Injury to the spinal cord and kyphosis are the two most feared complications of tuberculosis of the spine. Since tuberculosis affects principally the vertebral bodies, anterior decompression is usually recommended. Concomitant posterior instrumentation is indicated to neutralise gross instability from panvertebral disease, to protect the anterior bone graft, to prevent graft-related complications after anterior decompression in long-segment disease and to correct a kyphosis. Two-stage surgery is usually performed in these cases. We present 38 consecutive patients with tuberculosis of the spine for whom anterior decompression, posterior instrumentation, with or without correction of the kyphus, and anterior and posterior fusion was performed in a single stage through an anterolateral extrapleural approach. Their mean age was 20.4 years (2.0 to 57.0). The indications for surgery were panvertebral disease, neurological deficit and severe kyphosis. The patients were operated on in the left lateral position using a 'T'-shaped incision sited at the apex of kyphosis or lesion. Three ribs were removed in 34 patients and two in four and anterior decompression of the spinal cord was carried out. The posterior vertebral column was shortened to correct the kyphus, if necessary, and was stabilised by a Hartshill rectangle and sublaminar wires. Anterior and posterior bone grafting was performed. The mean number of vertebral bodies affected was 3.24 (2.0 to 9.0). The mean pre-operative kyphosis in patients operated on for correction of the kyphus was 49.08 degrees (30 degrees to 72 degrees) and there was a mean correction of 25 degrees (6 degrees to 42 degrees). All except one patient with a neural deficit recovered complete motor and sensory function. The mean intra-operative blood loss was 1175 ml (800 to 2600), and the mean duration of surgery 3.5 hours (2.7 to 5.0). Wound healing was uneventful in 33 of 38 patients. The mean follow-up was 33 months (11 to 74). None of the patients required intensive care. The extrapleural anterolateral approach provides simultaneous exposure of the anterior and posterior aspects of the spine, thereby allowing decompression of the spinal cord, posterior stabilisation and anterior and posterior bone grafting. This approach has much less morbidity than the two-stage approaches which have been previously described.

Spinal deformity and paraplegia/quadriplegia are the most common complications of tuberculosis (TB) of spine. TB of dorsal spine almost always produces kyphosis while cervical and lumbar spine shows reversal of lordosis to begin with followed by kyphosis. kyphosis continues to increase in adults when patients are treated nonoperatively or by surgical decompression. In children, kyphosis continues to increase even after healing of the tubercular disease. The residual, healed kyphosis on a long follow-up produces painful costopelvic impingement, reduced vital capacity and eventually respiratory complications; spinal canal stenosis proximal to the kyphosis and paraplegia with healed disease, thus affecting the quality and span of life. These complications can be avoided by early diagnosis of tubercular spine lesion to heal with minimal or no kyphosis. When tubercular lesion reports with kyphosis of more than 50° or is likely to progress further, they should be undertaken for kyphus correction. The sequential steps of kyphosis correction include anterior decompression and corpectomy, posterior column shortening, posterior instrumentation, anterior bone grafting and posterior fusion. During the procedure, the spinal cord should be kept under vision so that it should not elongate. Internal kyphectomy (gibbectomy) is a preferred treatment for late onset paraplegia with severe healed kyphosis.

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Background:Life style related behavioural risk factors are mainly implicated for increased burden of cardio- vascular diseases. Research related to these risk behaviours especially among medical students is essential, considering their role as future physicians and role models in public health intervention programmes.Objective:To evaluate the burden of cardiovascular risk behaviours among students of a medical college of Delhi, India.Materials and Methods:A cross sectional study was carried out among undergraduate medical students of a medical college in Delhi. Self administered questionnaire was used to collect information on identification data and risk behaviours in relation to cardiovascular diseases. Binary logistic regression analysis was done to calculate adjusted odds ratio to assess association between risk behaviours and covariates.Results:The minimum recommendation of taking at least five servings per day of fruits and vegetables was complied only by 12% of students. Consumption of carbonated soft drinks either once or more on daily basis was present in 23.7% students and 32.0% reported frequent consumption of fast foods in past week. Consumption of alcohol was present in 28.8% students but only small proportion of students (7%) was current tobacco users. Large proportions of students (42.6%) were either not carrying out or were involved in only occasional physical activity in past week.Conclusions:Unhealthy behavioural practises are present and may progress as student advance through medical college. Developing strategies targeting at these risk behaviours and determining factors is necessary to promote healthy life style among medical students.

Summary Variations in the KCNJ6 gene appear to influence both acute and chronic pain phenotypes. G-protein coupled inwardly rectifying potassium (GIRK) channels are effectors determining degree of analgesia experienced upon opioid receptor activation by endogenous and exogenous opioids. The impact of GIRK-related genetic variation on human pain responses has received little research attention. We used a tag SNP approach to comprehensively examine pain-related effects of KCNJ3 (GIRK1) and KCNJ6 (GIRK2) gene variation. Forty-one KCNJ3 and 69 KCNJ6 tag SNPs were selected, capturing the known variability in each gene. The primary sample included 311 Caucasian patients undergoing total knee arthroplasty in whom post-surgical oral opioid analgesic medication order data were available. Primary sample findings were then replicated in an independent Caucasian sample of 63 healthy pain-free individuals and 75 individuals with chronic low back pain (CLBP) who provided data regarding laboratory acute pain responsiveness (ischemic task) and chronic pain intensity and unpleasantness (CLBP Only). Univariate quantitative trait analyses in the primary sample revealed that 8 KCNJ6 SNPs were significantly associated with the medication order phenotype (p < 0.05); overall effects of the KCNJ6 gene (gene set-based analysis) just failed to reach significance (p=.054). No significant KCNJ3 effects were observed. A continuous GIRK Related Risk Score (GRRS) was derived in the primary sample to summarize each individual's number of KCNJ6 “pain risk” alleles. This GRRS was applied to the replication sample, which revealed significant associations (p<.05) between higher GRRS values and lower acute pain tolerance and higher CLBP intensity and unpleasantness. Results suggest further exploration of the impact of KCNJ6 genetic variation on pain outcomes is warranted.

Background:Pediatric forearm fractures are still considered an enigma in view of their propensity to redisplace in cast. The redisplacement may be a potential cause for malalignment. We prospectively analyzed the role of risk factors and above casting indices in predicting significant redisplacement of pediatric forearm fractures treated by closed reduction and cast.Materials and Methods:113 patients of age range 2–13 years with displaced forearm fractures, treated by closed reduction and cast were included in this prospective study. Prereduction and postreduction angulation, translation, and shortening were noted. In addition, for distal metaphyseal fractures, obliquity angle was noted. In postreduction X-ray, apart from fracture variables, casting indices were also noted (cast index [CI] for all patients with three-point index [TPI] and second metacarpal radius angle in addition for distal metaphyseal fractures). In 2nd week, X-rays were again obtained to check for significant redisplacement. These patients were managed with remanipulation and casting or were operated if remanipulation failed. Comparison of various risk factors was made between patients with significant redisplacement and those which were acceptably reduced. A subgroup analysis of patients with distal metaphyseal fractures was done.Results:Thirteen (11.5%) patients had significant redisplacement; all of them required remanipulation. No association with respect to age, sex, level of fracture, side of injury, surgeon's experience, number of bones fractured, and injury to definitive cast interval was seen. The presence of complete displacement in any of the plane in either of the bones was seen to be highly significant predictor of redisplacement (P < 0.001). Postreduction angulation more than 10° in any plane in either of the bone and fracture obliquity angle in distal metaphyseal fracture also had a highly significant association with redisplacement. There was a significant difference in the mean values of all three casting indices assessed. TPI was the most sensitive casting index (87.5%).Conclusions:Conservative management with aim of anatomical reduction, especially in patients with complete displacement, should be the approach of choice in closed pediatric forearm fractures. Casting indices are good markers of quality of cast.

The optimal method for the management of neglected traumatic bifacetal dislocation of the subaxial cervical spine has not been established. We treated four patients in whom the mean delay between injury and presentation was four months (1 to 5). There were two dislocations at the C5-6 level and one each at C4-5 and C3-4. The mean age of the patients was 48.2 years (27 to 60). Each patient presented with neck pain and restricted movement of the cervical spine. Three of the four had a myelopathy. We carried out a two-stage procedure under the same anaesthetic. First, a posterior soft-tissue release and partial facetectomy were undertaken. This allowed partial reduction of the dislocation which was then supplemented by interspinous wiring and corticocancellous graft. Next, through an anterior approach, discectomy, tricortical bone grafting and anterior cervical plating were carried out. All the patients achieved a nearly anatomical reduction and sagittal alignment. The mean follow-up was 2.6 years (1 to 4). The myelopathy settled completely in the three patients who had a pre-operative neurological deficit. There was no graft dislodgement or graft-related problems. Bony fusion occurred in all patients and a satisfactory reduction was maintained. The posteroanterior procedure for neglected traumatic bifacetal dislocation of the subaxial cervical spine is a good method of achieving sagittal alignment with less risk of iatrogenic neurological injury, a reduced operating time, decreased blood loss, and a shorter hospital stay compared with other procedures.

Although US guided injections have a higher accuracy of drug placement in the subacromial bursa, there is no difference in terms of clinical outcomes or safety profile of either of the method. Hence US guided injections seems to be unjustified, when compared to equally efficacious and cost effective LMG steroid injection.