COMPARATIVE STUDY OF HEMIREPLACEMENT ARTHROPLASTY WITH BIPOLAR PROSTHETIC AND PROXIMAL FEMORAL NAIL (PFN) IN UNSTABLE INTERTROCHANTERIC FRACTURE OF FEMURE: INTERVENTIONAL PROSPECTIVE RANDOMIZED STUDY

Background: Intertrochanteric femur fracture incidence has increased due to increased life expectancy and osteoporosis. Methods- The present study was prospectively carried out in 60 consecutive patients of Fracture Intertrochanter Femur and treated with Hemiarthroplasty with Cemented Bipolar Prosthesis and Proximal Femoral Nail. Results: The age of the patients in present study was in range of 60 - 80 years. There was a preponderance of female in present study in both groups. The mean duratioin of surgery in the Bipolar group (91.24±9.21Minutes) was much More That In PFN (53.12 ±6.02Minutes) Group. All patients of Bipolar group was discharged between 4 to 9 days and in PFN group 4 to 12 days after surgery. The average harris hip score in PFN group is 87.32±4.13 and in Bipolar group is 85.02±7.92. Final functional outcome were better in PFN group (P value 0.01) than by Bipolar group and significant. Conclusion: The outcomes of the stable fractures treated with either Bipolar or PFN were similar. Unstable comminuted fractures treated with Bipolar showed significantly better outcomes with all patients having good results. Keywords: Hip Arthroplasty, PFN, Complication

Monopolar vs. Bipolar Trans Urethral Resection of Prostrate (TURP) - A Comparative Outcome Analysis in Benign Prostatic Hyperplasia - A Single Centre Experience in Western Odisha

BACKGROUND In this study we wanted to compare the clinical outcomes in terms of symptom improvement and perioperative results of monopolar and bipolar trans urethral resection of prostrate (TURP) for benign prostatic hyperplasia (BPH) and evaluate the advantages of bipolar transurethral resection over the monopolar resection. METHODS A total of 150 patients who underwent trans urethral resection of prostate (TURP) surgical procedure, (n = 75 for monopolar TURP) and (n = 75 for bipolar TURP) for BPH enrolled between December 2018 to November 2020 at the Department of Urology in VSSIMSAR, Burla, Odisha. RESULTS Significant differences were found in operating time in minutes (45.11 ± 4.029 vs 41.99 ± 5.020, P < 0.025) between monopolar and bipolar TURP. The mean sodium falls in post-operative period in bipolar and monopolar TURP was 7 Meq and 3 Meq respectively which was statistically significant (P - value less than 0.05). Bipolar TURP is equally effective as monopolar in reducing the international prostate symptom score (IPSS), improvement in quality of life, maximum urinary flow rate. Trans urethral resection (TUR) syndrome was reported in two patients who had undergone monopolar resection without any incidence in bipolar group. 3 patients in monopolar group developed clot retention compared to 1 in bipolar group in post-operative period. Fall in haemoglobin (Hb) and packed cell volume (PCV) was more with monopolar group but insignificant. CONCLUSIONS Bipolar TURP is safe and equally effective as monopolar TURP with advantage of shorter operative time and absence of dilutional hyponatremia and TUR syndrome, but needs large randomized trials with long follow up to confirm its efficacy and safety. KEYWORDS Monopolar TURP; Bipolar TURP; Benign Prostate Hyperplasia

COMPARATIVE STUDY OF HEMIREPLACEMENT ARTHROPLASTY WITH BIPOLAR PROSTHETIC AND PROXIMAL FEMORAL NAIL (PFN) IN UNSTABLE INTERTROCHANTERIC FRACTURE OF FEMURE: INTERVENTIONAL PROSPECTIVE RANDOMIZED STUDY

Background: Intertrochanteric femur fracture incidence has increased due to increased life expectancy and osteoporosis. Management of these fractures in elderly is challenging due to difficult anatomical reduction, poor bone quality and osteoporosis. Internal fixation in these cases usually involves prolonged bed rest to prevent implant failure which leads higher complication such as deep vein thrombosis, pneumonia pulmonary embolism, bed sores, increased morbidity. Methods: The present study was prospectively carried out in 60 consecutive patients of Fracture Intertrochanter Femur and treated with Hemiarthroplasty with Cemented Bipolar Prosthesis and Proximal Femoral Nail. Results: The average harris hip score in PFN group is 88.21±4.36 and in Bipolar group is 85.21±8.12. Final functional outcome were better in PFN group (P value 0.02) than by Bipolar group and significant. Conclusion: The outcomes of the stable fractures treated with either Bipolar or PFN were similar. Unstable comminuted fractures treated with Bipolar showed significantly better outcomes with all patients having good results. Keywords: Hip arthroplasty, PFN, Complication

Response Processes to Looming Appetitive and Aversive Cues in Euthymic Bipolar Patients and Their First-Degree Relatives: An Exploratory Study

Background: Patients with bipolar disorder demonstrate increased sensitivity to appetitive/rewarding stimuli even during euthymia. On presentation of arousing pictures, they show a peculiar response, suggesting heightened vigilance. While responding to looming arousing cues, studies show subjects with anxiety spectrum disorders exhibit increased reaction time (RT), explained by the “looming-vulnerability model.” This study aimed to investigate the responses to looming arousing cues in euthymic bipolar patients and their first-degree relatives, as compared to healthy controls. Method: A looming appetitive and aversive cue paradigm was designed for assessing the RT of patients to process appetitive and aversive cues. The behavioral inhibition/activation and sensitivity to reward/punishment amongst the groups were also assessed. Results: The bipolar group showed significantly longer RT to process appetitive cues irrespective of the looming condition. Aversive cues elicited significantly longer RT in both the bipolar group and in first-degree relatives, but only when presented with the looming condition. Significant looming bias was elicited in the bipolar group which suggested a particular cognitive style to looming cues. A composite measure of RT along with sensitivity to reward/punishment distinguishes the bipolar group and their first-degree relatives from the healthy controls. Conclusion: The looming vulnerability model may provide important insights for future exploration of cognitive endophenotypes in bipolar disorder.

Comparative study of histological changes (thermal artefacts) in resected specimens of monopolar and bipolar trans-urethral resection of bladder tumours

Objective The primary aim of the study was to study the histological changes (Thermal artefacts) noted in the resected specimens between the Monopolar and Bipolar Trans-Urethral Resection of Bladder Tumours (TURBT). Patients and Methods The study was done between March 2012 and Feb 2013. This was a comparative study between Monopolar and Bipolar resection specimens studied for histological changes (Thermal artefacts). Institutional Ethics Committee approval was obtained. Informed consent was taken from all patients. Patients were randomized into two groups, Monopolar Group or Bipolar Group of 50 each to undergo TURBT. Patients either underwent Monopolar or Bipolar TURBT in Glycine and Saline respectively. Results Thermal artefacts were graded according to WHO (World Health Organization) grading system. There was no difficulty noticed during histo-pathological examination of resected specimens. In Monopolar group, there were 27 (54%) grade 2 thermal damage, 17 (34%) grade 1 thermal damage and no grade-3 thermal damage in examined specimen. In Bipolar group, there were 07 (14%) grade 2 thermal damage, 12 (24%) grade 1 thermal damage and no grade 3 thermal damage in examined specimen. Conclusion The degree of thermal damage is much lesser in histological sections of specimen resected using Bipolar energy and interpretation of the grade is easier which is one of the most important prognosticators especially in bladder tumours since high grade lesions are proven beyond doubt to progress and recur.

TO STUDY THE PRESENCE OF NEUROLOGICAL SOFT SIGNS IN CONTROL POPULATION AND TO COMPARE FINDINGS WITH PATIENT POPULATIONS.

Background: The study was conducted at the Mental Health & Hospital, Agra. It is a tertiary referral center and a postgraduate teaching hospital. The hospital has a wide catchments area which includes diagnosis of schizophrenia and bipolar affective disorder. Result: The total number of neurological soft signs present in a subject. Schizophrenia group had the highest number of NSS (mean±SD= 10.43±4.13) then were the bipolar group (mean±SD= 5.63±3.46) and least number of NSS were in control group (mean±SD=1.03±1.73) i.e. bipolar group was intermediate between schizophrenia and control group in terms of total number of positive NSS. Results of one way ANOVA revealed significant group differences F (2, 87) =62.05, p<.01. Games-Howell post hoc comparisons revealed significant differences in Schizophrenia vs Bipolar group (p< .01), Schizophrenia Vs Control group (p< .01) as well as in Bipolar Vs Control group (p< .01) i.e. schizophrenia group had significantly higher number of positive NSS than bipolar and control group. Also bipolar group had significantly higher number of positive NSS than control group. Conclusion: On various subscales of Neurological Evaluation Scale, schizophrenia patients differed from bipolar patients on all the subscale but not on the sequencing of complex motor acts subscale. Neurological Soft Signs are present even during the symptom free period and therefore they are not due to the effects of active illness. Hence, these Neurological Soft Signs in our study may represent a trait like abnormality in both schizophrenia and bipolar disorder. Keywords: Neurology, Schizophrenia, Bipolar Disorder & Sign

TO STUDY THE PRESENCE OF NEUROLOGICAL SOFT SIGNS IN PATIENTS WITH SCHIZOPHRENIA AND BIPOLAR DISORDER AND COMPARE THE VARIOUS SUBSCALES.

Background: The study was conducted at the Mental Health & Hospital, Agra. It is a tertiary referral center and a postgraduate teaching hospital. The hospital has a wide catchments area which includes diagnosis of schizophrenia and bipolar affective disorder. Result: It included AV integration, Stereognosis, Graphesthesia, Extinction and Right left confusion. On sensory integration subscale of NES schizophrenia group had the highest mean score (4.93±2.74) then were the bipolar group (1.50±1.98) and least score was of control group (0.20±0.66) i.e. on sensory integration subscale of NES bipolar group scores were intermediate between schizophrenia and control group. Results of one way ANOVA revealed significant group differences F (2, 87) =45.35, p< .01. Games-Howell post hoc comparisons revealed significant differences in Schizophrenia vs Bipolar group (p< .01), Schizophrenia Vs Control group (p< .01) as well as in Bipolar Vs Control group (p< .01) i.e. on sensory integration subscale of NES schizophrenia patients scored significantly higher than bipolar and control group. Also bipolar group scored significantly higher than control group. Conclusion: On “Sensory Integration” subscale of NES, schizophrenia patients scored significantly higher than both the bipolar patients and controls. Bipolar patients scored significantly higher than controls. On “Motor Coordination” subscale of NES, schizophrenia patients scored significantly higher than both the bipolar patients and controls. But bipolar patients did not differed significantly from controls. Keywords: Neurology, Schizophrenia, Bipolar Disorder & Sign

Superiority of fixed stem bipolar prosthesis over Austin Moore prosthetic in fracture neck femur

<p class="abstract"><strong>Background:</strong> Hemi arthroplastyis a better option in treatment of fracture neck femur as it eliminates avascular necrosis of femoral head and non-union. It allows immediate weight bearing to return elderly patients to activity which helps in avoiding complications of recumbency and inactivity. The decision to perform hemi arthroplasty using a unipolar or bipolar prosthesis is a controversial issue. Both the prosthesis can be used even in remote areas both are cost effectives, good results can be achieved by general orthopaedic surgeons and post-operatively, it can be well adapted by Indian population. This study was done to compare the efficiency of Austin Moore’s prosthesis (AMP) and bipolar prosthesis for the management of intra capsular fracture neck femur in elderly patients.</p><p class="abstract"><strong>Methods:</strong> Patient’s above 60 years with fracture neck of femur were included. In all total 140 patients were randomly allocated for treatment by either AMP or bipolar prosthesis, in the department of Orthopaedics, IIMSR Medical College, Badnapur, Jalna between March 2014 to March 2017. The patients were followed up at 6 weeks, 12 weeks, 6 months and 1year. Functional outcome was assessed and compared with modified Harris hip score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Modified Harris hip score was better with bipolar group as compared to AMP group. Functional activities like use of public transport were better with bipolar group. Complications like acetabular erosion were rare in bipolar group as comparison to AMP group.</p><p class="abstract"><strong>Conclusions:</strong> Fixed stem bipolar prosthesis is a superior option as compared to Austin Moore’s prosthesis.</p>

Treatment of Displaced Femoral Neck Fractures: Unipolar Hemiarthroplasty Versus Bipolar Hemiarthroplasty

Background: Femoral neck fractures are common in the elderly population. To avoid the poor outcome of internal fixation and for early mobilization, hemiarthroplasty is performed. However, there is inadequate evidence to support the choice between unipolar or bipolar hemiarthroplasty.Objectives: The aim of this study was to compare the outcome of unipolar with the bipolar prosthesis in geriatric patients.Methods: Forty-one patients above 60 years of age and an acute displaced fracture of the femoral neck were randomly allocated to treatment by either unipolar or bipolar hemiarthroplasty, in the Department of Orthopaedics at Khwaja Yunus Ali Medical College and Hospital, Enayetpur, Sirajgonj, Bangladesh in between December 2014 and February 2017. Functional outcome was assessed and compared using Harris hip score and radiological parameters with a follow-up of one year.Results: The two groups of patients with mean age of 67.3 in bipolar group and 75.6 in unipolar group did not differ in their pre-injury characteristics and perioperative parameters. The mean Harris hip score in bipolar and unipolar groups was 86.18±12.18 and 79.79±15.55, respectively (p=0.183); range of motion was 210.63±28.39 and 181.58±37(p=0.015) with bipolar and unipolar groups, respectively. Functional activities were better in the bipolar group. Complications like painful hip, posterior dislocation, periprosthetic fracture and acetabular erosion were encountered in unipolar prostheses.Conclusion: The use of bipolar endoprosthesis in the management of displaced femoral neck fractures in the elderly was associated with better mean Harris hip score and incidence of complications was limited. Hence, bipolar would be a better option in elderly patients with fracture neck of femur.KYAMC Journal Vol. 8, No.-1, Jul 2017, Page 10-14

Thyroid profile in depression: a cross-sectional study from North-East India

Background: Thyroid function disorder is a common feature in depression, with mixed type of response. Some cases are associated with hyperthyroidism and most commonly hypothyroidism. Unipolar and bipolar depressions are also related differently in consideration to thyroid status. This study comprises of assessment of the thyroid disorder prevalence in depressive patients and comparative analysis among unipolar and bipolar groups.Methods: Study consisted of 161 unipolar and 160 bipolar cases of depression as diagnosed by ICD 10 criteria supported by MINI. Thyroid profiling was done against common thyroid hormones TSH, T3, T4 and FT4 by standard method.Results: Gender wise males were dominant with majority in bipolar group in the younger age group. Most of the cases were normal with few hyperthyroid and hypothyroid cases. Bipolar group comprised the majority of overt hyperthyroid, overt hypothyroid and subclinical hyperthyroid cases, whereas unipolars were more in the subclinical hypothyroid category.Conclusions: This study concludes that differences exist in the thyroid response among the unipolar and bipolar depression group, more prominent numbers of hypothyroidism in unipolar group.