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Summary: Changes in taste have been perceived as a common side effect of different cancers and may lead to malnutrition. Hence, the importance of understanding cancer patients' sensory taste perceptions and its impact on nutritional status, quality of life (QoL), and oral nutrition supplements (ONS) compliance becomes crucial. This qualitative study involved semi-structured, in-depth interviews with 24 adults (15 with multiple myeloma and 9 with head & neck cancer). The interviews were transcribed and the data analysis was conducted using reflexive thematic analysis and template analysis. This guided the development of four themes: 1. Taste and smell changes, 2. Impact on nutritional status and quality of life, 3. Information and help available for people experiencing changes in their taste, and 4. ONS and its compliance. Our findings show significant negative impact of chemosensory changes on nutritional status, quality of life and ONS compliance. Patient's experience with the level of support received for the management of taste changes during cancer treatment varied widely. Providing adequate information and support in a timely manner about changes in taste during treatment can improve patients' coping strategies and maintain their nutritional status. Overall, the findings highlight the importance of addressing taste changes and ONS compliance for people with multiple myeloma and head and neck cancer undergoing treatment. Specifically, the taste changes and its impact experienced by people with head and neck cancer were found to be more severe than those experienced by multiple myeloma patients. This study provides an understanding of changes in sensory taste perception experienced by cancer patients and its impact on nutritional status and QoL. This understanding can provide insight into ways to improve ONS consumption and compliance for preventing malnutrition. It is crucial to further conduct ONS sensory evaluations that cater to the specific needs of this cohort to help prevent malnutrition among cancer patients.

In this research, a comparative analysis of plug-in hybrid electric vehicle (PHEV) engine was conducted with two advanced low temperature combustion (LTC) techniques viz. Homogeneous charge with direct injection (HCDI) and reactivity-controlled compression ignition (RCCI), utilizing alternative fuels diethyl ether (DEE) and ethanol. This was attempted to exhibit the promising potential of LTC based PHEV to achieve the highest efficiency and low emissions. The experimental results disclosed that DEE powered HCDI can achieve superior thermal efficiency with an impressive peak torque of 14 Nm. On the other hand, ethanol powered RCCI produced a peak torque of 17.5 Nm with remarkable emission reduction characteristics, especially CO2. It was vindicated that HCDI-PHEV outperformed the RCCI-PHEV in terms of fuel economy despite both HCDI and RCCI being lower than the conventional diesel PHEV. The NOx emissions from HCDI were almost negligible. About 20 % lower nitrogen oxide (NOx) emissions were recorded for RCCI respectively as compared to diesel (36 g/s). HCDI and RCCI showcased about 2 and 1.3 times higher soot emissions than diesel (7.12 g/s). Fuel economy was improved by 15 % and 43 % respectively under HCDI and RCCI modes over the conventional diesel mode of PHEV operation. When the PHEV was operated continuously for about 3.5 h, the battery's SOC dropped from 80 % to 45 % under diesel operation, whereas it only reached 50 % and 60 % under RCCI and HCDI mode operation. Low fuel consumption characteristics, acceptable torque production capabilities and ultralow NOx reduction potential established HCDI as the preferable choice for PHEV over RCCI.

Andrographolide is a natural diterpene lactone with multiple biological effects. In the present study, a total of 11 andrographolide-loaded emulgels (ANG 1- ANG 11) were prepared by emulsification and solvent evaporation method using flaxseed oil and xanthan gum in different ratios, as suggested by the Design-Expert software. A 2-factor-5-level design was employed with different responses including spreadability, extrudability, viscosity, and drug release after 1 h (h) and 24 h. Based on the Design-Expert software response, the optimized emulgel ANG 12 was formulated and evaluated. The 24 h In-vitro drug release was found to be 95.7 % following Higuchi kinetics. Ex-vivo skin retention of 784.78 ug/cm2 was observed during the study. MTT assay performed on Human epidermoid carcinoma (A-431) cells demonstrated cell growth arrest at G0/G1 and G2/M phase after 24 h of ANG 12 treatment (IC50: 11.5 µg/ml). The cellular permeability of ANG-12 was assessed by Fluorescein isothiocyanate (FITC) assay. Compared to untreated cells (0.54 % uptake) the ANG-12 treated cells had shown 87.17 % FITC permeation. The biocompatibility study performed on non-cancerous human dermal fibroblast cells (HDF cells) shows 91.54 % viability after 24 h of the treatment showing the non-toxic nature of ANG-12. Confocal imaging had shown a significant time-dependent increase in in-vivo cellular uptake with enhanced, progressive penetration of the emulgel into the skin. An in-vivo skin irritation study conducted on Swiss albino mice confirmed the safety aspects of the ANG 12. Hence, it can be concluded that nanoemulgel of andrographolide (ANG 12) could be a novel approach to treating skin cancer.

This paper describes various setups for testing electric vehicle (EV) on-road operating conditions. The significance of a high-power density energy source during EV acceleration and deceleration is highlighted in this work. The drive motor (DM) draws a large current during acceleration, the magnitude of which is determined by the acceleration time and vehicle parameters. Also, the source must capture all of the regenerative power from the DM during deceleration. The battery life will be reduced if it is used as an energy source for acceleration. Furthermore, due to its low power–density, the battery cannot quickly store regenerative power. To meet the aforementioned requirements, a high power–density source, such as an ultracapacitor (UC), is required. The simulation results as well as hardware results are shown for EV emulation systems.

This work provides an electric vehicle (EV) test bench with a motor/dynamometer setup with a battery and ultracapacitor (UC) hybrid energy storage. Extending the driving range and enhancing the battery life are the main concerns with EVs nowadays. The drive motor (DM) used is a three-phase induction motor (IM), which is controlled by the current sensorless indirect vector control method. This fault-tolerant method can be used in the case of current sensor failure. All the resistive forces acting on an EV are emulated based on the concept of vehicle equivalent rotational inertia for different real-life driving cycles, namely ECE R15 and NYCC. The battery alone is not capable of handling the surge current requirement during the acceleration period and is not able to capture the total power during regenerative breaking as it has a low power density. Hence, a high power density source like UC is a must to handle these conditions during frequent stop and go city traffic conditions as per ECE R15 and NYCC driving cycles. This EV emulation technique helps in getting the DC-link power profile for an EV for any driving scenario. Hence, it is possible to test the different powertrain components of an EV using this proposed technique.

Objective: Vesical Imaging Reporting and Data System (VIRADS) score was developed to standardize the reporting and staging of bladder tumors on pre-operative multiparametric magnetic resonance imaging. It helps in avoiding unnecessary repeat transurethral resection of bladder tumor in high-risk non-muscle-invasive bladder cancer patients. This study was done to determine the validity of VIRADS score prospectively for the diagnosis of muscle-invasive bladder cancer. Methods: This study was conducted from March 2019 to March 2020 at Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India. Patients admitted with the provisional diagnosis of bladder tumor were included as participants. All these patients underwent a 3 Tesla mpMRI to obtain a VIRADS score before they underwent transurethral resection of bladder tumor and these data were analyzed to evaluate the correlation of pre-operative VIRADS score with muscle invasiveness of the tumor in final biopsy report. Results: A cut-off of VIRADS ≥4 for prediction of detrusor muscle invasion yielded a sensitivity of 79.4%, specificity of 94.2%, positive predictive value of 90.0%, negative predictive value of 87.5%, and diagnostic accuracy of 86.4%. A cut off of VIRADS ≥3 for prediction of detrusor muscle invasion yielded a sensitivity of 91.2%, specificity of 78.8%, positive predictive value of 73.8%, negative predictive value of 93.2%, and accuracy of 83.7%. The receiver operating curve showed the area under the curve to be 0.922 (95% confidence interval: 0.862–0.983). Conclusion: VIRADS score appears to be an excellent and effective pre-operative radiological tool for the prediction of detrusor muscle invasion in bladder cancer.

The dry method of coffee processing generates a significant amount of coffee husk, an agricultural waste for which currently there is a lack of profitable use, and their disposal constitutes a major environmental problem. Pectin was extracted from coffee husk using citric acid solution (pH 1.5) by microwave-assisted extraction method, followed by using ice-cold ethanol. The coffee husk pectin (CHP) with a yield of 40.2% was characterized using SEM, FT-IR, and XRD techniques. The CHP exhibited significant in-vitro antioxidant activity as measured by using 2,2-diphenyl-1-picrylhydrazyl; (IC50 value of 395.1 ± 0.42 μg/mL), ferrous reducing antioxidant capacity (A700 nm = 0.55 ± 0.08), 2,2′-Azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) radical scavenging (42.02 ± 0.38%) and ascorbic acid auto-oxidation inhibition (92.01 ± 0.28%) assays. CHP demonstrated antibacterial activity against Escherichia coli and Bacillus cereus with an inhibition diameter of 20 ± 1.01 mm and 18 ± 0.84 mm, respectively. Interestingly, CHP showed a significant anti-inflammatory effect by negatively modulating the expressions of TNF-α and TGF- β in LPS-stimulated macrophage cell lines. Collectively, our findings suggest that the coffee husk is a potential source of commercial pectin, microwave-assisted extraction has a great potency on the commercial pectin extraction from the coffee husk and CHP demonstrates significant biological activity.

The growing nanoparticulate pollution (e.g. engineered nanoparticles (NPs) or nanoplastics) has been shown to pose potential threats to human health. In particular, sensitive populations such as pregnant women and their unborn children need to be protected from harmful environmental exposures. However, developmental toxicity from prenatal exposure to pollution particles is not yet well studied despite evidence of particle accumulation in human placenta. Our study aimed to investigate how copper oxide NPs (CuO NPs; 10–20 nm) and polystyrene nanoplastics (PS NPs; 70 nm) impact on gene expression in ex vivo perfused human placental tissue. Whole genome microarray analysis revealed changes in global gene expression profile after 6 h of perfusion with sub-cytotoxic concentrations of CuO (10 µg/mL) and PS NPs (25 µg/mL). Pathway and gene ontology enrichment analysis of the differentially expressed genes suggested that CuO and PS NPs trigger distinct cellular response in placental tissue. While CuO NPs induced pathways related to angiogenesis, protein misfolding and heat shock responses, PS NPs affected the expression of genes related to inflammation and iron homeostasis. The observed effects on protein misfolding, cytokine signaling, and hormones were corroborated by western blot (accumulation of polyubiquitinated proteins) or qPCR analysis. Overall, the results of the present study revealed extensive and material-specific interference of CuO and PS NPs with placental gene expression from a single short-term exposure which deserves increasing attention. In addition, the placenta, which is often neglected in developmental toxicity studies, should be a key focus in the future safety assessment of NPs in pregnancy.

Background: Type 2 diabetes mellitus (T2DM) is one of the major contributing factors of sexual dysfunction in males. Given the presence of limited literature on prevalence of T2DM associated sexual dysfunction in North Indian population, the following study was conducted with aim of investigating the prevalence of ED. Materials and methods: A multicenter observational study was conducted across 11 centers in Lucknow, North India. A total of 460 patients were asked to fill a validated International Index of Erectile function (IIEF) Questionnaire, and sexual dysfunction was assessed based on scoring for erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction over a period of 4 weeks. Chi-Square analysis was performed to form an association between ED or OFD and other confounding factors. Results: ED and OFD were found to be prevalent in 32% and 43.3% of patients, respectively. Their presence correlated significantly with T2DM duration (ED, p = 0.0101; OFD, p = 002). In Indian context, the prevalence of ED was found to correlate with, presence of macrovascular complications and serum creatinine levels, whereas OFD significantly correlated with T2DM duration, macro– and microvascular complications among other factors. Conclusion: The prevalence of ED and OFD in men suffering from T2DM is on significant rise, considerably impacting the lives of millions of men worldwide. Thus, the findings of this study highlight the significance of taking follow-up of sexual discomfort and disorders by the clinicians during the visits.

Background: DNA is the main target for UV-B-irradiation-induced skin photodamage and accounts for 90 % of all the non-melanoma skin cancers. Purpose: In this study, we explored the mechanistic basis of photoprotective effect of Trigonelline, a naturally occurring alkaloid from the Trigonella foenum-graecum, against UV-B-induced oxidative DNA Damage Response using Primary Human Dermal Fibroblasts (HDFs) and BALB/C mice as models of skin photodamage. Methods: Primary HDFs were subjected to UV-B exposure (10 mJ/cm2) with or without TG for 24 h. Effect of UV-B exposure and TG treatment was evaluated by analyzing the cell survival, cellular morphology, oxidative stress & DNA damage response markers by performing biochemical studies, florescent microscopy & protein expression studies. In in-vivo study, TG pre-treated BALB/c mice were -irradiated with 180 mJ/cm2 of UV-B dose thrice a week on alternative days for four months, followed by topical application of different concentrations of TG. The photodamage caused by UV-B exposure and its ameleoriation by topical treatment of TG was studied by physical and morphological appearance and analyzing the oxidative stress & DNA damage response markers from skin. Results: We found that TG significantly alleviates UV-B–induced cell death effects in HDFs. TG protects HDF cells and BALB/c mice from UV-B-induced DNA damage by regulating the expression profile of key protein markers of DNA damage which include P53, ATM, ATR, ϒH2AX, Chk1 and Chk2. We found that TG offers geno-protection to UV-B–irradiated HDFs by alleviating CPD induction, reducing the number of TUNEL positive cells and by decreasing the expression levels of DNA damage marker protein ϒH2AX in immunocytochemistry. Further, we found that TG prevents the UVB induced oxidative stress by activating the PI3K-AKT-Nrf2 signalling pathway. On employing PI3K inhibitor, LY294002, we found the expression of ϒH2AX and p-P53 is significantly increased compared to UV-B treated only, indicating that TG mediates the geno-protection against UV-B irradiation via PI3K-AKT-Nrf2 signalling pathway. Conclusion: Current study presents for the first time the photo-protective role of TG against UV-B–induced oxidative DNA damage and provides its mechanistic insights also and provide strong evidence for TG to be carried forward as a potential remedial and cosmeceutical agent against UV-B–induced skin photodamage disorders.

Total maxillectomy is referred to as bilateral resection of maxillae in patients suffering from a benign, malignant neoplasm or chronic infections like osteomyelitis, etc. It causes communication between the oral and antral cavity extending to the nasopharynx. A complete bilateral maxillectomy defect presents a considerably reconstructive challenge for the prosthodontist because of the absence of normal hard and soft tissues for the support of prosthesis. The surgical obturator was retained via spring which develops the seal between the acrylic plate and the dorsum of the tongue during deglutition, thus helping the patient to take a soft diet orally during the healing period. The definitive conventional closed bulb hollow obturator fabricated using the “lost wax bolus” technique, is a reliable and feasible treatment option to restore the total maxillectomy defect, thus improving and enhancing the quality of patient’s life and livelihood.

The factors affecting the adoption of modern varieties (MVs) of rice and impact on poverty in Odisha, India were discussed. A total of 363 households from Cuttack and Sambalpur districts of Odisha via multistage sampling technique participated in the survey. The Cragg's Double hurdle model was used to model the determinants of adoption and intensity of adoption of MVs of rice, and the propensity score matching was used to analyze the impact of adoption on poverty. The results showed that age, education, risk aversion, land size, yield, perception of MVs as high yielding, resistant to diseases and availability of MVs positively influenced the decision to adopt. However, variables such as household size, experience of a farmer, off-farm job participation, amount of credit received, cost of seeds, insecticides and fertilizers negatively influenced the adoption of MVs. Intensity of adoption of MVs was negatively influenced by experience of a farmer, cost of fertilizer and marketability of MVs, and positively affected by household size, risk aversion, land size, cost of insecticides, perception of MVs as high yielding and availability of MV seeds. Poverty incidence, gap and severity were high among non-adopters to adopters of MVs. After matching adopters and non-adopters of MV groups using four different algorithms of nearest neighbour matching, stratification matching, radius matching and kernel matching, the impact of MV adoption resulted in higher per capita monthly household expenditure by about US$ 52.82 to US$ 63.17. Keywords: Rice, Adoption, poverty, Cragg's Double hurdle model, Modern variety

Objectives: This study aims to examine the correlation between the different types of migrant acculturation strategies according to Berry’s model of acculturation (integration, assimilation, separation, and marginalisation) and their effects on mental health conditions, such as depression, anxiety and PTSD. Study design: Systematic Review. Methods: Three databases (PubMed, Ovid and Ebsco) were searched using different combinations of search terms to identify relevant articles to be included. The search terms were pre-identified using relevant synonyms for “migrants”, “mental health” and “integration”. The list of article titles from these searches were then filtered using predefined inclusion and exclusion criteria. The mental health consequences included a range of common conditions including suicide/self-harm, depressive disorders, psychosis, as well as substance misuse. Results: 21 primary studies were included in the review, which assessed 61,885 migrants in total (Fig. 1 and Supplemental File 1). Of these, seven were cohort studies and fourteen were cross-sectional studies.Most studies showed that marginalisation was associated with worse depression symptoms, compared to integration, assimilation and separation, while integration was associated with the least depressive symptoms.Marginalisation more than triples the likelihood of anxiety-related symptoms compared to integration. Similarly, separation increased the likelihood of anxiety-related symptoms nearly six-fold. Conclusions: Our review found out that marginalisation had the worst effects on mental health of the migrant populations while integration had the most positive effects. The study also identified three key sources which may contribute to acculturation stress and worse mental health: low education or skill set, proficiency of the host country’s language, and financial hardships.

Self microemulsifying formulation is an approach used for enhancing the bioavailability of poorly soluble molecules due to their lipidic nature and small particle size. The objective of the present study was to evaluate the hepatoprotective activity of poorly soluble hydroxy- and polyhydroxy-organic phytomolecules rich Lagerstroemia speciosa leaves extract in modern formulation i.e. “Self microemulsifying System”. Different doses of SME (Self microemulsifying) formulation of L. speciosa leaves extract were evaluated for the hepatoprotective activity against carbon tetrachloride induced liver toxicity in rats. The parameters evaluated were (a) biochemical parameters like serum enzymes: aspartate aminotransferase (AST), serum glutamate pyruvate transaminase (ALT), serum alkaline phosphatase (ALP) and total bilirubin (b) liver antioxidant parameters as estimation of Lipid peroxidation (LPO), catalase (CAT), Superoxide dismutase (SOD) activity and concentration of reduced glutathione (GSH). Oral administration of SME formulation provided the significant protection in marker enzyme of treated group at 100 mg/kg, p.o. as AST (P

Background: Lagerstroemia speciosa (SEL) leaves are a popular folk medicine for diabetes treatment due to presence of corosolic acid. It has low water solubility resulting poor absorption after oral administration. Self micro-emulsified drug delivery system is the way by which we can improve the oral absorption of drug. Objective: The objective of this study was to develop the self micro-emulsifying formulation of standardized extract of SEL leaves and evaluate its pharmacodynamic performance for antidiabetic activity. Materials and methods: The SME formulation was prepared by using sefsol-218 as oil, cremophor-EL as surfactant and transcutol-P as co-surfactant. The ratio of surfactant and co-surfactant was determined by pseudoternary phase diagram. SME formulations were characterized for dilution at different pH, self emulsification, optical clarity, globule size and thermodynamic stability. Pharmacodynamic evaluation of formulations was assessed in Wistar rats by using parameters viz. blood glucose level and serum lipid profile. Results: SEL loaded SME formulation was successfully developed by using sefsol-218, cremophor-EL and transcutol-P with a droplet size 23.53 nm. Pharmacodynamic results showed a higher reduction in blood glucose by SME formulation than SEL without SMES respectively at 50 mg/kg dose while reduction produced at dose of 100 mg/kg was found significant and better on 15th day of study. The percentage reduction produced by SME formulation on serum lipid profile was also significant and was more prominent than SEL. Conclusion: This study confirms that the formulation elevates the pharmacodynamic performance of SEL approximately two fold. Keywords: Self micro-emulsifying formulation, Lagerstroemia speciosa, antidiabetic activity

【Abstract】Objective: The treatment of multi-fragmentary, intraarticular fractures of the distal humerus is difficult, even in young patients with bone of good quality. Small distal fragment, diminished bone mineral quality and increased trauma-associated joint destruction make stable joint reconstruction more problematic. The anatomically preshaped locking plates allow angular stable fixation for these complex fractures. We evaluated functional results of patients treated with open reduction and internal fixation with distal humerus locking plates for complex distal hu-merus fractures. Methods: Forty-three consecutive patients with ar-ticular fractures of the distal humerus were treated by open reduction and internal fixation with AO distal humerus plate system and locking reconstruction plates. Forty patients were available for the final outcome analysis. According to AO/ASIF classification, there were 2 cases of type A2, 4 cases of type A3, 1 case of type B1, 1 case of type B2, 14 cases of type C1, 7 cases of type C2 and 11 cases of type C3. Open reduction with triceps splitting technique was used in all patients. The clinical and radiographic follow-up was performed and outcome measures included pain assessment, range of motion, and Mayo elbow performance score. Results: Forty patients were available for the final outcome analysis. There were 29 males and 11 females with an average age of 38.4 years (18-73 years). Clinical and ra-diological consolidation of the fracture was observed in all cases at an average of 11.6 weeks (9-14 weeks). The average follow-up was 12 months (10-18 months). Using the Mayo elbow performance score the results obtained were graded as excellent or good results in 33 patients (82.5%). One pa-tient had superficial infection, and 4 had myositis ossificans. There were no cases of primary malposition or secondary displacement, implant failure or ulnar neuropathy. Conclusion: Anatomically preshaped distal humerus locking plate system is useful in providing stable fixation for complex distal articular fracture and facilitating early post-operative rehabilitation. The low rate of implant failure in the present study indicates that the technique is promising and warrants further investigation. Key words: Humerus; Fractures, bone; Bone plates; Fracture fixation, internal

【Abstract】Dislocation of the radial head in adults is uncommon. A simultaneous dislocation of the radial head and fracture of the ipsilateral distal end of radius with no other associated injuries is extremely rare. As far as we know, such an injury after an unusual mode of injury has been seldom reported in the English literature. We report such a case without any associated injuries or comorbidity. Closed reduction was performed within two hours after injury and results were satisfactory. Immobilisation was continued for 3 weeks. Gradual mobilisation was started after removal of the plaster under the supervision of a physiotherapist. At 6 months’ follow-up, the patient had no residual pain at the elbow with full flexion & extension. Almost full supination with a restriction of last 10 degrees of pronation was achieved. There was no evidence of instability of the elbow. Key words: Radial heads; Dislocations; Radius fractures

【Abstract】Hip dislocation in children can occur congenitally in isolation or in conjunction with other con-genital abnormalities. Traumatic hip dislocations in children are relatively uncommon and anterior dislocation of hip joint is even rarer. We report such a case following unusual mode of injury in a 12-year-old child. The patient underwent suc-cessful emergent closed reduction of left hip. The clinical course and follow-up assessment of the patient was other-wise uneventful. At 2 years’ follow-up there was no evi-dence of osteoarthritis, coxa magna, heterotrophic calcification, in congruency of the joints or avascular ne-crosis of the head of femur. Key words: Hip; Dislocations; Child

【Abstract】 Nonunion in tibial plateau fractures is very rare. Limited literature is available on Pubmed search on intraarticular tibial nonunion. Most of the cases reported have been following failed surgical treatment and none was neglected fractures. Three patients of isolated and neglected medial tibial plateau nonunion with almost similar demo-graphic profile are reported in this paper. All the three pa-tients were managed by minimally invasive compression fixation using lag screws supplemented with limb realign-ment procedure of high tibial osteotomy. We discussed the injury mechanism, management and rehabilitation in such cases and reviewed the available literature regarding such a presentation. Key words: Fracture healing; Tibial fractures; Frac-ture fixation; Osteotomy

【Abstract】Objective: To present our experience in treatment of difficult ununited long bone fractures with locking plate. Methods: Retrospective evaluation of locking plate fixation in 10 difficult nonunions of long bone fractures was done. Fixation was done with locking plate for femoral shaft fracture (3 patients), supracondylar fracture of femur (gap nonunion), fracture of clavicle, fracture of both forearm bones (radius and ulna) fracture of ulna, fracture of shaft of humerus, fracture of tibial diaphysis and supracondylar frac-ture of humerus (one patient each). Five fractures had more than one previous failed internal fixation. One patient had infected nonunion which was managed by debridement with cast immobilization followed by fixation with locking plate at six weeks. Seven fractures were atrophic, two were oligotrophic, and one was hypertrophic. Fibular autograft was used in 2 cases and iliac crest cancellous bone graft used in all the patients. Results: Minimum follow-up was 6 months (range, 6 months to 2.5 years). Average time for union was 3.4 months (range 2.5 to 6 months). None of the patients had plate-related complications or postoperative wound infections. Conclusion: Along with achieving stability with lock-ing compression plate, meticulous soft tissue dissection, acceptable reduction, good fixation technique and bone grafting can help achieve union in difficult nonunion cases. Though locking plate does not by itself ensure bony union, we have found it to be another useful addition to our arma-mentarium for treating difficult fracture nonunions. Key words: Fractures, bone; Fractures, ununited; Bone plates; Orthopedic fixation devices

【Abstract】Simultaneous bilateral intertrochanteric fractures are very rare. There is a paucity of data in current literature documenting patients with such kind of hip fractures. It is severe and potentially life-threatening, associated with a high morbidity. The major determinants of successful outcome are high vigilance, early single stage stabilization and mobilization as well as management of associated comorbid conditions that may influence the long term rehabilitation of patients. Here we reported 4 cases of concurrent bilateral trochanteric fractures along with review of the literature. Our study aimed to discover its frequency, identify the injury mechanisms as well as factors present in the pathogenesis of these fractures, and outline the available treatment modalities. Key words: Hip fractures; Bone screws; Bone plates

【Abstract】 Thoracic impalement injuries are very rare and the majority of patients do not survive to reach a medical care facility. In this case report, we describe the successful outcome of a case of double thoracic impale-ment by two steel tors, of which one steel tor had impaled two patients simultaneously. The case report highlights all aspects of managing such rare and complex cases right from prehospital care; extrication process which happened un-der controlled environment at the trauma centre itself, till the definitive management of the impaled thoracic objects. Thoracic impalement injuries are dramatic and appear very challenging. However presence of mind of the managing team, coordinated team effort and availability of adequate facilities can lead to a successful outcome. Key words: Thoracic injuries; Emergency medical services; Accidents, traffic

【Abstract】Isolated trochlea fracture in adults is a rare surgical entity as compared to its capitellar counterpart. It has been only mentioned sporadically in the literature as case reports. Fracture of the trochlea is accompanied by other elbow injuries like elbow dislocation, capitellum fracture, ulnar fracture and extraarticular condylar fracture. Here we report a unique case of isolated displaced trochlea fracture associated with fractures of the lateral end clavicle and the distal end radius. We propose a unique mechanism for this rare combination of injuries: typical triad of injury, i.e. fracture of the distal end radius with trochlea and fracture of the lateral end of the clavicle. Nonoperative treatment is recommended for undisplaced humeral trochlea fractures; but for displaced ones, anatomical reduction and internal fixation are essential to maintain the congruous trochleacoronoid articulation and hence to maintain the intrinsic stability of the elbow. Key words: Isolated trochlea fracture; Clavicle; Radius fractures

【Abstract】Open anterior dislocation of the hip is a very rare injury, especially in adults. It is a hyperabduction, external rotation and extension injury. Its combination with open posterior dislocation of the elbow has not been described in English language-based medical literature. Primary resuscitation, debridement, urgent reduction of dislocation, and adequate antibiotic support resulted in good clinical outcome in our patient. At 18 months follow-up, no signs of avascular necrosis of the femoral head or infection were observed.

【Abstract】The presence of anterior hip dislocation along with contralateral posterior hip dislocation in the ab-sence of other major traumas is a distinctly rare injury pattern. We report such a case, along with a review of previous cases. A 40-year-old male patient after motorcycle skidding had posterior dislocation of the left hip and anterior dislo-cation of the right one without other associated injuries. The patient underwent successful closed reduction of both hips. The clinical course and follow-up assessment of the patient was uneventful. Key words: Wounds and injuries; Hip dislocation; Accidents, traffic

Leptospirosis is an acute anthropo-zoonotic infection of worldwide significance caused by spirochaete Leptospira interrogans which has 23 serogroups and >200 serovars. Various factors influencing the animal activity, suitability of the environment for the survival of the organism and behavorial and occupational habits of human beings can be the determinants of incidence and prevalence of the disease. The disease was considered inconsequential till recently, but it is emerging as an important public health problem during the last decade or so due to sudden upsurge in the number of reported cases and outbreaks. Since isolation rate of the microorganism from clinical specimens is low due to prior indiscriminate use of antibiotics, serological techniques remain the cornerstone of diagnosis.

Cardiac mapping is a broad term that covers several modes of mapping such as body surface,1 endocardial,2 and epicardial3 mapping. The recording and analysis of extracellular electrograms, reported as early as 1915, forms the basis for cardiac mapping.4 More commonly, cardiac mapping is performed with catheters that are introduced percutaneously into the heart chambers and sequentially record the endocardial electrograms with the purpose of correlating local electrogram to cardiac anatomy. These electrophysiological catheters are navigated and localized with the use of fluoroscopy. Nevertheless, the use of fluoroscopy for these purposes may be problematic for a number of reasons, including: 1) the inability to accurately associate intracardiac electrograms with their precise location within the heart; 2) the endocardial surface is invisible using fluoroscopy and the target sites can only be approximated by their relationship with nearby structures such as ribs, blood vessels, and the position of other catheters; 3) due to the limitations of two-dimensional fluoroscopy, navigation is not exact, time consuming, and requires multiple views to estimate the three-dimensional location of the catheter; 4) inability to accurately return the catheter precisely to a previously mapped site; and 5) exposure of the patient and medical team to radiation. Newer mapping systems have revolutionized the clinical electrophysiology laboratory in recent years and have offered new insights into arrhythmia mechanisms. They are aimed at improving the resolution, three-dimensional spatial localization, and/or rapidity of acquisition of cardiac activation maps. These systems use novel approaches to accurately determine the three-dimensional location of the mapping catheter and local electrograms are acquired using conventional, well-established methods. Recorded data of the catheter location and intracardiac electrogram at that location are used to reconstruct in real-time a representation of the three-dimensional geometry of the chamber, color-coded with relevant electrophysiological information. However, these mapping systems are very expensive and not required for the commoner clinical arrhythmias like atrioventricular nodal reentry (AVNRT), accessory pathway mediated tachycardia (WPW syndrome and concealed pathways) and typical atrial flutter. The purpose of this article is to discuss the possible contribution of newer cardiac mapping system to treat various arrhythmias.

BACKGROUND: Enteric fever continues to be a major public health problem, especially in the developing countries of the tropics. We determined the incidence of Salmonella bloodstream infections and their antimicrobial resistance patterns from May to August in the years 1997-2001 in Haryana, a large state of India. The minimum inhibitory concentration (MIC) was also determined for 60 isolates of S. typhi to various commonly used antimicrobial agents. MATERIAL AND METHODS: Blood cultures of 6,956 patients (PUO/septicemia) were processed by standard procedures and the Salmonella spp. isolates were identified with specific antisera and with standard biochemical tests. Antimicrobial susceptibilities were determined by Stokes disc diffusion method. The MIC of 60 randomly isolated strains of S. typhi was determined by agar dilution method using Mueller Hinton Agar medium. RESULTS: Isolation rates of Salmonella spp. increased in 2000 and 2001. Multidrug resistance (MDR) in S. typhi had increased while in S. paratyphi it had decreased markedly. Ninety per cent chloramphenicol sensitivity was seen in S. typhi by MIC method. There was a decrease in the susceptibility to ciprofloxacin of S. typhi with MIC showing an upward trend. All S. typhi tested were sensitive to third generation cephalosporins and aminoglycosides with MIC well below the breakpoint. DISCUSSION: Our study indicates that MDR in S. typhi is on the rise in our area. There is also re-emergence of chloramphenicol sensitivity. Rising MIC values of ciprofloxacin may lead to prolonged treatment, delayed recovery or pose treatment failure. Thus, sensitivity pattern of causative organism must be sought before instituting appropriate therapy to prevent further emergence of drug resistance.

【Abstract】Controlling postoperative pain after total hip replacement is important and controversy remains regarding different regimens. By reviewing 18 studies, we attempt to find whether local infiltration analgesia after total hip replacement has any effect on postoperative pain, length of hospital stay and opioid consumption. We conclude that local infi ltration analgesia is an effective method for decreasing postoperative pain. Key words: Arthroplasty, replacement, hip; Analgesia; Pain, postoperative