Introduction : Bone healing after a fracture is a special form of wound-healing. The Teriparatide Hormone (Fig. 1) is a synthetic molecule which has the first 34 fragments of the biological human parathyroid hormone and hence retains most of the biochemical activities of the human PTH. When teriparatide is intermittently administered it has similar anabolic effects of PTH that stimulate bone formation and activate bone remodeling [1, 3] enhancing the micro-architecture of the trabecular and cortical bone [4]. Teriparatide is the only anabolic molecule used in osteoporosis which had an approval by the Food and Drug Administration [5]. Aim of the study: To study the role of injection Teriperatide in fracture healing in elderly patients. Method: It is a Prospective- observational study. Conducted in Sri Ramachandra Institute Of Higher Education And Research (SRIHER), Porur, Chennai, Tamil Nadu. Duration of study is from October 2017 to October 2019. Sample size is total 50 (25 cases and 25 controls). Basic blood investigation were obtained. After taking patient concent injection Teriparatide was administered subcutaneously over lateral aspect of thigh. Serial xray radiograph was obtained at immediate post injection, 6 weeks, 3rd and 6th months. Presence of osteoporosis was assessed using SINGH INDEX Callus formed were quantified as follows, at 6 weeks, 3 months, 6 months post-operatively, 2pi r1(r2-r1)L (Fig. 4).The primary endpoint of fracture healing was taken as the time of cortical bridging in three of four cortices. Result: On statistical analysis, callus formation at 6 weeks, 3 months and 6 months in cases group (group 1) was found to be highly significant factor (P- value of <0.001) in our study compare to control group (group 2). out of 25 cases, 15 cases (60%) had osteoporosis (which include osteopenic patients also) and out of 25 controls 15 controls (60%) had osteoporosis (which include osteopenic patients also) measured by Singh index (Fig. 15-16). 7 cases had nausea (28%), 2 cases had vomiting (8%), 5 cases had induration (33%) and 3 cases had headache (12%) as an complications in our study.Conclusion: PTH (1–34) is one of the new and potent bone anabolic drug. Teriparatide is a relatively safe drug with minimal adverse effects. Economical compared to other options of fracture healing like bone grafting and second surgery when there is delayed union. It is the only medication so far that may help to restore failing bone microstructure. The effects of other combinations are currently unknown. Teriparatide administration helps in early callus formation, bony bridging, reduction of fracture gap and complete bone union in elderly osteopenic, osteoporotic and non-osteoporotic patients.
Maize is one of the leading crops in the world but is sensitive to drought stress There are different critical growth stages regarding moisture stress. Drought is one of the most detrimental abiotic stresses across the world which is seriously hampering the productivity of agricultural crops. Gibberellic acid is one of the most important growth regulators in plants, which improve drought tolerance and growth of plants under optimum concentration. Fodder scarcity is a very serious issue in pothwar region. The experiment was done in 2 phases. A preliminary petri dish experiment and later a pot experiment was conducted to assess the influence of GA3 on maize fodder under drought stress, at laboratory and glasshouse of Agronomy department, PMAS-Arid Agriculture University, Rawalpindi, Pakistan. In laboratory, Petri dish experiment was conducted in which 2 best performing maize fodder varieties were screened out based on genetic potential. Sohni Dharti and Afghoi varieties were grown in pot experiment. Gibberellic acid was applied at 4-6 leaf stage at the rate of 0, 50 and 100 ppm. The data was subjected to Analysis of Variance and where there were significant differences among treatments, means was compared using Least Significance Difference (LSD) at 5%level of significance.
The investigation and monitoring of forest resources can effectively grasp the current situation and changes using High Resolution Satellite Images (HRSI) to extract and classify forest types. However, HRSI contains abundant detailed information and spatial characteristic information, and spectral heterogeneity within the object is increased, which significantly causes difficulties in HRSI processing and information extraction. Therefore, aiming at the problem of extracting forest types from China\'s domestic GaoFen-2 satellite image, this paper proposes a classification method based a stratified classification strategy and feature learning using an object-oriented convolution neural network (CNN). First, the study area is under-segmented using the Multi-Resolution Segmentation (MRS) algorithm, which uses histogram statistics of the NDVI values of the segmented objects combined with typical ground object NDVI values to determine the NDVI threshold for dividing the vegetation and non-vegetation regions. Then, the multi-layer feature learning of the CNN and the regional Majority Voting algorithm are combined to classify the forest types within the vegetation region. Finally, the identification results within vegetation and the non-vegetation regions are merged to obtain several classification results in the study area. The overall extraction accuracy of the proposed method in this paper was 0.92. The experimental results show that the stratified classification strategy avoids the complexity of scale selection, to some extent, and improves the ultimate efficiency of forest extraction. The object-oriented method can avoid the “salt and pepper” phenomenon that exists in the pixel-based classification. Compared with traditional Random Forest machine learning method, which the overall extraction accuracy was 0.82, CNN can extract the deep features contained in HRSI, which is effectively conductive to category identification. In addition, the method proposed in this paper has a greater applicability to forest extraction from HRSI.
INTRODUCTION:Intertrochanteric fractures are the most frequently operated fracture type and have the highest postoperative fatality rate.The incidence of fractures in the proximal femoral area has risen with increasing numbers of elderly persons with osteoporosis and traffic accidents in young adults. The aim of surgery is to achieve early mobilization and prompt return to pre-fracture activity level. The treatment of this fracture remains a challenge to the surgeon. Two broad categories of internal fixation devices are commonly used for intertrochanteric femoral fractures: sliding compression hip screws with side plate assemblies and intramedullary fixation devices. AIM OF THE STUDY: To assess the functional outcome of fixation of intertrochanteric fractures with both dynamic hip screw fixation and proximal femoral nailing fixation and follow up outcomes. MATERIALS AND METHOD: Totally 20 unstable Inter-trochanteric hip fractures that were surgically treated at Department of orthopedicsin the year 2018 at Sri Ramachandra Medical College & Research Institute, SRIHER, porur, Chennai were included in the study. Patients were treated with DHS and PFN fixation. All surgeries were done on a traction table and are followed up at regular intervals of 6 weeks, 10 weeks, 4 months, 6 months were included to compare the outcomes.\nRESULTS: We had 6 cases of type-1, 8 cases of type-2, 4 cases of type-3, and 2 cases of type-4 fractures. 3 cases of type-1, 4 cases of type-2, 2 cases of type-3, and 1 case of type-4 fractures cases were fixed with a dynamic hip screw and other 10 cases were fixed with proximal femoral nailing. The functional results are assessed with Harris Hip Score and we observed good or excellent results in 64% of the DHS group and good or excellent results in 80% of PFN group. We observed no statistically significant difference between two groups in view of late & early complications and time to union. The mean follow up period was 13 months (range, 9 -16 months). CONCLUSIONS: After analyzing the functional outcome of all patients by Harris hip score the average score was found to be 83.2. We had 3 excellent results, 14 good results, and 3 fair results.We observed significantly better functional outcome in PFN group for unstable inter-trochanteric fractures. In unstable fractures, we observed the total duration of surgery, blood loss, and image intensifier exposure time to be significantly lower in PFN group. We concluded that PFN may be the better fixation device for most unstable inter-trochanteric fractures.
INTRODUCTION: Intertrochanteric (IT) femur fractures comprise approximately half of all hip fractures.The risk factors leading to hip fractures include increasing age, female gender, osteoporosis, a history of falls, and gait abnormalities. The incidence of Intertrochanteric fracture is rising because of increasing number of senior citizens with osteoporosis. Both surgical, as well as non-surgical interventions have been studied by various study modalities. AIM OF THE STUDY: To analyze the clinical and functional outcome of unstable intertrochanteric and subtrochanteric fractures treated with Proximal Femoral Nail. MATERIALS AND METHODS: Totally 20 unstable Inter-trochanteric and sub-trochanteric hip fractures that were surgically treated at Department of orthopedics in the year 2017 at Sri Ramachandra Medical College & Research Institute, SRIHER, Pour ,Chennai, were included in the study. 20 Patients with unstable Intertrochanteric and subtrochanteric fractures who met our inclusion criteria were selected. Basic blood investigations were obtained, X-rays of involved hip with thigh taken. Fractures were classified by Seinsheimers, and Boyd and Griffin Classification.Open reduction is done only when not able to achieve closed reduction. Both short and long proximal femur nail were used depending upon the needs. Patients were treated operatively and evaluated with modified Harris Hip Score. Results: In our study, mean age of the patient was 55.18 yrs, 16 cases were of type 2 fractures, 4 cases were type 3 A fracture. As assessed by modified Harris hip score, excellent to fair results were obtained at 12 months follow up in 16 cases, 4 cases had poor results. Two patient s had superficial infection; one had deep infection that was treated with i.v. antibiotics. 6 patients had limb shortening of 2 cms, varus malunion seen in one patient with Z-effect. CONCLUSION: Proximal femur nail has widened the indication of intramedullary nailing for more complex fractures of the proximal femur. By doing closed reduction, it offers minimal soft tissue damage, preserves the fracture hematoma, decreased blood loss and reduces the operating time.
Introduction:Melorheostosis are rare and have only been occasionally reported. We herein report a case of Melorheostosis affecting left femur and tibia which was diagnosed based on clinical and radiological features and managed with bisphosphonates.Case Presentation Report:A 30 years old woman presented with left leg pain with mild swelling and limitation of knee movement. Initially patient presented with pain in left hip, knee and stiffness of left lower limb with difficulty in moving since 4 years. Pain was insidious in onset, progressive in nature, aggravated on daily routine activities, relieved with analgesics. Clinically, the main symptom is local pain aggravated by mobilization of the affected limb. On physical examination, the patient had minimal swelling with tenderness over the affected limb, with increased local temperature and mild hyperpigmentation. All the joints of the affected segments showed decreased range of motion compared with the healthy limb. No neurological deficit was noted. No other deformity was seen. Radiography x-ray of left proximal femur and middle third tibia shows sclerotic lesion with no cortical breach and periosteal reaction (fig.1,2) and MRI of left femur and tibia shows hypointense lesion (fig.3-7).Conclusion :Melorheostosis is an uncommon cause of a common symptom, it is a rare condition. Positive clinical and imaging features helped us to arrive at the diagnosis. Proper work up would help in early diagnosis and management. More evidence is needed to illustrate the effectiveness of medical or surgical treatments for patients.