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In an epidemiological study traumatic injury to the thoracolumbar area constitute of 75% of total back skeletal injuries. Most of these injuries comprises of thoracolumbar segment of the spine (t10 to l2), also high incidence of neurological deficits is associated with thoracolumbar fractures. Numerous classifications were proposed on an anatomical basis to guide the management of TL fractures and define the indications for surgery but none of these classification systems have taken into account the stabilizing effect of para- spinal muscles. The aim of this article is to review the present literature on evidence of management of TL fractures using operative versus conservative techniques. 40 patients with dorsolumbar spine injuries falling into inclusion criteria were managed with conservative and operative intervention between December 2008 to January 2010. 16 patients were treated with operative intervention with short or long segmented fixation & fusion with bone grafts.24 patients were treated non operatively with DLSO brace and kept immobilised for 4-6 weeks. The maximum period of follow up was 18 to 24 months with a minimum period of follow up of 9 to 12 months. At follow up on regular check of neurological status, 50% of operatively treated patients were showing improvement. Patients treated non operatively had no or occasional pain according to pain score. 10 patients had excellent score treated operatively while 12 patients had good score. 8 patients treated non operatively had good to fair score according to grading for neurological improvement by SRS (scoliosis research society). Surgical intervention should be advocated in cases of unstable burst fractures of the dorsolumbar region, irrespective of status of neurological damage, but might be restricted in the patients with incomplete spinal cord injuries.

Context: Study of the prevalence of echocardiographic abnormalities and there relation to disease progression in chronic kidney disease (CKD). Aims: Study correlation of echocardiographic changes and CKD progression. Settings and Design: A prospective, cross-sectional, observational, analytical study, where we performed complete echocardiographic evaluation of patients with CKD stage II–V. We compared various echocardiographic parameters to predict the progression of CKD. Subjects and Methods: Ninety CKD patients stage II–V presenting to our hospital from November 2016 to December 2017 were included in the study. A complete echocardiographic evaluation was done. Left ventricular hypertrophy (LVH), systolic and diastolic dysfunction using Doppler indices at mitral inflow, left atrial volume, speckle tracking, and global longitudinal strain (GLS) were studied. Results: Patients were age and sex matched in all the groups with a male preponderance. Forty-one patients (45.56%) were diabetic and 74 (82.22%) were hypertensive. The prevalence of hypertension increased from 66.67% to 89.29% as CKD stage progressed from stage II to stage V. There were significant echocardiographic abnormalities seen in CKD patients. The severity increased with worsening of the stages of CKD. LVH and early diastolic mitral inflow to annular velocity ratio progression was statistically significant when stage V was compared to stage II. Left atrial volume, mitral early diastolic to late diastolic velocity ratio, maximum tricuspid regurgitation (TRmax) velocity, and diastolic dysfunction prevalence were significantly raised in stage IV and stage V compared to stage II. Only GLS showed statistical significance between stage II to stage III, stage IV and stage V and thus predicting progression of CKD. Conclusions: LVH, dilated left atrium, abnormal GLS, TRmax, diastolic dysfunction, and related tissue Doppler imaging parameters correlate with worsening renal function. GLS was the only parameter showing significant difference between stage II and stage III. This can be used as a novel modality for detection of subclinical cardiac dysfunction in CKD.

Background The safety and efficacy of dabigatran in the periprocedural period for patients undergoing atrial fibrillation ablation is not well established. We conducted a meta-analysis of the periprocedural use of dabigatran vs warfarin (with or without heparin bridging). Methods A literature search was performed using multiple databases. Outcomes were (1) major bleeding; (2) minor bleeding; and (3) thromboembolic events. Odds ratios (ORs) were reported for dichotomous variables. Results Eleven controlled studies (9 cohorts, 1 randomized controlled trial and 1 case-control study; 3841 patients) were identified. Dabigatran was used in 1463 patients, uninterrupted in 223 and held up to 36 hours in the remainder. No significant differences were noted in major bleeding rates between dabigatran and warfarin groups (1.9% vs 1.6%; OR, 1.04 [95% confidence interval (CI), 0.51-2.13]; P = 0.92). Cardiac tamponade was observed in 1.4% in dabigatran vs 1.1% in warfarin groups (OR, 1.1; 95% CI, 0.55-2.11; P = 0.82). Similar rates for dabigatran vs warfarin were reported for minor bleeding (3.8% vs 4.5%; OR, 0.85; 95% CI, 0.58-1.25; P = 0.40), hematoma (2% vs 2.7%; OR, 0.67; 95% CI, 0.41-1.08; P = 0.1), and thromboembolic events (0.6% vs 0.1%; OR, 2.51; 95% CI, 0.78-8.11; P = 0.12). Conclusions This meta-analysis suggests that dabigatran and warfarin have similar safety and efficacy overall for periprocedural anticoagulation in patients undergoing radiofrequency atrial fibrillation ablation. Signals were seen favouring dabigatran (for hematomas) and warfarin (for thromboembolic events), but neither was statistically significant because of low event rates. More high-quality data are required to definitively compare the 2 strategies.

A 40-year-old lady was admitted with a week’s history of fever and dyspnoea. Transthoracic echocardiography revealed 0.5 × 0.5 cm vegetation on the posterior mitral leaflet with a severe eccentric mitral regurgitation (MR) hugging the left atrial aspect of anterior mitral leaflet and the interatrial septum (IAS) which was confirmed by a transoesophageal echocardiogram (figure 1A, arrows). Multiple vegetations were seen all along the anterior mitral leaflet (left atrial aspect) and …

A 35-year-old menstruating woman presented with exertional angina, and was diagnosed with an unruptured left sinus of Valsalva and a noncoronary sinus of Valsalva aneurysm. Hypereosinophilia and coronary artery occlusion was also observed; this association is extremely rare.

Background: The purpose of this prospective study was to assess the functional outcome of conservative treatment with early ambulation of dorso-lumbar spine fractures with no neurological deficit. Aims & Objective: The purpose of this prospective study was to identify the risk factors for dorso-lumbar spine injuries, and to assess the efficacy of non-operative treatment with early ambulation, and functional outcome of the patients. Material and Methods: From October 2008 to June 2010, 48 consecutive patients with single- level thoracolumbar spinal injury, with no neurological deficit were managed non-operatively. A custom-made thoracolumbosacral orthosis was worn by all patients for six months, and early ambulation was recommended. Patients were evaluated as per TLICS score, and if score was

A 22-year-old man, diagnosed 7 weeks before with pulmonary tuberculosis and started on antitubercular therapy, presented with non-exertional retrosternal chest pain since the past week. He was diagnosed on the strength of thoracic radiograms and CT imaging to have a mediastinal abscess, which was percutaneously drained. He was continued on the same regimen of drugs. Analysis of the fluid obtained was suggestive of tuberculous aetiology. Steroids were not required.

Rheumatic heart disease is the most common cause of mitral stenosis, and percutaneous balloon mitral valvotomy (BMV) has stood the test of time as the standard therapy for the same. We describe a very unusual complication of cardiac catheterisation that occurred during an otherwise uneventful procedure. A 65-year-old woman was diagnosed with severe mitral stenosis due to rheumatic heart disease. She was in atrial fibrillation and was admitted for BMV. She had a …