Girish Kumar Singh

Comparison of Ponseti and Kite's method of treatment for idiopathic clubfoot.

Background: The manipulation and corrective cast application for club foot was known to be done by Kites method. The Kites method of manipulation (center of rotation of malaligned foot and fulcrum on cuboid) was modified by Ponseti (fulcrum on head of talus). Recently, Ponsetis method has gained popularity and vastly improved results are reported. We report randomized controlled trial where manipulation of club foot was done by Ponsetis and Kites method and correction evaluated by Pirani score to compare the outcome of treatment. Materials and Methods: Sixty feet in 38 patients, 22 with bilateral and 16 with unilateral clubfeet in children less than two years of age and without any prior manipulation or surgical treatment were randomly allocated to the Ponseti (30 feet) and Kite (30 feet) methods of manipulation. This process resulted in the right and left feet of the same patient in 12 bilateral cases being compared with one another (Paired analysis). In the remaining 10 bilateral cases, four patients had both feet treated by Ponseti and six had both feet treated by Kite (unpaired analysis). Finally, in 16 unilateral cases, 10 feet were allocated to the Ponseti and six to Kite methods of manipulation (unpaired analysis). Feet were followed up weekly for 10 weeks for change of cast and recording of hindfoot, midfoot and total Pirani scores. Correction was measured as a difference between hindfoot, mid foot and total Pirani scores weekly from weeks 1 to 10 and corresponding baseline scores. Absolute correction and rate of correction in (i) bilateral clubfeet treated by Ponsetis method on one side and Kites method on the other side in the same patient were compared using paired Students t test and (ii) patients with unilateral clubfoot (where either of the methods was used) or those with bilateral clubfoot (where both feet treated by either of the two methods on both the sides) were compared using difference between means (mean correction by Ponseti minus mean correction by Kite) for magnitude of difference and unpaired Students t test (if data was normally distributed) or Mann Whitney U statistics (otherwise) for significance of difference. Results: In 12 bilateral clubfeet, where one foot received Kites method and the other Ponsetis manipulation, feet treated by Ponsetis technique showed faster rates of decrease in Pirani score (improvement) as compared to feet treated by Kites method with the mean of difference between baseline and follow up scores showing significantly greater (P<0.05) difference from zero from fourth week onwards to up to 10 weeks. In unpaired analysis, both for unilateral or bilateral clubfeet, regardless of side, mean Pirani scores in Ponseti feet improved much faster than Kite feet but the difference achieved statistical significance only at the 10th week from the start of treatment. Conclusions: Hind foot, midfoot and total Pirani scores reduce much faster with Ponseti than the Kites method of manipulation of clubfoot. In paired analysis the difference becomes statistically significant at fourth week and in unpaired analysis at 10th week from the start of treatment.

Progressive osseous heteroplasia in a 10-year-old male child

We report a sporadic case of progressive osseous heteroplasia (POH) in a 10-year-old male child who developed progressive ossification of the skin and deep connective tissue. The condition needs to be distinguished from other causes of childhood heterotopic ossification, such as fibrodysplasia ossificans progressiva, pseudohypoparathyroidism, and pseudopseudohypoparathyroidism. The cause of POH is an inactivating GNAS1 (guanine nucleotide-binding protein alpha-stimulating activity polypeptide 1) mutation caused only by paternal inheritance of the mutant allele. Most cases are sporadic and only 2 instances of familial transmission have been documented, suggesting an autosomal dominant mode of inheritance with possible somatic mosaicism. The condition is associated with progressive superficial to deep ossification, progressive restriction of range of motion, bleak prognosis, and recurrence if excised.

Risk Factors for Drug Abuse Among Nepalese Samples Selected from a Town of Eastern Nepal

The study focuses on the serious issue related to the adolescents’ and adults’ behavior and health. It aims to identify the risk factors for drug abuse from samples taken from a town of Eastern Nepal. This is a matched case-control study. The conditional logistic regression method was adopted for data analysis. The diagnosis cut off was determined by Receiver Operating Characteristic curve. A representative sample of 150 matched pairs was recruited from Dharan in 2006. The final model after adjusting 17 possible variables each other, detected some factors like education, occupation, short temper, depression, etc that were significantly associated with drug abuse, but shy behavior was not a significant predictor for drug abuse among the study sample. The level of education, occupation and depression were the strong predictors as identified by the model. The findings of the study may have implications to aware families and schools in developing countries like Nepal.

Improvised cost-effective halo vest brace using a recycled Ilizarov ring and a threaded rod

SUMMARY We designed less expensive halo vest brace using an Ilizarov ring and a threaded rod, which is as effective as the normal halo vest. It can be used in any orthopedic set-up.

Probability Sampling in Matched Case-Control Study in Drug Abuse

S properties (dipolarity/polarizability, hydrogen bond donor acidity and hydrogen bond acceptor basicity) are well known to be measurable with different solvatochromic dyes. These dyes shift their UV absorbance maximum wavelength depending on the particular solvent features. This solvatochromic comparison method was pioneered about 30 years ago by Kamlet and Taft. We used this approach to examine the effects of different macromolecular crowding agents such as dextran, Ficoll, polyethylene glycol, etc on the solvent properties of water. It was found that changes of protein properties in crowded solutions may be at least partially explained by the polymer-induced changes in the solvent properties of aqueous media. We also examined the effects of different osmolytes such as sorbitol, sucrose, trimethylamine N-oxide (TMAO), trehalose and urea on the solvent properties of water in their solutions. The solvatochromic comparison method was also used to analyze the effects of elastin-like polypeptide and small heat-shock protein on the solvent properties of water. The results obtained in these studies will be presented and discussed in the framework of possible new model of the regulatory effects of chemical chaperones in vivo.