed rough surface of copolymer.Inclusion of synthetic component into HD was confirmed by FTIR and 13C NMR.Hydrogel dressings absorbed 8.491.03 g/g simulated wound fluid and exhibited non-hemolytic(3.70.02%hemolytic potential)and antioxidant(37.421.54%free radical scavenging in DPPH assay)properties.Polymers required 35.05.0 mN detachment force to get it detach from the mucosal surface during mucoadhesive test.Tensile strength was found to be 1.880.13 N/mm2 during mechanical stability test.Hydrogel dressings were permeable to O2/H2O and impermeable to microbes.Release of drug vancomycin occurred through non-Fickian diffusion mechanism and release profile was best described by Korsmeyer-Peppas kinetic model.Overall,these results revealed that these hydrogels could be explored as materials for hydrogel wound dressings.

Training medical undergraduates in the core disciplines of community medicine through community postings-an experience from India

Objective:Family medicine,epidemiology,health management and health promotion are the core disciplines of community medicine.In this paper,we discuss the development of a commu-nity posting program within the framework of community medicine core disciplines at a primary health centre attached to a teaching hospital in Puducherry,India.Methods:This is a process documentation of our experience.Results:There were some shortcomings which revolved around the central theme that post-ings were conducted with department in the teaching hospital as the focal point,not the primary health centre(PHC).To address the shortcomings,we made some changes in the existing com-munity posting program in 2013.Student feedback aimed at Kirkpatrick level 1(satisfaction)evaluation revealed that they appreciated the benefits of having the posting with PHC as the focal point.Feedback recommended some further changes in the community posting which could be addressed through complete administrative control of the primary health centre as urban health and training center of the teaching hospital;and also through practice of core disciplines of com-munity medicine by faculty of community medicine.Conclusion:It is important to introduce the medical undergraduates to the core disciplines of community medicine early through community postings.Community postings should be con-ducted with primary health centre or urban health and training centre as the focal point.

Coronavirus Disease-2019(COVID-19)and the Liver

Within a year of its emergence,coronavirus disease-2019(COVID-19)has evolved into a pandemic.What has emerged during the past 1 year is that,apart from its potentially fatal respiratory presentation from which the severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2)derives its name,it presents with a myriad of gastrointestinal(GI)and liver manifestations.Expression of the angiotensinconverting enzyme-2(ACE-2)receptor throughout the GI tract and liver,which is the receptor for the SARS-CoV-2,may be responsible for the GI and liver manifestations.Besides acting directly via the ACE-2 receptor,the virus triggers a potent immune response,which might have a role in pathogenesis.The virus leads to derangement in liver function tests in close to 50%of the patients.The impact of these derangements in patients with a normal underlying liver seems to be innocuous.Severe clinical presentations include acute decompensation and acute-on-chronic liver failure in a patient with chronic liver disease,leading to high mortality.Evolving data suggests that,contrary to intuition,liver transplant recipients and patients with autoimmune liver disease on immunosuppression do not have increased mortality.The exact mechanism underlying why immunosuppressed patients fare well as compared to other patients remains to be deciphered.With newer variants of COVID-19,which can spread faster than the original strain,the data on hepatic manifestations needs to be updated to keep a step ahead of the virus.

An epidemiological study on tbe road traffic accidents from hills of north India

Road traffic injuries are increasingly being reported as an important cause of morbidity and disability worldwide.Various epidemio-logic factors related to road traffic crash cases were examined to identify potential targets for future preventative strategies.This hospital-based descriptive study collected relevant information by use of a predesigned and pretested questionnaire given to total of 401 consecutive individuals that received nonfatal injuries from road traffic crashes who reported to the Indira Gandhi Medical College Hospital in Shimla,India between June 2005 to May 2006.The percentage of cases corresponding to preselected catego-ries were compared using chi-square analyzes to determine statistical significance.A majority of the injured victims included in this study were between 20-49 years of age,with a male to female ratio of 5.3:1.The largest numbers of victims were employees and occupants of transport vehicles.Human error was the most reported cause of crash,and the most common mode of crash was skid-ding and/or rolling down.The highest proportion of crashes occurred on curved roads.The most at-risk population in Shimla,India for receiving nonfatal traffic-related injuries is males between 20 and 49 years of age who utilize transport vehicles.As the majority of nonfatal injuries occur in passengers of light transport vehicles(LMVs)in accidents at road curves,road safety strategies should target these locations and the drivers of these vehicles in order to most effectively protect their occupants.