Proximal humeral reconstruction using nail cement spacer in primary and metastatic tumours of proximal humerus

Limb salvage surgery for malignant tumours of proximal humerus is an operative challenge, where the surgeon has to preserve elbow and hand functions and retain shoulder stability with as much function as possible. We treated 14 consecutive patients with primary malignant or isolated metastasis of proximal humerus with surgical resection and reconstruction by nail cement spacer. There were 8 females and 6 males, with a mean age of 28.92 years (range 16–51 years) and a mean follow-up of 30.14 months (range 12–52 months). The diagnosis was osteosarcoma in 8 patients, chondrosarcoma in 4 patients and metastasis from thyroid and breast carcinoma in 1 patient each. One of our patients had radial nerve neuropraxia, 1 developed inferior subluxation and 3 developed distant metastasis. Two patients died of disease and one developed local recurrence leading to forequarter amputation, leaving a total of 11 patients with functional extremities for assessment at the time of final follow-up which was done using the Musculoskeletal Tumour Society (MSTS) score. Though we were able to preserve the elbow, wrist and hand functions in all patients, the abductor mechanism, deltoid muscle and axillary nerve were not salvageable in any of cases. The mean MSTS score at the time of final follow-up was 19.09. Thus, proximal humeral reconstruction using nail cement spacer is a technical simple, cost-effective and reproducible procedure which makes it a reliable option in subset of patients where the functions around the shoulder cannot be preserved despite costlier prosthesis.     

Clinical and microbiologic effects of commercially available dentifrice containing aloe vera: a randomized controlled clinical trial

Background: Certain plants used in folk medicine serve as a source of therapeutic agents that have antimicrobial and other multipotential effects. This prospective, randomized, placebo, and positively controlled clinical trial was designed to evaluate the clinical and microbiologic effects of a commercially available dentifrice containing aloe vera on the reduction of plaque and gingival inflammation in patients with gingivitis. Methods: Ninety patients diagnosed with chronic generalized gingivitis were selected and randomly divided into three groups: group 1, placebo toothpaste; group 2, toothpaste containing aloe vera; and group 3, toothpaste with polymer and fluoride containing triclosan. Clinical evaluation was undertaken using a gingival index, plaque was assessed using a modification of the Quigley‐Hein index, and microbiologic counts were assessed at baseline, 6 weeks, 12 weeks, and 24 weeks. A subjective evaluation was also undertaken by questionnaire. Results: Toothpaste containing aloe vera showed significant improvement in gingival and plaque index scores as well as microbiologic counts compared with placebo dentifrice. These improvements were comparable to those achieved with toothpaste containing triclosan. Conclusion: Toothpaste containing aloe vera may be a useful herbal formulation for chemical plaque control agents and improvement in plaque and gingival status.     

Ethnic density,cultural congruity and mental illness in migrants

Migration is now well understood to be associated with mental illness in many parts of the world. However, the cause and effects of migration that are associated with mental illness continue to be a point of debate. The Ethnic Density concepts give a plausible explanation. On further elaboration, we conclude that a move from a sociocentric society to an egocentric one leads to more distress and more mental illness. Cultural incongruity faced by a migrant in an alien culture has a similar impact. Several theories on migratory distress have tried to explain psychiatric morbidity: high morbidity at source, individual predisposition, stress, misdiagnosis and racial discrimination. We hypothesise that the impact of ethnic density and cultural congruity occurs in a social context.     

Risk factors for posterior reversible encephalopathy syndrome in hypertensive pregnant women presenting with seizures

Neurological Sciences - Pregnant women developing generalised tonic–clonic seizures in the absence of a prior neurological disorder are often diagnosed as eclamptic. Posterior reversible...     

A quick glance at selected topics in this issue

“A quick glance at selected topics in this issue” aims to highlight selected articles and provide a quick review to the readers.