Maxillofacial Injuries in Counter Proxy War Posture of the Armed Forces

Background

Various maxillofacial injuries, sustained in counter insurgency operations in the counter proxy war posture (CPWP) of the Armed Forces in the Kashmir valley are being treated at various maxillofacial surgical centres.

Method

Proper triage, documentation of injuries and mode of injuries along with various clinical, radiological and other investigations were carried out before operating these individuals for primary reconstruction of skeletal tissue and facial soft tissue.

Result

A total of 324 persons with various types of maxillofacial injuries were treated within the period ranging from 01 January 2000 to 30 June 2002 successfully in this centre as a part of the advanced trauma life support (ATLS) system of Combat Medical Support.

Conclusion

Proper primary reconstruction (soft tissue and skeletal tissue) of the facial region goes a long way in reducing subsequent disfigurement and morbidity. Improving the structural design of the combat head gear for safety and comfort will go a long way in preventing majority of maxillofacial injuries or can at least reduce the severity of these injuries.Key Words: Battle accident, Battle casualties, Counter proxy war posture, Maxillofacial injuries     

The relationship between albuminuria and hypercholesterolemia

BACKGROUND: To test the hypothesis that the albuminuria is an independent risk factor for hypercholesterolemia. METHODS: Cross-sectional study (The Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994) of the civilian, noninstitutionalized US population. Of the total 33,994 NHANES III participants, those aged 17 years or more and those who had complete urinary albumin-to-creatinine (UAC) ratio information formed our primary study population (n=17,702). The main outcomes of interest were: high serum TC level, defined as levels more than 6.2 mmol/L (240 mg/dL); high serum LDL cholesterol level, defined as levels more that 4.1 mmol/L (160 mg/dL); and low serum HDL cholesterol level, defined as levels less that 0.9 mmol/L (35 mg/dL). RESULTS: Compared to individuals with normoalbuminuria, the odds ratio (OR) of high serum TC level and high LDL cholesterol level were respectively 1.04 and 1.32 for those with microalbuminuria, and 1.96 and 1.69 for those with macroalbuminuria. Increasing quintiles of UAC ratio was associated with graded increase in the odds of high serum TC (OR, 1,1.23,1.25,1.33,1.46; p trend=0.02) and LDL cholesterol (OR, 1, 0.99, 1.09, 1.46, 1.59; p trend=0.02) levels. In our analyses, the fourth quintile of UAC ratio was associated with significant OR of hypercholesterolemia, despite it being in the currently accepted normal range. However, albuminuria was not associated with low HDL cholesterol in our analysis. CONCLUSIONS: Increasing albuminuria is associated with continuous, and graded increase in the odds of high serum TC and LDL cholesterol levels. Our results call for future follow-up studies to confirm if albuminuria precedes the development of hypercholesterolemia.     

Imaging in acute abdomen

Objective The present study aims at establishing the exact role and limitation of ultrasound in pediatric acute abdomen.Methods Fifty children less than 14 years of age presenting with acute abdomen were evaluated by US and other imaging modalities. The mean age of presentation was 312 years. Maximum number of cases were seen in less than two years of age. There were 17 cases of intussusception with US sensitivity and specificity of 88.2% and 100% respectively and positive and negative predictive values of 100% and 94.5% respectively. There were 13 cases of appendicitis. US was diagnostic in 11 with sensitivity and specificity of 91.6% and 97%; the positive and negative predictive values were 91.6% and 97% respectively.Results : There were two cases each of congenital bands, adhesive intestinal obstruction, malrotation of bowel with volvulus, incarcerated inguinal hernia, hypertrophic pyloric stenosis, duplication cyst and pseudopancreatic cyst, one case each of trichobezoar, Meckel’s diverticulum, ureteric calculus and worms as a cause of intestinal obstruction. The sensitivity of US for diagnosing specific cause of acute abdomen was found to be 77.5%. The main limitation of US was in the diagnosis of acute intestinal obstruction such as congenital bands and adhesions.Conclusion. US should now be considered as imaging modality of choice in pediatric acute abdomen. However, at times, plain radiography, conventional contrast studies and CT may be vital to reach the true diagnosis     

Survival and morbidity in extremely low birth weight (ELBW) infants

We report the morbidity and mortality in extremely low birth weight neonates (ELBW) from a tertiary care hospital over seven years (1994-2000). Data regarding maternal and neonatal details was obtained from old records, computer database and medical files. Of the 12,807 live births during this period, 137 (1.07%) were ELBW infants. All of them were managed without surfactant. Overall, 67 infants (48.7%) survived to discharge. The most commonly encountered morbidities were hyperbilirubinemia(65%), respiratory distress(65%), sepsis(52%), intraventricular hemorrhage(29%), pneumonia (25%) and retinopathy of prematurity(24%). Need for resuscitation, pulmonary hemorrhage, seizures, acute renal failure, sclerema and air leak syndromes were significantly associated with mortality. Sepsis accounted for 41% of all deaths while immaturity was the second most important cause, accounting for 24% deaths. The average length of stay for survivors was 49 days (SD +/- 15.9 days)     

Awareness of HIV/AIDS and household environment of pregnant women in Pune, India

Our objective was to determine the level of HIV/AIDS knowledge of pregnant women in India. In a sub-sample of these women, we documented the extent to which they experienced adverse social and physical difficulties within their home. The study was performed at an urban antenatal hospital clinic in Maharastra, India. From April to September 2001, structured interviews were conducted on 707 randomly selected antenatal clinic patients related to HIV/AIDS knowledge. Of these, 283 were further interviewed to document any social or physical difficulties they experienced. Over 75% of women displayed knowledge of primary transmission routes. Nearly 70% of women demonstrated knowledge of maternal to child transmission, however, only 8% knew of any methods of prevention. TV and written material were more strongly related to knowledge than access to radio messages or conversations with individuals. Thirty per cent of the women experienced physical or mental abuse or their spouse's alcohol and/or drug problems. Women reporting such abuse were more than twice as likely to have adequate HIV/AIDS knowledge compared with women reporting no such abuse. We found no relationship between reported household abuse and educational level of woman, husband, occupation of either partner, language or religion. We found no relationship between HIV status and knowledge of HIV and no relationship between HIV status and risk of abuse in the household. However, the total number of HIV patients in our sample was very small.