Mayo Institute of Medical science

Barabanki, India

Mayo Institute of Medical science

Barabanki, India
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Mahendra M.,University of Lucknow | Singh R.,Mayo Institute of Medical science
Journal of Clinical and Diagnostic Research | Year: 2017

Introduction: Diabetic foot complications pose a significant public health hazard and had negative effect on life quality. These complications are associated with increased risk of amputations and premature death. So focus is increasing on early treatment of complicated diabetic foot. Aim: To assess the diagnostic accuracy and surgical utility of MRI in complicated diabetic foot. Materials and Methods: Thirty four complicated diabetic patients were evaluated prospectively. Initially x-ray was done and a provisional management plan was formulated. Later T1W, T2W and FSat sequences of the affected foot and ankle was carried out. The soft tissue, tendons and osseous apparatus were evaluated and subsequently compared with histopathological examination. Before and after MRI, change in management plan was marked. Previously operated cases with persistent ulcer of affected foot were excluded from the study. Results: Twenty two males and 12 females with mean age of 52±8.8 years were analysed. The sensitivity of MRI for tenosynovitis and osteomyelitis was 88% and 100% respectively. The specificity for the same was 100% and 90%. Of all 34 cases, MRI reshapes surgical planning in 23.5% cases (8 patients). The difference between MRI and histopathological findings was evaluated statistically using Fisher-Z test and the proportion of difference between these two groups was not significant as values for tenosynovitis was Z=0.50 (p-value >0.05) and for osteomyelitis Z= 0.54 (p-value>0.05). Conclusion: The result indicates that MRI is a sensitive and accurate imaging modality for evaluation of diabetic foot and for planning proper treatment and the MRI correlates significantly with the surgical finding. © 2017, Journal of Clinical and Diagnostic Research. All rights reserved.

Singh A.K.,Government Medical College | Narsaria N.,GCRG Medical College | Gupta R.K.,Mayo Institute of Medical science
Injury | Year: 2017

Background: The reverse oblique trochanteric fractures are common fractures and its treatment poses a challenge. The purpose of this study was to compare the biomechanical parameters of the construct using proximal femoral nail (PFN) and proximal femoral locking compression plates (PFLCP) in these fractures using cadaveric specimens. Materials and Methods: Twenty freshly harvested cadaveric femoral specimens were randomly assigned to two groups after measuring bone mineral density, ten of which were implanted with PFN and the other ten with PFLCP. The constructs were made unstable to simulate reverse oblique trochanteric fracture (AO type 31A3.3) by removing a standard size posteromedial wedge. These constructs were tested in a computer controlled cyclic compressive loading with 200. kg at a frequency of 1 cycle/s (1. Hz) and test was observed for 50,000 cycles or until implant failure, whichever occurred earlier. Peak displacements were measured and analysis was done to determine axial stiffness and subsidence in axial loading. Results: All the specimens in PFN group completed 50,000 cycles and in PFLCP group, seven specimens completed 50,000 cycles. Average subsidence in PFN group was 1.24. ±. 0.22. mm and in PFLCP group was 1.48. ±. 0.38. mm. The average stiffness of PFN group (72.6. ±. 6.8. N/mm) was significantly higher than of PFLCP group (62.4. ±. 4.9. N/mm) (P = 0.04). The average number of cycles sustained by PFLCP was 46634 and for PFN group was 50,000 (P = 0.06). Conclusion: The PFN is biomechanically superior to PFLCP in terms of axial stiffness, subsidence and number of specimens failed for the fixation of reverse oblique trochanteric fractures of femur. © 2017.

Chaturvedi P.,Mayo Institute of Medical science | Singh A.K.,Major SD Singh Medical College and Hospital | Shukla S.,Mayo Institute of Medical science | Agarwal L.,Mayo Institute of Medical science
North American Journal of Medical Sciences | Year: 2014

Background: For the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections and decolonization of MRSA carriers, the use of mupirocin a topical antibiotic is increasing day by day. Aim: The present study was carried out to determine the prevalence rate of high-level and low-level mupirocin resistant MRSA isolates among patients admitted to a tertiary care hospital. Materials and Methods: This is a prospective study carried out on MRSA isolated from the various clinical specimens from outpatient and inpatient departments during period of one year. A total of 82 MRSA isolates were recovered from 6468 different clinical specimens. Mupirocin resistant MRSA was detected by two different methods: Epsilometer test (E-test) and agar dilution method. D-shaped zone test (D-zone test) was also performed for determination of inducible clindamycin resistance in MRSA isolates. Results: Out of 82 non-duplicate MRSA isolates mupirocin resistance were found in 15 (18.3%) isolates by both E-test and agar dilution method. Of these 15 mupirocin resistant, 8 (53.3%) isolates were high-level resistant (MuH) and 7 (46.7%) isolates were low-level resistant (MuL). Four isolates were D-zone test positive showing simultaneous inducible clindamycin resistance among mupirocin resistant MRSA isolates. Conclusion: Higher prevalence of both high-level and low-level of mupirocin resistant MRSA was observed in patient from the population. It is advisable to perform routine test to detect MRSA colonization among health care workers and nasal decolonization to prevent spread of MRSA infections among hospitalized patients.

Singh A.K.,Mayo Institute of Medical science | Rastogi A.,Institute of Medical science
Indian Journal of Orthopaedics | Year: 2013

Background: Distal femur fractures are difficult to manage and the selection of implant for internal fixation remains controversial. The objective of this study is to establish the relative strength of fixation of a distal femoral locking plate (DFLP) compared with the dynamic condylar screw (DCS) in the distal femur fractures. Materials and Methods: Study was conducted on 16 freshly harvested cadaveric distal femoral specimens, eight implanted with DCS and other eight with DFLP. The construct was made unstable by removing a standard sized medial wedge of 1 cm base (gap-osteotomy) beginning 6 cm proximal to the lateral joint line in distal metaphyseal region with the loss of medial buttress. Fatigue test was conducted under load control mode at the frequency of I Hz. Specimens were subjected to cyclic loading of 2 kN, under observation for 50,000 cycles or until failure/cutout, which ever occurred earlier. Results: In DFLP group, there was no implant failure and the average number of cycles sustained was 50,000. Six out of eight specimens completed 50,000 cycles and two failed in DCS group. The average number of cycles sustained by DCS was 46150. Though the bone quality as assessed by dual energy X-ray absorptiometry DEXA was comparable in both DFLP and DCS group ( P = 0.06), none failed in DFLP group and subsidence was 1.02 ± 0.34 mm (range: 0.60-1.32 mm), which was significantly 43% lower ( P = 0.006) than subsidence in DCS group (1.82 ± 0.58; range: 1.20-3.08 mm). The average stiffness of DCS group was 52.8 ± 4.2 N/mm, which was significantly lower than average stiffness of locked condylar plate group (71.2 ± 5.1 N/mm) ( P = 0.02). Conclusions: DFLP fixation of the distal femur fractures resulted in stronger construct than the DCS fixation in both cyclic loading and ultimate strength in biomechanical testing of a simulated A3 distal femur fracture.

Agrawal A.,University of Lucknow | Kumar A.,University of Lucknow | Consul S.,Mayo Institute of Medical science | Yadav A.,University of Lucknow
Indian Journal of Critical Care Medicine | Year: 2015

Scorpion bites are common in India. Usually, these bites are harmless but sometimes have serious clinical sequelae, including death. We report herein a case of scorpion bite with electrocardiographic abnormalities simulating early myocardial infarction. Pulmonary edema and congestive heart failure accompanied these electrocardiographic changes as well as serum cardiac markers. The etiology of cardiovascular manifestations in severe scorpion sting is related to venom effect on sympathetic nervous system and the adrenal secretion of catecholamines as well as to the toxic effect of the venom on the myocardium itself. It is a rare case of scorpion sting presented as myocardial infarction and heart failure, successfully treated with Intensive Care Unit care, noninvasive ventilation, vasopressors, and antiischemic treatment.

Pal R.,University of Lucknow | Chaudhary M.J.,Mayo Institute of Medical science | Tiwari P.C.,University of Lucknow | Babu S.,University of Lucknow | Pant K.K.,University of Lucknow
International Immunopharmacology | Year: 2015

Theophylline (non-specific PDE inhibitor) and their interactions with nitric oxide modulators were evaluated in adjuvant-induced arthritic model of rats. Wistar rats (200-300 g), 8 animals per group were used in the study. The animals were injected with 0.1 mL of squalene and 0.2 mL of complete Freund's adjuvant on day (0) in sub-planter region of right hind paw controls received only saline. The treatment with theophylline and nitric oxide modulators were done from day 14 to day 28. Arthritis indexes, ankle diameter, paw volume, and body weight were determined to assess RA progression from day (0) to day 28. On day 28 animals were sacrificed and their blood collected for IL-10 and TNF-α cytokine levels and hind paw for pathological analysis. Synovial fluid from joint spaces of CFA inoculated rats was collected to estimate TNF-α level in synovial fluid. The data obtained was analyzed by two-way ANOVA followed by the Newman-Keuls post-hoc test. Theophylline (10 and 20 mg/kg) significantly decreased adjuvant induced increased arthritis-index, paw volume and ankle diameter (p < 0.05 in all parameters) compared to only adjuvant control group. It also reversed adjuvant induced slight decrease in body weight to normalcy. l-Arginine 100 mg/kg + theophylline 20 mg/kg suppressed TNF-α and elevates IL-10 level as well as reversed adjuvant-induced elevated arthritic parameters as compared to only adjuvant and prednisone group (p < 0.001). Synovial TNF-α level of adjuvant only group was several fold higher than its serum level. Treatment with theophylline 20 mg/kg significantly reduces synovial TNF-α level as compared to adjuvant only group. Theophylline 20 mg/kg + L-NAME 10 mg/kg significantly reversed these adjuvant-induced changes in immunological, histopathological and arthritis parameters (p < 0.05). © 2015 Elsevier B.V. All rights reserved.

Singh A.K.,Mayo Institute of Medical science | Arun G.R.,Sri Mokambika Institute of Medical science | Narsaria N.,Mayo Institute of Medical science | Srivastava A.,Mayo Institute of Medical science
Archives of Orthopaedic and Trauma Surgery | Year: 2014

Background: The aim of this prospective comparative study was to compare outcomes and complications of humeral diaphyseal fracture non-unions managed with humerus interlocking nail (HIL) and locking compression plate (LCP). Materials and methods: 40 patients with non-union of humeral diaphyseal fractures were included in this study and were randomly allocated in two groups; group A had 20 cases treated with HIL and group B had 20 cases treated with LCP. Clinico-radiological assessments were done for each case up to 2-year follow-up period. Primary outcome measures (time to fracture union, union rate) and secondary outcome measures (functional outcome and complication such as infection, malunion, delayed union, implant failure, joint stiffness and iatrogenic radial nerve palsy) were compared between both the groups. Disabilities of the arm, shoulder and hand (DASH) scoring and Steward and Hundley's scoring system were used to assess functional outcome of the fracture fixation. Results: There was no significant difference (p = 0.12) in terms of mean fracture union time between group A (15.8 ± 4.2 weeks) and group B (17.2 ± 3.8 weeks). Group A had 95 % union rate and group B had 100 % union rate (p = 0.14). At the 2-year follow-up visit, there was no significant difference found between both the groups regarding range of motion of shoulder and elbow joint. There was no significant difference found in final functional outcomes between both the groups on comparing DASH score (p = 0.14) and Steward and Hundley's score (p = 0.08). In terms of complications, there was insignificant difference found between both the groups. Conclusions: This study concludes that both the implants can be used in non-union of humeral shaft fractures with good functional outcomes and acceptable rate of complications. © 2014 Springer-Verlag.

Narsaria N.,Mayo Institute of Medical science | Singh A.K.,Mayo Institute of Medical science | Arun G.R.,Sri Mokambika Institute of Medical science | Seth R.R.S.,Mayo Institute of Medical science
Journal of Orthopaedics and Traumatology | Year: 2014

Conclusions: EIN is a safe, minimally invasive surgical technique with a lower complication rate, faster return to daily activities, excellent cosmetic and comparable functional results, and can be used as an equally effective alternative to plate fixation in displaced midshaft clavicle fractures.Level of evidence: Level 2.Background: This prospective comparative study was done to evaluate the effectiveness of implants of different design (titanium elastic intramedullary nail versus anatomical precontoured dynamic compression plate) in treatment of displaced midshaft clavicular fractures.Materials and methods: Sixty-six patients between 18 and 65 years of age were included in this study. They were randomized in two groups to be treated with either elastic intramedullary nail (EIN) or plate. Clinical and radiological assessments were performed at regular intervals. Outcomes and complications of both groups over 2 years of follow-up time were compared.Results: Length of incision, operation time, blood loss and duration of hospital stay were significantly less for the EIN group. American Shoulder and Elbow Surgeons (ASES) and Constant Shoulder scores were significantly higher (p < 0.05) in the plating group than the EIN group for the first 2 months but there was no significant difference found between the two groups regarding functional and radiological outcome at the 2-year follow-up. Significantly higher rates of refracture after implant removal (p = 0.045) in the plating group was observed. Infection and revision surgery rates were also higher in the plate group, but this difference was insignificant (p > 0.05). © 2014, The Author(s).

Seth V.,Mayo Institute of Medical science | Yadav S.,Mayo Institute of Medical science
International Journal of Pharma and Bio Sciences | Year: 2015

Bronchial asthma is characterised by inflammation in airways leading to hyperreactivity and spasm of the bronchial smooth muscle, oedema and disruption of the mucosa, and obstruction of the lumen by mucus. The drugs used for asthma are broadly classified into bronchodilators (reliever therapies) and anti-inflammatory drugs (preventer therapies). The preventer therapies mainly include corticosteroids besides mast cell stabilizers, antileukotriene drugs and omalizumab. Omalizumab is a humanised monoclonal antibody which binds to circulating IgE. This compound has demonstrated efficacy in the patient population in a number of clinical studies and its use for severe allergic asthma has been endorsed by several international consensus bodies. It is generally indicated for patients unresponsive to high-dose inhaled steroids and have allergy as an important cause of their asthma. Omalizumab is given as a subcutaneous injection every two to four weeks depending on dose which in turn depends on the body weight and the IgE level. This review will further discuss the status of Omalizumab in the management of asthma and where does it fit into the treatment of asthma of different severities.

Singh A.K.,Mayo Institute of Medical science | Vinay K.,Institute of Medical science BHU
Journal of Orthopaedics and Traumatology | Year: 2013

Background: The aim of this retrospective study was to determine the need for bone grafting in the surgical treatment of displaced intra-articular calcaneal fractures. We reviewed 390 cases of displaced intra-articular calcaneal fractures treated with plate osteosynthesis with or without autologous iliac bone grafting, and compared outcomes and complications related to fracture stabilization. Materials and methods: Three hundred ninety patients with displaced intra-articular calcaneal fractures that were treated with plate osteosynthesis from December 2002 to December 2010 were reviewed. Two hundred two patients (group A) were treated by osteosynthesis with autologous bone grafting, and 188 patients (group B) were treated by osteosynthesis without bone grafting. One hundred eighty-one patients with an AO type 73-C1 fracture (Sanders type II), 182 patients with an AO type 73-C2 fracture (Sanders type III), and 27 patients with an AO type 73-C3 fracture (Sanders type IV) were included in this study. Bohler's angle, the crucial angle of Gissane, and calcaneal height in the immediate postoperative period and at the 2-year follow-up were compared. Any change in the subtalar joint status was documented and analyzed. The final outcomes of all patients were evaluated by the AOFAS Ankle-Hindfoot Scale and compared in both groups. Results: The mean full weight-bearing time in group A (with bone grafting) was significantly lower (median 6.2 months, range 2.8-9.2 months) than that in group B (without bone grafting; median 9.8 months, range 6.8-12.2 months). The immediate-postoperative Bohler's angle and that at the 2-year follow-up were significantly higher in group A. The loss of Bohler's angle after 2 years was significantly lower in group A (mean 3.5°; 95 % CI 0.8° -6.2°) than in group B (mean 6.2°; 95 % CI 1.0° -11.2°). The average change in the crucial angle and the average change in calcaneal height were not statistically significant for either group. The infection rate in the bone grafting group was higher, though statistically insignificantly so, than in the nongrafting group (8.3 vs. 6.3 %). No significant difference was found between the groups in terms of the rates of good reduction, postoperative osteoarthritis, and subtalar fusion. Regarding the efficacy outcomes, the mean AOFAS score was lower (mean 76.4 points; 95 % CI 65.8-82.9 points) in group A than in group B (mean, 81.6 points; 95 % CI, 72.3-88.8 points), but this difference was not significant (p > 0.05). Conclusions: Bohler's angle showed improved restoration and the patients returned to full weight-bearing earlier when bone grafting was used in the treatment of intra-articular calcaneal fracture. However, the functional outcomes and complication rates of both groups were similar. © 2012 The Author(s).

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