BackgroundEpidural steroid injections are an accepted procedure for the conservative management of chronic backache caused by lumbar disc pathology. The purpose of this study was to evaluate the epidurographic findings for the midline, transforaminal and parasagittal approaches in lumbar epidural steroid injections, and correlating them with the clinical improvement.MethodsSixty chronic lower back pain patients with unilateral radiculitis from a herniated/degenerated disc were enrolled. After screening the patients according to the exclusion criteria and randomly allocating them to 3 groups of 20 patients, fluoroscopic contrast enhanced epidural steroids were injected via midline (group 1), transforaminal (group 2) and parasagittal interlaminar (group 3) approaches at the level of the pathology. The fluoroscopic patterns of the three groups were studied and correlated with the clinical improvement measured by the VAS over the next 3 months; any incidences of complications were recorded.ResultsThe transforaminal group presented better results in terms of VAS reduction than the midline and parasagittal approach groups (P < 0.05). The epidurography showed a better ventral spread for both the transforaminal (P < 0.001) and the paramedian approaches (P < 0.05), as compared to the midline approach. The nerve root filling was greater in the transforaminal group (P < 0.001) than in the other two groups. The ventral spread of the contrast agent was associated with improvement in the VAS score and this difference was statistically significant in group 1 (P < 0.05), and highly significant in groups 2 and 3 (P < 0.001). In all the groups, any complications observed were transient and minor.ConclusionsThe midline and paramedian approaches are technically easier and statistically comparable, but clinically less efficacious than the transforaminal approach. The incidence of ventral spread and nerve root delineation show a definite correlation with clinical improvement. However, an longer follow-up period is advisable for a better evaluation of the actual outcom.

14Aortic root motion was previously identified as a risk factor for aortic dissection due to 15 increased longitudinal stresses in the ascending aorta. The aim of this study was to investigate 16 the effects of aortic root motion on wall stress and strain in the ascending aorta and evaluate 17 changes before and after implantation of personalised external aortic root support (PEARS). 18 19Finite element (FE) models of the aortic root and thoracic aorta were developed using 20 patient-specific geometries reconstructed from pre-and post-PEARS cardiovascular magnetic 21 resonance (CMR) images in three Marfan patients. The wall and PEARS materials were 22 assumed to be isotropic, incompressible and linearly elastic. A static load on the inner wall 23 corresponding to the patients' pulse pressure was applied. Cardiovascular MR cine images 24 were used to quantify aortic root motion, which was imposed at the aortic root boundary of 25 the FE model, with zero-displacement constraints at the distal ends of the aortic branches and 26 descending aorta. 27 28 Measurements of the systolic downward motion of the aortic root revealed a significant 29 reduction in the axial displacement in all three patients post-PEARS compared with its pre-30 PEARS counterparts. Higher longitudinal stresses were observed in the ascending aorta when 31 compared with models without the root motion. Implantation of PEARS reduced the 32 longitudinal stresses in the ascending aorta by up to 52%. In contrast, the circumferential 33 stresses at the interface between the supported and unsupported aorta were increase by up to 34 82%. However, all peak stresses were less than half the known yield stress for the dilated 35 thoracic aorta. 36 37 38 3

The pattern of arrangement of superficial veins in the cubital fossa was studied in 400 cubital fossae of 200 living persons from amongst the medical students and staff of the Medical School, University of Calabar, Nigeria. In the present study, the patterns of arrangement of the veins in the cubital fossa varied considerably from usual textbook descriptions. Five types of variations have been observed. The commonest pattern observed was the median vein of the forearm dividing into two branches, one joining the basilic and the other the cephalic vein.

Background and objectives: Preemptive transplantation is ideal for patients with advanced chronic kidney disease (CKD).The practice has been to perform coronary angiography (CA) on all patients aged >50, all diabetics, and all patients with cardiac symptoms or disease with a view to revascularization before transplantation. Historically patients have delayed CA until established on renal replacement therapy due to concerns of precipitating the need for chronic dialysis. The objectives of this study were to establish the risk of contrast nephropathy in patients with advanced CKD who undergo screening CA, and to determine whether or not preemptive transplantation is achievable.Design

INTRODUCTION:Resistance to antimicrobial agents is a major concern worldwide and is exemplified by the global spread of the Methicillin resistant Staphylococcus aureus (MRSA). Health care workers (HCWs) and asymptomatically colonized patients are important sources of nosocomial MRSA infections.AIMS AND OBJECTIVES:To determine the prevalence of MRSA colonisation, two hundred HCWs and 200 consecutive outpatients attending our tertiary care hospital were studied.MATERIAL AND METHODS:Two sterile pre-moistened cotton tipped swabs were used to collect specimens from their anterior nares. These were inoculated immediately on Blood agar with oxacillin, Mannitol salt agar with oxacillin and CHROM agar. Resistance to cefoxitin was confirmed by PCR by demonstration of mecA gene. Antibiotic susceptibility was determined by Kirby Bauer's disc diffusion method and MIC of vancomycin by using broth dilution and Vitek-2 Compact system.RESULTS:The nasal carriage of MRSA among HCWs was found to be 7.5% and in outpatients 3%. All strains of MRSA from HCWs and outpatients grew on three selective media and mecA gene amplified in all of them. All the isolated strains of MRSA showed high degree of resistance to co-trimoxazole (93.3%), ciprofloxacin (80%) and erythromycin (66.66%). However, there was 100% susceptiability to vancomycin, teicoplanin, linezolid and Rifampicin.CONCLUSION:Although a direct casual relationship could not be established, it could be assumed that the transmission from colonised health care worker is responsible atleast in part for MRSA infection among patients. Therefore emphasis should be laid on strict implementation of standard infection control practices which would help in minimizing the carriage and transmission of MRSA in the hospital.

Background: Thalassaemia is a chronic disorder requiring lifelong transfusions and medications causing emotional and financial burden to the family. This study was done to assess the knowledge and awareness of parents having a thalassemic child and to ameliorate their experiences in the upbringing of their child.Methods:A cross sectional, descriptive study was conducted in Pediatric Ward of a Tertiary care Hospital in Navi Mumbai from May-August 2016 in which parents of 40 beta Thalassemia major children between age group of 6 months to 15 years were enrolled. Parents were interviewed through a questionnaire to assess their knowledge, awareness, the practices they follow in regard to the transfusion, treatment, vaccination and prevention of thalassemia. The study also focuses on the emotional suffering of the parents.Results: 47.5% of parents were aware of thalassemia being a genetic disorder.62.5% were aware of regular blood transfusion. 23 parents were aware of the regular medications taken by their children. 42.5% parents had adequate knowledge of the optional vaccines to be taken. 90% parents followed a good practice of getting their child for regular blood transfusion and 92.5% gave them regular medicines.31 parents would periodically get their child investigated but 65% of parents lacked in giving optional vaccines to the child.60% agreed to undergo MTP while only 45% knew about the antenatal detection.Conclusions:Majority of parents followed good practice and had a positive attitude, though the knowledge and awareness about the disease was inadequate.

15Implantation of a personalised external aortic root support (PEARS) in the Marfan aorta is a 16 new procedure that has emerged recently, but its haemodynamic implication has not been 17 investigated. The objective of this study was to compare the flow characteristics and 18 hemodynamic indices in the aorta before and after insertion of PEARS, using combined 19 cardiovascular magnetic resonance imaging (CMR) and computational fluid dynamics 20 (CFD). Pre-and post-PEARS MR images were acquired from 3 patients and used to build 21 patient-specific models and upstream flow conditions, which were incorporated into the CFD 22 simulations. The results revealed that while the qualitative patterns of the haemodynamics 23were similar before and after PEARS implantation, the post-PEARS aortas had slightly less 24 disturbed flow at the sinuses, as a result of reduced diameters in the post-PEARS aortic roots.

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