Letteratura scientifica selezionata sul tema "Tannage – Innovation"

The article presents the clinical effectiveness of complex etiopathogenic therapy of rotavirus infection in children using a combination of «Adiarin» — tannate gelatin, hyposmolar rehydration solution and probiotic containing lactobacilli LGG and bifidobacteria BB-12. It was found that in patients receiving innovative treatment, compared with children who were on traditional therapy, fever was significantly less frequent, its duration and hospitalization time were reduced by 2.4 days. In addition, acidosis was significantly less pronounced in this group compared to the control group. Thus, the use of the «Adiarin» line of products contributes to a faster recovery of children with rotavirus infection compared to patients who received standard treatment.

Introduction and Aim: Apis florea commonly known as “dwarf honey bee” harbors enormous gut bacteria that can digest complex carbohydrates and other food components. In this regard, the present investigation was focused on analyzing the polysaccharide degrading ability of bacteria isolated from the gut of honeybee, for their possible application in nutraceutical and pharmaceutical industries. Materials and Methods: Nine bacterial isolates were screened for carbohydrate degrading enzymes viz., amylase, pectinase, cellulase, tannase and laccase, using respective substrate by plate assay method. Further activities of amylase and pectinase were measured quantitatively by dinitrosalicylic acid (DNS) method. Results: All the nine selected isolates exhibited amylase and pectinase activities. However, only two isolates exhibited lignolytic and cellulolytic activity. None of the isolates showed tannin degradation. Maximum amylase activity (4.95 U/mg) was observed in Bacillus halotolerans af-M9 followed by Klebsiella oxytoca af-G4 (4.62 U/mg). With respect to pectinase activity Klebsiella pneumoniae af-E17 displayed higher activity (0.24 U/mg) followed by Klebsiella oxytoca af-G4 (0.20 U/mg). Conclusion: Habitat-specific innovations are being explored for novel compounds for therapeutic applications. This study throws a light on selection of carbohydrate degrading bacteria from a new source i.e., GUT of honeybee.

This interview was conducted at the famous Lotus Clinic at Mumbai. Interview of Dr DD Tanna (DDT) was personally conducted by our Editor Dr Ashok Shyam (AK). It was an interesting two hours talk in late evening and we are presenting here the salient features of the interview. AK: First let me thank you for this interview. Let’s begin by asking about your family and where you grew up? DDT: I grew up in Kalbadevi area in Bombay in a typical Gujrati locality. I had four brothers so we were five of us together with my father and mother. At that time education was not something very popular in our family and when I graduated I was among the handful in 2 mile radius and when I completed post-graduation there were none in the entire area. The trend was that people used to go to college just for the stamp of collage and then join the father business. But I was a good student and so I did complete my studies AK: Tell us something more about your childhood? DDT: I had a very eventful childhood, we used to play many sports. I was very good at cricket and even at medical college I was captain of the cricket team. But along with cricket I played many local sports kho-kho, langadi, hoo-to-too, football, volleyball, swimming etc. Didn’t get chance to play hockey but I did play everything I came across. AK: I understand you have seen Mahatma Gandhi and heard him speak. Please share your remembrance of that? DDT: Once Gandhiji was holding a meeting in Bombay and my father said to me ”let’s go see Gandhiji”. I went with him and there was a huge crowd and I felt quite uncomfortable. I wanted to leave when my father said to me ‘why are you afraid of the crowd, these are all your fellow human beings, not cattle herd”. That statement touched me very much and till today, I am not afraid of any crowd. Understanding that all are my fellow human beings, took away my stage fright forever. I can speak my thoughts clearly and without fear and I can dance with the crowd with equal ease. I have seen Mahatma Gandhi at close distance and he appeared to be a very frail man. At first I wasn’t impressed, but then I realised that this frail man can have the huge crowd following him just because of his thought process. That understanding has helped me a lot in my life. AK: So why did you become a doctor, what was your inspiration? DDT: I was good in studies and in those days there were only two choices either to be an engineer or to be a doctor. I had decided that I would be an engineer with no doubt in my mind. One day one of my uncles, who happened to be an engineer, visited us. When asked I told him my intention to become an engineer, to which he replied ”In that case you have to take up a government job all your life”. In those days the only scope for an engineer was to be in government job, but the idea of being a enslaved for life by an organisation was something I couldn’t accept. My freedom was very dear to me and overnight I changed my decision and pledged to become a doctor. AK: How was your MBBS term? Why did you choose orthopaedic surgery? DDT: I was quite casual in MBBS and was more involved in sports. I got serious in last year to get good grades. Frankly speaking there were none who influenced me in the undergraduate college. After joining medicine developed a natural liking to surgery and always wanted to become a surgeon. Doing general surgery and then super specialisation for another two years seemed to be a long time. Orthopaedic surgery was a new branch at that time and offered direct super specialisation. And so I joined orthopaedic surgery. AK: What were your early influences in medical college? DDT: I wasn’t a very serious student in medical college. Possibly I became a bit serious in my last year of MBBS to score marks to get the branch of my choice. After MBBS and before joining post-graduation I had some spare time at hand which I utilise in reading. That period was a period of change I my life. I read authors like Bertrand Russel who had a major influence in my life. I read ‘Altas shrugged’, ‘We the Living’, and ‘Fountainhead’ and these three books had deep impact on me. I also read The Manusmrti’s specifically for their philosophical treatise and not the religious aspect. I still like to ponder on these philosophical aspects from time to time. By the time I joined as an orthopaedic registrar, I was a pretty serious person. In first 6 months of my orthopaedic residence I was fascinated with basics specially the histopathological aspect of orthopaedics. I read all about the histiocytes, the fibroblasts etc and even today I still think in these terms when I think about orthopaedics. AK: You joined the B Y L Nair Hospital, Mumbai in 1965. Tell us something about your life at Nair Hospital? DDT: Well in fact I passed my MS in 1965. I joined possibly in 1954 as a medical student. I was a student, house surgeon, lecturer, honorary surgeon all at Nair hospital. I was one of the youngest consultant as I became consultant at Nair hospital at age of 28, merely 8 months after passing MS exams. Possibly God was kind to me. Nair hospital was a decent place, but it became a force once Dr KV Chaubal joined Nair. Earlier KEM hospital had big name because of Dr Talwalkar and Dr Dholakia. I was lecturer when Dr Chaubal joined. He changed Nair hospital with his modern and dynamic approach. He gave me an individual unit within 3 years. Our rounds would be more than 4 hours in Nair hospital and had great academic discussions. AK: We have heard about a very famous incident when you operated Dr Chaubal? Do tell us something about that DDT: Well Dr Chaubal was suffering from a prolapsed disc and he had taken conservative management for some time with recurrent episodes. At one point we went ahead and got a myelogram done (no MRI in those days), and a huge disc was diagnosed. He called me the next day and asked to operate on him. I was 10 years his junior and moreover he was my boss and there were many more senior surgeons who were available. It came as a shock to me that he would chose me to operate on him [and of course it was an honor to be chosen]. Dr Laud and Dr Pradhan assisted me in operating him and it was big news at that time AK: You were pioneer in bringing C-arm to India? Tell us something about the C-arm Story? DDT: We used to do all surgeries under X ray guidance in those days, at the most we had 2 x-rays set together by Dr Talwalkar to get orthogonal views. I used to go to USA and they would do all surgeries under C-arm. I came back and contacted Mr Kantilal Gada who used to manufacture X ray machines. He agreed to try to make a C arm if I pay him one lakh rupees [in those days]. The condition was if he succeeded, he would give the c arm to me at no profit rate and if he failed my money would be lost. He did succeed and we had India’s first C-arm at my place. It helped me at many times in clinical practice. One specific incidence about an Arab patient who had a failed implant removal surgery previously and Icould remove the implant within 30 mins because I could clearly see the distal end of the nail entrapped. This patient was a friend of The Consulate General of UAE and since then I started getting lot of patients from there. So that was a wise investment I think. AK: You were specifically instrumental in developing trauma surgery in India. Why focus of Trauma Surgery? DDT: Dr Chaubal the first person to start trends in everything. At first we were spine surgeons as Dr Chaubal was very interested in spine surgery. Dr Bhojraj and Dr VT Ingalhalikar were our students. I was one of the first people to do total hip and total knee surgeries very soon after Dr Dholakia did it for the first time in India. But somehow I felt these surgeries did not hold much challenge. Trauma surgeries were challenging and each case was unique and different. So I decided to stick to trauma surgery for the sake of sheer joy of intellectual and technical challenges it offers. AK: A lot has happened in the field of Orthopaedic Trauma in and you are witness to these growth and development. What according to you are the important landmarks in History of trauma Surgery? DDT: Interlocking is the major change. I used to go to AAOS meeting every year where people were talking about interlocking when we were doing only plates. I decided to make an interlock nail by drilling holes in standard K nail. There was no C-arm in those days and surgeries were done on X rays. We got a compound fracture tibia and I made a set of drilled K nails for this patient as per his measurements. We successfully did the static locking using K nail in this patient. We slowly developed the instrumentation and jigs for it and developed commercially available instrument nail. Interlocking spread like wild fire and I was called as the Father of Interlocking Nail in India. AK: Your specific focus was on Intramedullary nailing and you have also designed the ‘Tanna Nail’ How did you think of designing the nail? Tell us about the process of designing the nail, the story behind it? DDT: Like said above, I developed the nail and instrument set with one Mr Daftari in Bombay. This was sold as ‘Tanna nail’ in Bombay. Slowly implant companies from other states also copied the design and started selling it as ‘Tanna NAIL’. I had no objections to it and I didn’t have a copyright anyway. Slowly I phased away the name as the design progressed and asked them to call it simply interlocking nails. AK: You are known for Innovation. Tell us something more about it? DDT: I specifically remember C-arm guided biopsy which I used successfully for tumor lesions. The same principle I used for drilling osteoid osteoma under CT guidance, which avoided an open surgery. There are many more technical tips and surgical techniques that I have been doing and some of them are listed in my book named ‘Orthopaedic Tit Bits’ AK: The last two decades have seen a tremendous increase in the choices of implants available in the market. Many of these implants were sold as the next “new thing”. Do you feel these new implants offer justifiable and definite advantage over the older ones? How should a trauma surgeon go about this maze of implants and choose the best for his patients? DDT: There is no easy way to do that, because most implants comes with a huge propaganda and body of relevant research. Many senior faculties will start talking about it and using it. For example, distal femur plates have now reported to have 30% non-union rate. Earlier I had myself been a strong supporter of distal femur plate but through my own experience I saw the complications. Now I feel the intramedullary nail is better than the distal femur plat in indicated fractures. Same with trochanteric plates or helical screws in proximal femur fracture. So we learn the hard facts over a period of time and by burning our own hands. But then you have to be progressive and balance your scepticism and enthusiasm. In my case the enthusiasm wins most of the time. AK: Share your views on role of Industry in dictating terms to trauma surgeons? DDT: I feel it’s very difficult to bypass the industry. Also because the industry is supported by orthopods. But again like I said we learn from our own errors and something that does not have substance will not last for long. For example clavicle plating, I supported clavicle plating for some time [and it felt correct at that time], but now I do not find wisdom in plating clavicle and so I have stopped. So I believe it’s a process of constant learning and also realising and accepting mistakes. Once I was a great proponent of posterolateral interbody fusion (PLIF) in spine but after few years of using it I realised the fallacy and I presented a paper in WIROC (Western India regional orthopaedic conference) titled ‘I am retracting PLIF’ and it was highly appreciated by the audience. AK: Tell us about your move toward joint replacement surgeries? DDT: I was one of the first one after Dr Dholakia to start joint replacement surgeries in India and I continue to do many joint surgeries. And of course ‘cream’ comes from joint replacement surgeries (laughs heartily) AK: You have been active in teaching and training for over 4 decades, how has the scene changes in terms of teaching methods and quality of surgeons undergoing training? DDT: Teaching is now become more and more spoon feeding and I think it is not real teaching. Even in meetings I enjoy the format where there is small number of faculty and case based discussion on practical tips and surgical technique. The 8 minute talk pattern is something I think is not very effective. Real teaching of orthopaedics cannot be done in classroom or in clinics. In clinics we can teach students to pass exams but not orthopaedics. Dr Chaubal always used to say that real orthopaedics is taught in practical patient management and in operation theatres. I tell my fellows that I wont teach much, but they have to observe and learn. In medical colleges there is no teaching at all, its almost died off. AK: What you feel is the ‘Way of Working’ of Dr Tanna that makes him a successful Orthopaedic Surgeon? Your Mantra? DDT: Always do academically correct things. Like I have been practicing 3 doses of antibiotics since last 20 years. I read a lot and then distil the academic points and follow them in practice. I get up at 4 am and read everyday. AK: What technical tips would you give for someone who has just embarked on his career as an Orthopaedic surgeon? DDT : I have given one oration which is also on you tube, you should listen to that. Anybody who becomes an orthopaedic surgeon is actually cream of humanity and are capable of doing anything. The only thing required is a strong will to excel and passion to succeed AK: I understand that you are a very positive person, but do you have any regrets, specifically related to orthopaedics. Something that you wished to do but couldn’t? DDT: Honestly nothing. Today when people ask me ‘How are you’ I say ‘can’t be better’. I couldn’t have asked for a better life AK: Any message you will like to share? DDT: I think passion to be best is essential. Even if one patient does not do well or if we do a mistake in a surgery, it causes huge distress and misery to us. We as doctor should be truthful to your patients. Between you and your patient there can’t be any malpractice. You should treat every patient as if you are doing it on your son or daughter. Always keep patient first AK: What degree or accolades would you like me to mention in your introduction? DDT: Nothing just plain MS Orth, I have no other degrees. In fact after my MS I attempted to give D orth exam. My boss at that time Dr Sant, said ‘are you crazy, after passing MS you want to give KG exam?’ He actually did not allow me to appear (laughs). Never felt like having any more degrees, degrees won’t take me ahead, its only my orthopaedic skill that will be take me ahead in life.

AbstractTractate Yebamoth of the Babylonian Talmud contains a long unit devoted to the procedure of conversion (Yeb 46a‐48b). Form analysis of the unit reveals its design as a ‘tractate within a tractate.’ The unit is a collection of discussions on baraitas. It follows various literary conventions, such as placing a full description of the procedure towards the end and concluding with haggadic material and a verse of comfort. A variety of methods are applied in order to identify the unique Babylonian tendencies documented in this unit. Synoptic comparison to tannaitic parallels demonstrates the growing stringency and institutionalization of the rabbinic conversion procedure. A common structural feature of each discussion is the ending with an amoraic statement that reassure the halakhic validation of the stringent views. Stammaitic comments and the overall literary structure of the unit also seem to confirm this tendency.This unit demonstrates Babylonian efforts to further reinforce the boundaries of Jewish identity. The traditions as preserved in this unit show that Babylonian proclivities were gradually attributed to earlier Palestinian authorities. The most prominent example is the institution of the court for conversion. This is a Babylonian construct, systematically presented in places where it is missing in Palestinian rabbinic sources. In our unit it is also attributed to early Palestinain amora’im, and even to a tanna. Not only did the Babylonian sages change the model of conversion from witnessed circumcision (and later immersion) to court controlled procedure, they also projected their innovations onto earlier generations.

Introduction: In the fall of 1993, I arrived at King Circle station, a young orthopaedic graduate from the strife-ridden town of Jammu. Bombay, as it was known then, offered me the opportunity to work in one of the finest trauma centers in the country, a dream come true for someone displaced by the violent turmoil in Kashmir. Early Years and Professional Marvel (1993-2001): Working alongside esteemed colleagues such as NS Laud, VT Ingalhalikar, Joy Patankar, Ajay Puri, Ram Chaddha, and Arvind Goregaonkar felt like wielding a magic wand that turned everything to gold. Joining Sion Hospital, a professional marvel, was a significant leap for me. It was during this time that my friend, Ajay Puri, introduced me to the Bombay Orthopaedic Society (BOS), marking the beginning of a profound association. Executive Committee Member (2001-2003): Becoming an executive committee member in 2001 opened doors within BOS’s inner circles. The society, free from bias and politics, focused on nurturing the orthopaedic fraternity. Its unique selling point was enhancing orthopaedic surgery and promoting holistic development. Organising WIROC2003: The pinnacle of my involvement came when I organized WIROC2003, despite the personal adversity of losing my father. This flagship conference became a milestone, setting new standards in organization and academic excellence. From revolutionary conference organizing paradigms to creating academic events, BOS provided the freedom to unleash unrestrained creativity. Secretaryship and Refining Programs (2016-2018): Elected as Secretary in 2016, my role was to refine existing programs and introduce fresh academic activities, maintaining BOS’s academic dominance. Initiatives such as PG classes, the launch of the Journal of Clinical Orthopaedics, and more showcased a burning desire to contribute to the society. Presidency and Innovations (2023)): Now, as the President, I’ve introduced new programs like “Rising Star” and “Student of the Year” to recognize and inspire young talents. Tying it all together is WIROC 2023, with the theme “Brevis Longus Magnus,” aiming to solidify its status as the apex of orthopaedic education. Future Aspirations and Legacy: After relinquishing my office, I envision BOS exploring areas like orthopaedic advocacy, motivating the younger generation, and fostering empathy for patients. BOS, with its unbiased education and commitment to excellence, stands as a beacon for orthopaedic education and treatment. Conclusion: This two-decade journey from a reluctant newcomer to the President’s seat reflects the unique ethos of BOS. With a legacy of unwavering guidance from figures like LN Vora and Anand Thakur NS Laud, D D Tanna and many more who always stood up for BOS and it’s ethos. I shall leave with the confidence that BOS will continue to flourish, and maintain its place in exploring new frontiers in orthopaedic education and advocacy.

Trauma as a faculty is developing rapidly along with understanding of fracture patterns, change in trauma scenario and also development in new implants. However outreach of these new developments and percolation and applicability of these new developments is still a big question. We see cases that are complicated by wrong choice of surgery, wrong choice of implant and improper use of principles. Trauma International tried to interview the core team of Trauma Society of India on these two question of new implants and education and research in field of Trauma. We have compiled the responses in this editorial Dr DD Tanna: New implants like the precontoured anatomical plates are really good. They are definitely expensive but are good. Some Indian companies are also producing excellent variants of the anatomical plates and I believe these will definitely help in better management of complex articular fractures. However I also believe that not every new implant is a real improvement over the previous one. We have to wait for the clinical results and we have to be smart in selecting our cases to use these implants Trauma education is an ongoing process and we are all students at the same time. We have to continue to learn how to learn, only then we can learn about the new methods and technologies and also learn them well. It is essential for our growth as a surgeon and helps us deliver best treatment to our patients Dr Sudhir Babhulkar: New implants like fragment specific fixation and anatomic contoured plates are an excellent addition to armamentarium of a trauma surgeon. However we should learn to use them wisely and carefully Teaching the young generation is the key to spreading trauma education. Traumacon has created that interest in young surgeons about trauma. We need to focus on them and help them develop proper understanding of principles and correct execution of surgical techniques. Conferences, courses workshops all are needed to achieve this aim. Also teaching about correct principles and techniques should reach periphery. My practice has been 50 to 60% complicated reffered cases. Most of the cases were complicated because of wrong application of surgical principles. I think teaching that will address these issues the correct solution for trauma education in India. Dr GS Kulkarni: About new implants, some of them are really useful in certain situations like fragment specific fixation and contoured plates, but some new implants are not as useful as they are made to appear. New implants should be focussed on solving a surgical problem and should not be innovation for the sake of innovations. We have our innovation which is slotted plate for lengthening over a plate and it is aimed to solve a particular problem. I think that is how innovation should be aimed at. The focus of trauma education should be basics of trauma surgery. That is where many complications arise. Especially as cases of road traffic accidents are rising, basics of management of open fracture should be emphasised more. Principles of debridements, wound closure, when to close the compound wound, methods of closing the wound, external fixation and stabilisation of compound fracture should all be reviewed and highlighted again and again. Another area is use of antibiotics in fracture surgery specifically local and systemic therapies. Current evidence and experience suggest that with proper surgical management, a single day antibiotic therapy is enough. However most surgeons will give either three day or five day antibiotic therapy which is not good for the patient as well as the fracture. If there is a need for prolonged infection control use of local antibiotics systems like cement beads or cement rods should be utilised to reduce the systemic load of antibiotics. Even in cases of closed fracture proper surgical principles should be followed. For example if a surgeon is using locking plates without understanding the principles of locked plates, it becomes a dangerous implant in his hands and is one of the main cause of complications. Dr SC Goel: There are new implants launched every year and such developments should be taken with pinch of salt. Lot of these may be industry driven and we need good multicentric trails to validate the results before using them About education and research, I feel we should have focus on basic sciences too. Unfortunately there are not many basic science labs in India. There are many surgeons who have innovative ideas and techniques but do not get a chance to promote their ideas. I think either TSI or IOA should take these projects ahead and give a chance to all innovators to come forward Dr Sushrut Babhulkar: The science of orthopaedic trauma is evolving and our understanding of it is changing and that is reflected in development of new implants. New implants in trauma are very different from new implants in Arthroplasty where it is more industry driven rather than real evolution. As our understanding of fracture pattern and soft tissue injury improves and as we encounter more varied bone quality, the need for new implants will increase. These improvement in basic understanding is what fuels development of new implants in trauma and I think we are moving forward in sensible direction as far as trauma implants are concerned Education should focus on accurate understanding of principles of trauma surgery and principles of various implants. Both should be used in perfect harmony to achieve excellent result. If either of these principles are not followed, it would lead to complications. This is the main teaching of Traumacon every year. Again research should be promoted but not enforced, if it is enforced, we will get more poor quality research and publications. Sunil Kulkarni: We are facing new challenging in trauma surgery and number of complex and articular trauma has increased due to high energy accidents. I think new implants have helped us a lot in dealing with these complex injuries. Although simple trauma is still managed well with conventional implants, so proper patient selection is essential. Trauma education should be about practical knowledge. Textbook knowledge is not of much use in clinical practice. Especially trauma is a branch where even after decades of practice, on can see a completely new case of face new surgical challenge. Education should be focussed on preparing trauma surgeons to face these challenges and difficult practical problems. Dr Amit Ajgaonkar: New implants have definitely added more tools for trauma surgeons. Implants like Halifax nails, fragment specific fixation, far-cortex locking plates are based on sound principles and have definite advantages in properly selected cases Trauma Education should focus on peripheral surgeons. In recent months I have travelled a lot across the country and especially in the interiors. I realised that maximum trauma work is done by the peripheral surgeon in rural settings. There is an urgent requirement to provide both training as well as infrastructure to these places. I think TSI, IOA and Traumacon can contribute a lot in terms of improving the training but government should also focus on improving the infrastructure. If we carefully note the views of all the experts above we can deduce a chain of thought which can be summarised easily. New implants are good but understanding of the principles behind the implant and proper patient selection is must. As far as trauma education is concerned, all the experts believe basic principles are the building blocks and practical knowledge is of utmost importance. I too believe that trauma Education and research are not different entities, both are actually part of one spectrum. Academics originates from new research and initiation of research is from academics. Thus they both fulfil each other and through the churning of both these, innovative ideas and new implants are born. We thanks our panel for sharing their thoughts with us and we leave the readers now to enjoy the current issue of TI Dr Ashok Shyam Editor – Trauma International.

Trauma as a faculty is developing rapidly along with understanding of fracture patterns, change in trauma scenario and also development in new implants. However outreach of these new developments and percolation and applicability of these new developments is still a big question. We see cases that are complicated by wrong choice of surgery, wrong choice of implant and improper use of principles. Trauma International tried to interview the core team of Trauma Society of India on these two question of new implants and education and research in field of Trauma. We have compiled the responses in this editorial Dr DD Tanna: New implants like the precontoured anatomical plates are really good. They are definitely expensive but are good. Some Indian companies are also producing excellent variants of the anatomical plates and I believe these will definitely help in better management of complex articular fractures. However I also believe that not every new implant is a real improvement over the previous one. We have to wait for the clinical results and we have to be smart in selecting our cases to use these implants Trauma education is an ongoing process and we are all students at the same time. We have to continue to learn how to learn, only then we can learn about the new methods and technologies and also learn them well. It is essential for our growth as a surgeon and helps us deliver best treatment to our patients Dr Sudhir Babhulkar: New implants like fragment specific fixation and anatomic contoured plates are an excellent addition to armamentarium of a trauma surgeon. However we should learn to use them wisely and carefully Teaching the young generation is the key to spreading trauma education. Traumacon has created that interest in young surgeons about trauma. We need to focus on them and help them develop proper understanding of principles and correct execution of surgical techniques. Conferences, courses workshops all are needed to achieve this aim. Also teaching about correct principles and techniques should reach periphery. My practice has been 50 to 60% complicated reffered cases. Most of the cases were complicated because of wrong application of surgical principles. I think teaching that will address these issues the correct solution for trauma education in India. Dr GS Kulkarni: About new implants, some of them are really useful in certain situations like fragment specific fixation and contoured plates, but some new implants are not as useful as they are made to appear. New implants should be focussed on solving a surgical problem and should not be innovation for the sake of innovations. We have our innovation which is slotted plate for lengthening over a plate and it is aimed to solve a particular problem. I think that is how innovation should be aimed at. The focus of trauma education should be basics of trauma surgery. That is where many complications arise. Especially as cases of road traffic accidents are rising, basics of management of open fracture should be emphasised more. Principles of debridements, wound closure, when to close the compound wound, methods of closing the wound, external fixation and stabilisation of compound fracture should all be reviewed and highlighted again and again. Another area is use of antibiotics in fracture surgery specifically local and systemic therapies. Current evidence and experience suggest that with proper surgical management, a single day antibiotic therapy is enough. However most surgeons will give either three day or five day antibiotic therapy which is not good for the patient as well as the fracture. If there is a need for prolonged infection control use of local antibiotics systems like cement beads or cement rods should be utilised to reduce the systemic load of antibiotics. Even in cases of closed fracture proper surgical principles should be followed. For example if a surgeon is using locking plates without understanding the principles of locked plates, it becomes a dangerous implant in his hands and is one of the main cause of complications. Dr SC Goel: There are new implants launched every year and such developments should be taken with pinch of salt. Lot of these may be industry driven and we need good multicentric trails to validate the results before using them About education and research, I feel we should have focus on basic sciences too. Unfortunately there are not many basic science labs in India. There are many surgeons who have innovative ideas and techniques but do not get a chance to promote their ideas. I think either TSI or IOA should take these projects ahead and give a chance to all innovators to come forward Dr Sushrut Babhulkar: The science of orthopaedic trauma is evolving and our understanding of it is changing and that is reflected in development of new implants. New implants in trauma are very different from new implants in Arthroplasty where it is more industry driven rather than real evolution. As our understanding of fracture pattern and soft tissue injury improves and as we encounter more varied bone quality, the need for new implants will increase. These improvement in basic understanding is what fuels development of new implants in trauma and I think we are moving forward in sensible direction as far as trauma implants are concerned Education should focus on accurate understanding of principles of trauma surgery and principles of various implants. Both should be used in perfect harmony to achieve excellent result. If either of these principles are not followed, it would lead to complications. This is the main teaching of Traumacon every year. Again research should be promoted but not enforced, if it is enforced, we will get more poor quality research and publications. Sunil Kulkarni: We are facing new challenging in trauma surgery and number of complex and articular trauma has increased due to high energy accidents. I think new implants have helped us a lot in dealing with these complex injuries. Although simple trauma is still managed well with conventional implants, so proper patient selection is essential. Trauma education should be about practical knowledge. Textbook knowledge is not of much use in clinical practice. Especially trauma is a branch where even after decades of practice, on can see a completely new case of face new surgical challenge. Education should be focussed on preparing trauma surgeons to face these challenges and difficult practical problems. Dr Amit Ajgaonkar: New implants have definitely added more tools for trauma surgeons. Implants like Halifax nails, fragment specific fixation, far-cortex locking plates are based on sound principles and have definite advantages in properly selected cases Trauma Education should focus on peripheral surgeons. In recent months I have travelled a lot across the country and especially in the interiors. I realised that maximum trauma work is done by the peripheral surgeon in rural settings. There is an urgent requirement to provide both training as well as infrastructure to these places. I think TSI, IOA and Traumacon can contribute a lot in terms of improving the training but government should also focus on improving the infrastructure. If we carefully note the views of all the experts above we can deduce a chain of thought which can be summarised easily. New implants are good but understanding of the principles behind the implant and proper patient selection is must. As far as trauma education is concerned, all the experts believe basic principles are the building blocks and practical knowledge is of utmost importance. I too believe that trauma Education and research are not different entities, both are actually part of one spectrum. Academics originates from new research and initiation of research is from academics. Thus they both fulfil each other and through the churning of both these, innovative ideas and new implants are born. We thanks our panel for sharing their thoughts with us and we leave the readers now to enjoy the current issue of TI Dr Ashok Shyam Editor – Trauma International.

Trauma is one of the most basic faculty of medicine and treatment of injured is the oldest known speciality. The burden of trauma in immense and with current technological developments road traffic accidents and industrial accidents present with varied patient profiles. There is always a need for personalised care which also depends on the expertise of the surgeon involved. The infrastructure and facilities for trauma care also vary across the world and many practices are modified according to local needs. Care of the injured involves orthopaedic surgeon, general surgeon, plastic surgeon and occasionally vascular surgeon, neurosurgeon and other allied faculties. Multispecialty collaboration is needed for successful treatment of any trauma scenario. The entire point of the first paragraph is that trauma surgery is a very multifaceted speciality and involves complex decision making and requires equally complex specialities to be symbiotic. The same should reflect in the Trauma literature and this is the basic aim of starting the new journal. Trauma International is primarily a journal of Orthopaedic trauma and surgery, but it will also provide platform for all specialities involved in trauma care. Many a times while reading a journal we feel that many articles are almost irrelevant as far as practical patient care is concerned. There are many articles that wouldd focus on statistical or analytic part more than the actual clinical relevance of the study. Trauma International will focus on publishing most clinically relevant articles that will be useful in day to day clinical practice. The format of the articles will be easy to read with clinical relevance highlighted separately. Editors will be frequently commenting on the articles and will be clarifying any difficult issues that they feel require simplification . Readers will be allowed to comment online as well as through letter to editor channel. On other hand we will be including formats like technique videos, tips and tricks, innovations, most memorable patient etc where surgeons would be encouraged to share their experience and also help other learn from their experiences. The whole exercise is to provide the reader something that they can interact with and not something dead and unresponsive. Only participation from the readers and surgeon community can help us realise this dream There exists a lot of resistance especially from the surgeons from publications. This resistance is mostly because they are not familiar with the format of articles and submission process. Trauma international will be providing few solutions to overcome this resistance and encourage surgeons to publish. Firstly, as mentioned earlier we will be keeping simple formats of article submission which will be easy for beginners to write. Secondly, we have a collaboration with the orthopaedic research group and they have taken up the responsibility to guide the authors in terms of writing manuscript. This will be helpful, especially to authors who do not have English as their first language. The process will involve review and revision of primary draft and also help in formatting article as per journal guidelines. Thirdly along with Trauma International we are also launching a dedicated Journal of Trauma and Injury Case Reports. This journal will focus on providing platform to first time authors . This will be done through a special peer review process we call as ‘assistive peer review’. Here the along with providing the review, the reviewers will also suggest and correct the manuscript at most places. This will help the authors understand their errors and also help them learn methods used to correct the errors. This Assistive Peer Review will also be provided for Trauma International. We believe these initiatives will help trauma surgeons to publish more and participate in creating a global literature. Trauma International has received great support especially from the international community and we are proud to say that members of more than 40 countries have joined the Editorial board of Trauma International. This makes the journal a truly international journal. Since trauma is one of the most widespread practiced branch, we will be including more members till we have at least one member form each country in the world. This will help us collaborate and learn from each other in much better ways. We would like to thank all our contributors of the first issue. Special thanks to Dr DD Tanna for sharing his life experiences with us and letting us know about his journey as a trauma surgeon. I think we have promised a lot in this opening editorial but then we are equally passionate about holding ourselves to every promise that we made here. We invite suggestions and also invite you all to participate actively with the journal. With this we leave you to enjoy the issue. Dr Ashok Shyam Editor – Trauma International

Le procédé d'obtention du cuir à partir de peaux est appelé tannage. Il agit par stabilisation chimique du collagène. Il permet de transformer la peau en un matériau stable et durable. Actuellement, plus de 90% de la production mondiale de cuir est effectuée avec du sulfate de chrome, et les effluents du tannage contiennent des quantités importantes de ce sel métallique qu'il faut impérativement traiter par des procédés couteux. L’objectif de ce projet est de proposer une alternative, durable et écologique, au chrome pour le tannage. Dans ce but, des composés organiques ont été synthétisés et leur capacité à stabiliser le collagène a été évaluée par différentes méthodes. Des essais à petite échelle ont été réalisés sur du collagène pur et la capacité de stabilisation du collagène par ces composés organiques a été évaluée par DSC. Les composés organiques sélectionnés suite à ces essais ont été testés sur des peaux entières en tannerie
The manufacturing process used to obtain leather from skin is called tanning. It acts by chemical stabilization of collagen, which transforms the skin into a stable and durable material. Currently, more than 90% of the production of leather worldwide is carried out with chromium sulfate. Therefore, tanning effluents produce significant quantities of this metal salt, which must be treated by expensive processes. The purpose of this project is to offer a sustainable alternative to chromium for tanning. To this end, organic compounds have been synthesized and their ability to stabilize collagen has been evaluated by different methods. Small-scale tests were carried out on collagen and its stabilization by these organic compounds was evaluated by DSC. The organic compounds selected after these tests were then tested on hides

Le procédé d'obtention du cuir à partir de peaux est appelé tannage. Il agit par stabilisation chimique du collagène. Il permet de transformer la peau en un matériau stable et durable. Actuellement, plus de 90% de la production mondiale de cuir est effectuée avec du sulfate de chrome, et les effluents du tannage contiennent des quantités importantes de ce sel métallique qu'il faut impérativement traiter par des procédés couteux. L’objectif de ce projet est de proposer une alternative, durable et écologique, au chrome pour le tannage. Dans ce but, des composés organiques ont été synthétisés et leur capacité à stabiliser le collagène a été évaluée par différentes méthodes. Des essais à petite échelle ont été réalisés sur du collagène pur et la capacité de stabilisation du collagène par ces composés organiques a été évaluée par DSC. Les composés organiques sélectionnés suite à ces essais ont été testés sur des peaux entières en tannerie
The manufacturing process used to obtain leather from skin is called tanning. It acts by chemical stabilization of collagen, which transforms the skin into a stable and durable material. Currently, more than 90% of the production of leather worldwide is carried out with chromium sulfate. Therefore, tanning effluents produce significant quantities of this metal salt, which must be treated by expensive processes. The purpose of this project is to offer a sustainable alternative to chromium for tanning. To this end, organic compounds have been synthesized and their ability to stabilize collagen has been evaluated by different methods. Small-scale tests were carried out on collagen and its stabilization by these organic compounds was evaluated by DSC. The organic compounds selected after these tests were then tested on hides

There are many types of compound that have affinity for protein, and among the more effective of these are the aldehydes. Formaldehyde has been used for decades, glutaraldehyde for not so long. The reactivity of aldehydes in general is such that there are associated toxicity problems, to the extent that formaldehyde is effectively banned and glutaraldehyde may go the same way. Derivatives and analogous aldehydic reagents are now increasingly used in industry. Oil tanning for chamois leather is in a class of its own, because it is a leathering process and the result is unusual properties and performance of the product: the Ewald effect is a partial reversibility of wet heat denaturation. The other chemistry that is widely adopted involves the syntans, synthetic tannins. Although there are similarities among the basic structures, the syntans constitute a wide range of chemistries and reactivities, ranging from non-tanning auxiliaries to reagents capable of acting as solo tannages, analogous to vegetable tannins, and every role between. There is overlap with resins as a group of reagents, where the function may be more of a filling role than a tannage. Recent innovations, designed primarily to make white leather as an alternative to wet blue, exploit isocyanate and aromatic heterocyclic chemistries.