Sex determination using mandibular ramus flexure: a preliminary study on Indian population

Determination of sex by morphological assessment has been one of the oldest approaches in forensic anthropology. Loth and Henneberg(6) introduced a morphological trait "Mandibular Ramus Flexure" for sex identification with a high accuracy of 99% in African Blacks. However, the population specificity of sexually dimorphic features is well known. The purpose of this study is to test the reliability of this trait in Indian population. A total number of 112 adult mandibles (88 males and 24 females) were studied from the Department of Forensic Medicine, Institute of Medical Sciences, Banaras Hindu University, India. The mandibles were scored according to the original method by two observers in three different sessions. This was done to test inter and intra-observer errors in identifying the trait. The result shows that this trait can be used to diagnose sex with an average accuracy of upto 82%. Though, inter and intra-observer errors were present but could be minimized with extended practice. So, the trait has the potential to be relied upon as a single morphological trait for determination of sex in Indian population.     

Effect of patent ductus arteriosus on pulmonary vascular disease

The hemodynamic effects of a patent ductus arteriosus (PDA) are well known including systemic hypoperfusion and volume overload on the left ventricle. This article aims to provide a review of the long‐standing effect of a hemodynamically significant PDA on the pulmonary vasculature and the role of cardiac catheterization in preterm infants with a PDA and pulmonary hypertension.     

A prospective study of the prevalence of periapical pathology in severely worn teeth

The aim of this article was to carry out a prospective audit on a convenience sample of all new patients referred to the toothwear clinic at Cardiff University Dental Hospital to establish the prevalence of undiagnosed periapical pathology. CLINICAL RELEVANCE: The low prevalence value for undiagnosed periapical pathology in patients with advanced toothwear suggests that, for many patients, toothwear is a slow process which allows the defence mechanisms of the pulp to counteract the effects of wear. It also questions the necessity of taking routine radiographs of teeth with wear into dentine, in the absence of clinical symptoms. This would reduce the total radiation dose delivered to the patient and preserve valuable healthcare resources.     

Extra-anatomic aorto-femoral graft for acute limb ischemia after type a aortic dissection repair

We report an alternative approach to revascularization of the leg in a patient with acute type A aortic dissection, where other options were not feasible. An aorto-femoral extra-anatomic conduit was used to salvage the leg after major aortic surgery where further surgery or endovascular grafting would have lead to increased morbidity.     

Current concepts in managing fractures of metacarpal and phalangess

Fractures of the metacarpal and phalanges constitute 10% of all fractures. No where in the body, the form and function are so closely related to each other than in hand. Too often these fractures are treated as minor injuries resulting in major disabilities. Diagnosis of skeletal injuries of the hand usually does not pose major problems if proper clinical examination is supplemented with appropriate radiological investigations. Proper preoperative planning, surgical intervention wherever needed at a centre with backing of equipment and implants, selection of appropriate anaesthesia and application of the principle of biological fixation, rigid enough to allow early mobilisation are all very important for a good functional outcome. This article reviews the current concepts in management of metacarpal and phalangeal fractures incorporating tips and indications for fixation of these fractures. The advantages and disadvantages of various approaches, anaesthesia, technique and mode of fixation have been discussed. The take-home message is that hand fractures are equally or more worthy of expertise as major extremity trauma are, and the final outcome depends upon the fracture personality, appropriate and timely intervention followed by proper rehabilitation. Hand being the third eye of the body, when injured it needs a multidisciplinary approach from the beginning. Though the surgeon''s work appears to be of paramount importance in the early phase, the contribution from anaesthetist, physiotherapist, occupational therapist, orthotist and above all a highly motivated patient cannot be overemphasised.     

Centchroman Regresses Mastalgia: A Randomized Comparison with Danazol

We conducted a randomized trial to evaluate effectiveness of Centchroman in control of mastalgia and compared it with Danazol. Research Question- Is proportion of pain relief achieved by Centchroman similar to or inferior to that achieved by Danazol? In a randomized controlled trial of Centchroman vs. Danazol in mastalgia, 81 patients with mastalgia were studied. Thirty-nine patients were randomized to Danazol arm and 42 in Centchroman arm. The treatment was given for 12 weeks, followed by observation for 12 weeks. The pain was measured by visual analogue scale (VAS) of 0–10. At 12 weeks 89.7% women achieved reduction in pain score to ≤3 in Centchroman group (pvalue 0.001). In Danazol group 69.44% women achieved reduction in pain score to ≤ 3 (p = 0.001). Three months after stopping therapy, Centchroman was more effective in pain score reduction at 24 weeks as compared to Danazol (p = 0.019). Centchroman is an effective, safe and inexpensive alternative to Danazol for treatment of mastalgia.

Electronic supplementary material

The online version of this article (doi:10.1007/s12262-010-0216-z) contains supplementary material, which is available to authorized users.     

Is the problem with the vehicle or the destination? Does high‐dose ESA or high haemoglobin contribute to poor outcomes in CKD?

Randomized controlled trials have consistently demonstrated adverse outcomes from targeting higher haemoglobin levels in chronic kidney disease patients treated with erythropoiesis-stimulating agents (ESA). In contrast, observational studies have shown better survival in patients achieving high haemoglobin. Consequently, there is ongoing uncertainty as to whether high haemoglobin or high ESA dose contributes to poor outcomes in ESA-treated chronic kidney disease patients. The objectives of this article are to review the available evidence pertaining to this contentious area, provide recommendations where possible and suggest directions for future research efforts.