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Discussion Better nutrition, less number of children, and higher level of education may be the cause of higher BMI in the upper socioeconomic class in the present study. Nutrition and environmental factors have little role in head-to-chest circumference ratio and arm-to-height ratio in normal children irrespective of socioeconomic status. Further longitudinal studies with larger sample sizes is planned in the near future to get a better assessment of growth and nutrition of children in the present population.
Suparna Roy, Arunima Chaudhuri1, Samir K. Hazra2, Sudipta Saha3 Department of Biochemistry, Calcutta National Medical College, 1 Department of Physiology, BMCH, Burdwan, 2Department of Gynaecology and Obstretics, BMCH, Burdwan, West Bengal, 3 Department of Physiology, Dr. D.Y. Patil Medical College, Pune, Maharashtra, India Correspondence to: Dr. Arunima Chaudhuri, Krishnasayar South, Borehat, Burdwan, West Bengal, India. E-mail:
[email protected]
References 1. 2. 3.
4.
Gunther AL, Danckert NK, Kroke A, Remer T, Buyken AE. Dietary protein intake throughout childhood is associated with the timing of puberty. J Nutr 2010;140:565-71. Rockett JC, Lynch CD, Buck GM. Biomarkers for assessing reproductive development and health: Part 1-pubertal development. Environ Health Perspect 2004;112:105-12. Valente EA, Sheehy ME, Avila JJ, Gutierres JA, Delmonico MJ, Lofgren IE. The effect of the addition of resistance training to a dietary education intervention on apolipoproteins and diet quality in overweight and obese older adults. Clin Interv Aging 2011;6:235-41. Kumar N, GuptaN, Kishore J. Kuppuswamy’s socioeconomic scale: Updating income range for the year 2012. Indian J Public Health 2012;56:103-4.
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DOI: 10.4103/0975-2870.126391
Successful management of double level multiple flexor tendon injury Sir, We would like to report a case of traumatic injury of forearm where the flexor tendons were cut at multiple levels which were successfully repaired. Single tendon injuries are common in any trauma center. We are describing a double level tendon injury repair.
3 months of surgery, the patient had a good hand function. The postoperative appearance is shown in Figure 2. Out of the five pieces, four were flexor digitorum superficialis and one flexor digitorum profundus of middle finger. This shows that even with such double level injury to flexor tendons,
A 23-year-old male presented with history of injury to his right wrist due to a fall of heavy broken glass. On examination, he was found to have a deep avulsion injury on the volar aspect of his right wrist with a distally based triangular skin flap and the wound was deep up to the bone. All the volar structures were completely cut except the ulnar nerve [Figure 1]. Index and middle finger showed decreased vascularity. On exploration, there were five pieces of flexor tendons lying separately in the wound along with a large gap in the radial and ulnar artery. The vessels were repaired using a vein graft and tendon repair was done after 72 h once the circulation of the finger was well-established. After 260
Figure 1: Double level multiple flexor tendon injury
Medical Journal of Dr. D.Y. Patil University | March-April 2014 | Vol 7 | Issue 2
[Downloaded free from http://www.mjdrdypu.org on Wednesday, September 28, 2016, IP: 187.10.3.66] Letters to the Editor
Correspondence to: Dr. Ananta A. Kulkarni, Department of Plastic Surgery, Padmashree Dr. D.Y. Patil Hospital and Research Centre, Sector -5, Nerul, Navi Mumbai – 400 706, Maharashtra, India. E-mail:
[email protected]
References 1.
Figure 2: Completely healed injury
a good result can be achieved with primary repair. There is a tendency to underestimate damage to deeper structures due to glass injuries to the hand.[1] Our result match a larger series of similar injuries reported by Noaman.[2]
Ananta A. Kulkarni, Suhas Abhyankar, Santosh Bhatia, Rohit Singh1
2.
Provencher MT, Allen LR, Gladden MJ, Shin AY. The underestimation of a glass injury to the hand. Am J Orthop (Belle Mead NJ) 2006;35:91-4. Noaman HH. Management and functional outcomes of combined injuries of flexor tendons, nerves, and vessels at the wrist. Microsurgery 2007;27:536-43.
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Department of Plastic Surgery, Padmashree Dr. D.Y. Patil Hospital and Research Centre, Nerul, Navi Mumbai, 1Department of Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
DOI: 10.4103/0975-2870.126394
Indian signs in dermatology Sir, Dermatology, the science of the skin, was one of the many specialties, which evolved from general internal medicine during the course of the nineteenth century. In India, therapeutics of dermatoses have been known and practised by physicians for centuries. Charaka Samhita contains one chapter on the subject. In this ancient book, worshipful Atreya Punarvasu has described eighteen dermatoses. He attributed these dermatoses to the preponderance of morbid humors (vata, pitta and kapha) causing disturbances of body elements and thereby diseases.[1] There are many legendary dermatologists who had contributed in the field of Indian dermatology. Contributions of Dr. JS Pasricha in contact dermatitis and pulse therapy is remarkable.[2,3]
injecting intralesional steroids by a 26G needle, it has been often found that the medicine comes out through the follicular openings in a jet mimicking a “fountain”. [4]
We have compiled all signs given by Indian dermatologist. However some of these signs are not globally accepted.
Premlatha Sign
Fountain Sign This sign is mostly seen in Lichen Planus Hypertrophicus (LPH) lesions of less than 2 years duration. While Medical Journal of Dr. D.Y. Patil University | March-April 2014 | Vol 7 | Issue 2
Reverse Namaskar Sign In patients with Ehlers Danlos syndrome, there is hyperextensibility and fragility of the skin with easy bruisibility due to disorder in collagen. Patients are able to fold the forearms at the back and palms facing each other in a way to do Namaskar. This sign is known as reverse Namaskar sign.[5]
In patients with pemphigus vegetans, there are characteristic cerebriform changes seen on the tongue. Cerebriform tongue, characterized by a pattern of sulci and gyri on the dorsum of the tongue has been reported in up to 50% cases of Neumann type.[6] 261
