Average Duration Research Articles

Cemented bipolar hemiarthroplasty for unstable intertrochanteric fracture in elderly patients over 70years: Boon or bane?

The surgical management of intertrochanter femur fracture in elderly patient is still under debate. Various implants can be utilised but prosthetic replacement is gaining popularity. This study was performed to evaluate the functional and clinical outcomes of cemented bipolar arthroplasty as a primary treatment for unstable intertrochanteric fracture in elderly patients (> 70years). Thirty-seven patients with unstable intertrochanteric fracture in elderly patient (> 70years) who underwent cemented bipolar hemiarthroplasty. Intra-operative and post-operative complications were noted; functional outcomes were assessed using Harris hip score (HHS). All patients were followed up for a minimum of 12months. Overall 90% of patients has some minor or major intra or post-operative complication. One year mortality rate was 16% (6/37). Cardiopulmonary events were the most common life threatening incident. Mean fall in Haemoglobin was 1.6gm/dL. The average time for full weight bearing mobilisation with the help of walker was 2.8 ± 1.2days (1-8days). The average duration of surgery was 58 ± 6min (44-96min) with an average blood loss of 126 ± 24mL (90-380mL). HHS at the end of 12months was 77. The use of bipolar hemiarthroplasty in senile patient with unstable hemiarthroplasty gives an advantage of early weight bearing. However, it is associated with risk of significant intra or post-operative morbidity due to intra-operative trauma, surgical time and blood loss during the surgery. Although hemiarthroplasty can be a single-time solution to the complexities of intertrochanter fracture in elderly patients but should be performed in selected patients only.

Hidradenitis Suppurativa Patient Referrals to a Canadian Community Dermatology Practice: A Retrospective Chart Review.

Awareness of hidradenitis suppurativa (HS) among non-dermatology healthcare providers is essential to facilitate prompt diagnosis, treatment, and referral to dermatology for further management. The purpose of this study was to analyze recent referrals to a Canadian community dermatology practice and compare the diagnostic concordance rates for HS between dermatologists and non-dermatologists. This study was a single-centre, retrospective chart review that was completed at Beacon Dermatology in Calgary, AB. Patients who were referred by a non-dermatologist for suspicion of HS and/or were diagnosed with HS by a dermatologist at Beacon Dermatology for the first time between May 2020 and May 2023 were included. Referral letters and dermatology clinic notes were analyzed to extract patient demographics, suspected pre-referral and post-referral diagnoses, and interim management plans that were initiated by the referring provider. A total of 451 patient charts with suspected and/or confirmed HS were retrieved from the clinic database. The median wait time from referral to the first dermatology appointment was 9.1 weeks. The average duration of HS symptoms was 7.3 years. HS was suspected by the referring provider and confirmed by a dermatologist in 286 cases (63%). Preliminary management was initiated in 60% of mild and 66% of moderate-to-severe cases. Given the prolonged time to diagnosis of HS, increasing awareness among healthcare providers is essential. Furthermore, this study highlighted the low implementation rates for evidence-based treatment options in preliminary management plans. Ultimately, this study demonstrates the need for increased interdisciplinary education on HS management in Canada.

Effects of vitamin D on the incidence and severity of COVID-19

In the fall of 2023, infection of a number of European countries population with coronavirus intensified, with the most noticeable increase in incidence observed in the Russian Federation. Patients infected with SARS-CoV-2 usually have a low level and high prevalence of vitamin D deficiency. Data from measurements of vitamin D levels in the municipalities of the Khanty-Mansiysk autonomous Okrug — Ugra, compared with information from the department of health of the autonomous okrug based on the results of 2021, suggest that in the Khanty-Mansi autonomous Okrug — Ugra, the average duration of one case of disability due to illness with a diagnosis of COVID-19 is directly proportional to the prevalence of severe vitamin D deficiency. Our data characterizing the positive effect of a high level of vitamin D in the blood serum of a patient infected SARS-CoV-2, on the body’s ability to recover, is confirmed in foreign clinical practice, as evidenced by the results of our statistical calculations. In the Russian Federation, the dependence of the overall incidence of COVID-19 is directly proportional to the geographical latitude of the territory, and the relationship b etween the parameters is extremely high (p = 0.0008 in 2021 and p < 0.000001 in 2022), which, along with other reasons, suggests the effect of ultraviolet radiation level decrease. Vitamin D levels are one of the key factors in the incidence of COVID-19, as it has a major impact on its duration, more severe lung damage, and higher mortality in patients infected with SARS-CoV-2. Clinical studies by domestic and foreign scientists have shown that severe vitamin D deficiency [25(OH)D < 10 ng/ml] in patients infected with SARS-CoV-2 can be considered a predictor of death. During the COVID-19 pandemic, enormous positive experience has been gained in the use of vitamin D as a therapeutic agent to reduce the severity of the disease and the level of hospital mortality, however, in order to prepare informed recommendations for taking medications and identify severe vitamin D deficiency, mandatory measurement of 25(OH)D levels in patients is required in patients diagnosed with SARS-CoV-2 infection.

The role of medicines and therapeutics committees structure in supporting optimal antibacterial use in hospitals in Uganda: A mixed method study.

Although the roles of Medicines and therapeutic committees (MTCs) have been expanding, there is limited information on the role of their structure in optimal antibacterial use in hospitals, especially in low-and-middle-income countries. Our study explored the structure and role of MTC in supporting antibacterial use in regional referral, general hospitals and tertiary private not-for-profit (PNFP) hospitals in Uganda. We conducted an explanatory sequential mixed-method approach with triangulation to explore the structure and functional role of MTCs from August 2019 to February 2020 in hospitals in Uganda. Quantitative data was collected using an interviewer-administered questionnaire among chairpersons or secretaries of MTCs and was analysed using descriptive statistics. We conducted key informant interviews using an interview guide among long-term serving members of MTCs to collect qualitative data which triangulated the quantitative data. The study revealed that sixteen hospitals had successfully established MTCs with an average duration of the MTCs' existence of 5.6 (+2.7) years. The membership of the MTCs varied between 7 and 14, with a median value of 10, and the majority of members in MTCs were pharmacists (15 out of 16) and clinical specialists (13 out of 16). The most frequent subcommittees of the 16 hospitals MTC were supply chain (n = 14), antimicrobial stewardship (n = 13), and infection control (n = 12). Majority (14 out of 16) of the MTCs supported availability and access of antibacterial use by selecting and evaluating antibacterials agents for their formulary lists using established criteria. Additionally, 15 out 16 MTCs conducted antimicrobial stewardship activities to support optimal antimicrobial use. In our study, MTC membership and subcommittees were critical structural components that aided the selection and evaluation antibacterials on hospital formulary lists and they supported optimal antibacterial use through implementing various antimicrobial stewardship activities. There is a need for the Ministry of Health to conduct more training on operationalising MTCs structures in all hospitals.

A Single Center Description of Adult and Pediatric Endoscopic Posterior Costal Cartilage Grafting.

Posterior glottis impairment alters breathing, voicing, and swallowing. Bilateral vocal fold movement impairment (BVFMI) occurs when the vocal cords are fixed/remain midline. Studies inadequately assessed endoscopic posterior costal cartilage grafting (enPCCG) for BVFMI across broad ages. We aim to assess decannulation and prosthesis free airway in children and adults who have undergone enPCCG. Retrospective cohort. Referral center. This study included adults and children who received enPCCG for BVFMI (2010-2018) and were followed for 35 months on average. The main outcome was successful decannulation of patients, or airway improvement in those without tracheostomy. Data on comorbidities, surgical complications, and interventions following surgery were collected. Ten children and 11 adults underwent enPCCG for BVFMI. Eighty-one percentof patients had a tracheostomy at surgery; adults were more likely to have a tracheostomy at surgery (P = 0.035), and to undergo double-staged procedure (P = 0.035) and stent (P = 0.008). Average stent duration was 29.7 days. Overall decannulation rate was 76% (90% for children; 70% for adults). Children were more likely to receive postoperative intensivecareunit care (P = 0.004). Adults had mean 4.4 post-enPCCG interventions per patient compared to children's mean 3.91 interventions. The most common interventions were steroid injection (17.6%) and balloon dilation (16%). Preliminary analysis suggests postoperative dysphonia was reported in 66.7% of patients; postoperative dysphagia was rare. EnPCCG was more successful at achieving decannulation in children. Adults required additional interventions. A double-staged operation with prolonged stenting is recommended for adult patients. A majority of patients were decannulated at last follow-up.

Evaluation of corneal endothelial cell morphology off and on treatment by specular microscopy in children and adolescents with attention deficit hyperactivity disorder

Purpose To determine the structure and properties of corneal endothelial cells in children and adolescents with ADHD who received methylphenidate treatment at least six months. Method The prospective, observational study included 33 eyes of 33 patients diagnosed with ADHD who received methylphenidate treatment for at least six months, 33 eyes of 33 patients newly diagnosed with ADHD who did not start medication treatment, and 33 eyes of 33 healthy individuals. Average cell density, coefficient of variation, maximum cell area, normal cell area, minimum cell area, average cell area, and hexagonality ratio values were evaluated by non-contact specular microscopy. The parameters recorded in all three groups were compared. Results The average age of children in the ADHD + MPH, ADHD, and control groups is 9 ± 1.7, 8.9 ± 2.3, and 8.9 ± 1.8 years, respectively. (p > 0.05) The average MPH treatment dose is 0.94 ± 0.19 mg/kg, the average daily MPH intake is 34.12 ± 14.04 mg, and the average duration of use of MPH is 24.03 ± 12.46 months. Central corneal thickness (CCT) was measured as an average of 540.45 ± 31.23 in the ADHD + MPH group, 540.61 ± 29.69 in the ADHD group, and 546.58 ± 27.72 in the control group. (p = 0.499) The average coefficient of variation (CV) values were measured as 25.48 ± 4.22 in the ADHD + MPH group, 26.12 ± 3.48 in the ADHD group, and 26.12 ± 3.64 in the control group. (p = 0.491) The average hexagonality ratio (%) (HEX) values were measured as 69.45 ± 8.41 in the ADHD + MPH group, 68.21 ± 6.82 in the ADHD group, and 68.91 ± 7.97 in the control group. (p = 0.892) No statistically significant difference was observed between all three groups in terms of all parameters. Conclusion Methylphenidate treatment administered for at least six months with a diagnosis of ADHD did not have a toxic effect on the corneal endothelium.

Dynamic Compression Plating Versus Antegrade Intramedullary Nailing for the Treatment of OTA/AO 12-A Fractures: A Retrospective Cohort Study.

Fractures of the humerus diaphysis are common and often result from motor vehicle accidents (MVAs). Treatment methods range from nonoperative approaches to various operative techniques, including antegrade intramedullary nailing (AIMN) and dynamic compression plate (DCP) fixation. This study aimed to compare the cost effectiveness and outcomes of plating and nailing for humerus diaphyseal fractures. A retrospective cohort study involving 59 cases of humerus diaphyseal OTA/AO 12-A fractures was conducted at King Saud Medical City (KSMC), a level I trauma center located in the center region in Riyadh, Saudi Arabia. Patients treated with AIMN, anterolateral plating, or posterior plating were included. Data on demographics, clinical parameters, radiographic healing, and costs were collected and analyzed. The average surgical duration was shorter in the AIMN group compared to the anterolateral and posterior plating groups but with no statistical significance (P > 0.05). The average length of stay (LOS) was shorter, and the change in hemoglobin levels was lower in the AIMN group when compared to other groups but without a statistically significant difference (P > 0.05). The average cost of AIMN was significantly higher than that of anterolateral and posterior plating groups (P < 0.0001). While both nailing and plating procedures are options for treating OTA/AO 12-A fractures, AIMN carries a higher overall procedural cost. The practice of drain placement in our study population is likely the cause of the increased LOS in the plating groups. Relative additional analgesic requirements were associated with AIMN. Surgeons should consider meticulous hemostasis to avoid drain placement, which can decrease LOS, thus possibly decreasing unnecessary treatment costs of humerus shaft fractures.

Outcomes and Safety with Utilization of Metallic Midfoot Wedges in Foot and Ankle Orthopedic Surgery: A Systematic Review of the Literature

The use of midfoot wedges for the correction of flatfeet disorders, such as progressive collapsing foot disorder, has increased greatly in recent years. However, the wedge material/composition has yet to be standardized. Metallic wedges offer advantages such as comparable elasticity to bone, reduced infection risk, and minimized osseous resorption, but a comprehensive review is lacking in the literature. Therefore, the objective of this systematic review was to organize all studies pertaining to the use of metallic wedges for flatfoot correction to better understand their efficacy and safety. This systematic review adhered to PRISMA guidelines, and articles were searched in multiple databases (PubMED, SPORTDiscus, CINAHL, MEDLINE, and Web of Science) until August 2023 using a defined algorithm. Inclusion criteria encompassed midfoot surgeries using metallic wedges, observational studies, and English-language full-text articles. Data extraction, article quality assessment, and statistical analyses were performed. Among 11 included articles, a total of 444 patients were assessed. The average follow-up duration was 18 months. Radiographic outcomes demonstrated that patients who received metallic wedges experienced improvements in lateral calcaneal pitch angle and Meary’s angle, with an enhancement of up to 15.9 degrees reported in the latter. Success rates indicated superior outcomes for metallic wedges (99.3%) compared to bone allograft wedges (89.9%), while complications were generally minor, including hardware pain and misplacement. Notably, there were no infection complications due to the inert nature of the metallic elements. This review summarizes the effectiveness, success rates, and safety of metallic wedges for flatfoot correction. Radiographic improvements and high success rates highlight their efficacy. Minor complications, including pain and mispositioning, were reported, but the infection risk remained low. Our results demonstrate that metallic midfoot wedges may be a viable option over allograft wedges with proper planning. Future research should prioritize long-term studies and standardized measures.

Impact of COVID-19 outbreak on healthcare workers in a Tertiary Healthcare Center in India: a cross sectional study

Numerous speculations have continually emerged, trying to explore the association between COVID-19 infection and a varied range of demographic and clinical factors. Frontline healthcare workers have been the primary group exposed to this infection, and there have been limited global research that examine this cohort. However, while there are a few large studies conducted on Indian healthcare professionals to investigate their potential risk and predisposing factors to COVID-19 infection, to our knowledge there are no studies evaluating the development of long COVID in this population. This cross-sectional study systematically utilized the demographic and clinical data of 3329 healthcare workers (HCW) from a tertiary hospital in India to gain significant insights into the associations between disease prevalence, severity of SARS-Cov-2 infection and long COVID. Most of the study population was found to be vaccinated (2,615, 78.5%), while 654 (19.65%) HCWs were found to be SARS-CoV-2 positive at least once. Of the infected HCWs, 75.1% (491) did not require hospitalization, whereas the rest were hospitalized for an average duration of 9 days. A total of 206 (6.19%) individuals were found to be suffering from long COVID. Persistent weakness/tiredness was the most experienced long-COVID symptom, while females (1.79, 1.25–2.57), individuals who consumed alcohol (1.85, 1.3–2.64) or had blood group B (1.9, 1.33–2.7) were at a significantly higher risk for developing long COVID.

Catheter ablation in patients with atrial fibrillation and dilated cardiomyopathy.

Catheter ablation is an effective and safe strategy for treating atrial fibrillation patients. Nevertheless, studies on the long-term outcomes of catheter ablation in patients with dilated cardiomyopathy are limited. This study aimed to assess the electrophysiological characteristics of atrial fibrillation patients with dilated cardiomyopathy and compare the long-term clinical outcomes between patients undergoing catheter ablation and medical therapy. Patient baseline characteristics and electrophysiological parameters were examined to identify the predictors of atrial fibrillation recurrence following catheter ablation. The clinical outcomes of catheter ablation and medical therapy were compared using the propensity score matched method. A total of 343 patients were enrolled, with 46 in the catheter ablation group and 297 in the medical therapy group. Among the catheter ablation group, 58.7% (n = 27) had persistent atrial fibrillation. The recurrence rate of atrial arrhythmia was 30.4% (n = 14) after an average follow-up duration of 7.7 years following catheter ablation. The only predictive factor for atrial fibrillation recurrence after catheter ablation was the left atrial diameter. When compared to medical therapy, catheter ablation demonstrated significantly better outcomes in terms of overall survival, freedom from heart failure hospitalization, improvement in left ventricular ejection fraction, and a greater reduction in left ventricular diameter and left atrial diameter after propensity score matching. Therefore, catheter ablation proves to be effective in providing long-term control of atrial fibrillation in patients with dilated cardiomyopathy. In addition to standard heart failure care, catheter ablation significantly enhanced both morbidity and mortality outcomes and reversed structural remodeling when compared to heart failure medication alone.

Evaluation of the Tuberculosis Surveillance System in the Southern Region of Iran

Aim The aim of this study was the evaluation of Tuberculosis (TB) surveillance system in Southern Iran. Background TB is one of the most important infectious diseases that has been common since ancient times. Methods This is a cross-sectional descriptive-analytical study that was conducted by the census method using the TB Surveillance System on 77 patients with tuberculosis in the southern region of Kerman province in Iran. The study was conducted over one year, from April 2020 to March 2021. Statistical tests were used by SPSS version 20 to analyze the data. Results 90.62% of the patients were cured and the rest experienced treatment failure and absenteeism. The average and standard deviation of the interval between the onset of the first symptom and the diagnosis and discovery of the disease were 88 and 93 days, respectively. Regarding the treatment duration, 95.5% of the cases followed the prescribed duration while the remaining cases did not. Among the affected patients, 34.8% had a history of hospitalization, while the rest had no such history. The average hospitalization duration was 12.92 days, with a standard deviation of 9.94 days. The longest hospital stay was 60 days, while the shortest was 2 days. Conclusion We need to have a suitable program for early diagnosis of TB, compliance with the length of treatment, and training of private and public centers to strengthen the care system. Additionally, we should strengthen the process of the directly observed treatment, short-course (DOTS) program to control TB.

Efficacy of Core-Strengthening and Intensive Dynamic Back Exercises on Pain, Core Muscle Endurance, and Functional Disability in Patients with Chronic Non-Specific Low Back Pain: A Randomized Comparative Study.

Chronic back pains are progressively disabling working individuals, including 60-80% of the general population, for which their diagnosis is challenging to healthcare workers worldwide, thereby becoming a burden to nations. The study aimed to investigate the efficacy of core strengthening exercise (CSE) and intensive dynamic back exercise (IDBE) on pain, core muscle endurance, and functional disability in patients with chronic non-specific low back pain (LBP). The study was based on a three-arm parallel-group randomized control design. Forty-five participants with chronic non-specific LBP were recruited and randomly divided into the CSE, IDBE, and Control groups. The CSE and IDBE groups received CSE and IDBE, respectively. However, the Control group received no intervention. Numeric pain rating scale, Oswestry Disability Index, core flexors, extensors, and side bridge tests assessed pain intensity, functional disability, and endurance of core muscles. Outcome scores for the dependent variables were collected at baseline (pre-intervention) and six-week post-intervention. There were no follow-up measurements in this study. A one-way multivariate analysis of covariance (MANCOVA) was used to analyze the intervention effects on the outcomes within groups and between groups, respectively; keeping the significance-level alpha at 95%, i.e., p < 0.05. A univariate F-test was performed to observe the superiority of one treatment over another. Pearson's correlation coefficient test was conducted to determine a relation between the dependent variables. In all statistical analyses, the level of significance α was kept at 0.05. All forty-five out of sixty-three participants with chronic non-specific low back pain (male, 32 and female, 23; average age, 20.24 ± 1.46 years; average pain duration, 19.6 ± 5.42 weeks) completed the study and their data were analyzed. The MANCOVA test showed a significant difference between the treatment groups on the combined multiple endurance tests for the core muscles (flexors, extensors, side bridge tests to the right and left), Visual Analog Scale (VAS), and Oswestry Disability Index (ODI) scores after controlling for baseline scores of all the dependent variables: F (6, 12) = 23.381; p < 0.05; Wilks' Λ = 0.033; partial η2 = 0.819. A post hoc pair-wise comparison followed by a univariate F-test indicated that a significant improvement was found between the CSE vs. IDBE vs. Control groups on the post-test scores of all the dependent variables except VAS and EET (CSE vs. IDBE only). A Pearson's correlation coefficient test revealed a notable relation between the dependent variables. The experimental group CSE was found to be more effective than IDBE on improving functional disability, cores' flexors, and side bridges' endurance tests than IDBE. The magnitude of this improvement exceeded the minimal clinically important difference (MCID), suggesting a clinically relevant enhancement in functional disability, core flexors, and side bridge endurance for participants engaged in CSE. However, CSE vs. IDBE revealed non-significant differences on reducing pain and core extensors' endurance. The absence of statistically significant differences suggests that the observed changes did not exceed the established MCID for pain intensity and core extensors' endurance. In addition, partial eta-squared value revealed the superiority of CSE over IDBE and Control groups. This suggests that the observed differences between the two interventions are not only statistically significant, but also clinically relevant, surpassing the established MCID.

Gender differences in long term sickness absence

PurposeSickness absence is a major public health problem, given its high cost and negative impact on employee well-being. Understanding sickness absence duration and recovery rates among different groups is useful to develop effective strategies for enhancing recovery and reducing costs related to sickness absence.MethodsOur study analyzed data from a large occupational health service, including over 5 million sick-listed employees from 2010 to 2020, out of which almost 600,000 cases were diagnosed by an occupational health physician. We classified each case according to diagnosis and gender, and performed descriptive statistical analysis for each category. In addition, we used survival analysis to determine recovery rates for each group.ResultsMean sickness duration and recovery rate both differ significantly among groups. Mental and musculoskeletal disorders had the longest absence duration. Recovery rates differed especially during the first months of sickness absence. For men the recovery rate was nearly constant during the first 1.5 year, for women the recovery rate was relatively low in the first three months, and then stayed nearly constant for 1.5 year.ConclusionAcross almost all diagnostic classes, it was consistently observed that women had longer average sickness absence durations than to men. Considering mental disorders and diseases of the musculoskeletal system, women had relatively lower recovery rates during the initial months compared to men. As time progressed, the recovery rates of both genders converged and became more similar.

Cloud platform to improve efficiency and coverage of asynchronous multidisciplinary team meetings for patients with digestive tract cancer.

Multidisciplinary team (MDT) meetings are the gold standard of cancer treatment. However, the limited participation of multiple medical experts and the low frequency of MDT meetings reduce the efficiency and coverage rate of MDTs. Herein, we retrospectively report the results of an asynchronous MDT based on a cloud platform (cMDT) to improve the efficiency and coverage rate of MDT meetings for digestive tract cancer. The participants and cMDT processes associated with digestive tract cancer were discussed using a cloud platform. Software programming and cMDT test runs were subsequently conducted to further improve the software and processing. cMDT for digestive tract cancer was officially launched in June 2019. The doctor response duration, cMDT time, MDT coverage rate, National Comprehensive Cancer Network guidelines compliance rate for patients with stage III rectal cancer, and uniformity rate of medical experts' opinions were collected. The final cMDT software and processes used were determined. Among the 7462 digestive tract cancer patients, 3143 (control group) were diagnosed between March 2016 and February 2019, and 4319 (cMDT group) were diagnosed between June 2019 and May 2022. The average number of doctors participating in each cMDT was 3.26 ± 0.88. The average doctor response time was 27.21 ± 20.40 hours, and the average duration of cMDT was 7.68 ± 1.47 min. The coverage rates were 47.85% (1504/3143) and 79.99% (3455/4319) in the control and cMDT groups, respectively. The National Comprehensive Cancer Network guidelines compliance rates for stage III rectal cancer patients were 68.42% and 90.55% in the control and cMDT groups, respectively. The uniformity rate of medical experts' opinions was 89.75% (3101/3455), and 8.97% (310/3455) of patients needed online discussion through WeChat; only 1.28% (44/3455) of patients needed face-to-face discussion with the cMDT group members. A cMDT can increase the coverage rate of MDTs and the compliance rate with National Comprehensive Cancer Network guidelines for stage III rectal cancer. The uniformity rate of the medical experts' opinions was high in the cMDT group, and it reduced contact between medical experts during the COVID-19 pandemic.

Antibiotic Impregnated Cement Coated Intramedullary Nailing in the Management of Infected Fractures and Chronic Osteomyelitis of Long Bones

Background: In the era of modern transportation there is an increased incidence of compound fractures especially of long bones. As the skin barrier is broken, the bacteria from dirt, other contaminants can colonize at the wound site and thus can cause infection. Healing at the fracture site and that of soft tissues can be severely compromised by infection. So, treating the infection first followed by definitive fixation of fracture will nearly take 4-6 weeks. The antibiotic nailing technique can thus achieve both the targets in a short time. Local delivery of drug controls the infection and the fixation achieves stability. This even reduces the side effects due to over use of systemic and oral antibiotics. Osteomyelitis is also very common which can be hematogenous or post traumatic. This can weaken the bone and can cause fractures with trivial trauma. Discharging sinuses may also be accompanying. So even in this scenario long term use of antibiotics systemically may be required causing side effects. Antibiotic nailing can be very useful in this scenario. Methods: This is a prospective observational study. 20 patients above age of 20 years who were admitted or on follow up during the period of 2 years were considered for study. The patients with infected fractures with or without implant in situ and patients with chronic osteomyelitis with discharging sinuses were included. ASAMI Criteria: The final outcome is graded based on ASAMI criteria proposed by Paley et al. This was usually developed for determining the outcome after treatment of nonunion with Ilizarov ring fixator. It was applied in our study with some modification. Results: The average duration for achieving bony union was around 5 months (20 weeks). Minimum duration for bony union was around 4 months (16 weeks). Maximum duration for bony union was around 7 months (28 weeks) Average duration for control of infection in case of chronic osteomyelitis was around 4 months. Minimum duration for control of symptoms was 5 months. Maximum duration for control of symptoms was 7 months. Conclusion: Antibiotic impregnated cement coated intramedullary nailing is a very good and effective treatment for infected nonunion and chronic osteomyelitis long bones with bone defect less than 2 cm. In case of infected nonunion, as the bone ends will be sclerosed, freshening of ends and bone grafting is needed.

Ridge split assisted molar protraction

Protraction of a second molar into the gap left by a missing first molar is an option, although it is challenging to maintain root parallelism during mesial migration due to the thick and dense cortical bone. This study was carried out to make an attempt to evaluate whether molar protraction in subjects with missing mandibular first molar and knife edge ridges is possible or not using ridge split procedure (expansion).The sample consisted of 12 subjects with missing mandibular first molar and knife edge ridges. All pre-treatment records were taken, after initial leveling and alignment ridge split procedure was performed and molar protraction was carried out using mini implants. Data was collected at a fixed interval of every six weeks. Statistical analysis using Repeated-measures ANOVA and Paired t test were done for evaluation of the rate of molar protraction and mesial molar tipping 0.12mm per week and 0.9 mm per six weeks was the rate of molar protraction that was accomplished. The mean edentulous space decreased from pre protraction to third visit significantly with a p value of ≤ 0.001.There is mesial tipping of molar post protraction with a P value of 0.148 which is statistically non-significant. On an average duration for molar protraction was 8.4 months.Ridge split made molar protraction possible in subjects with missing mandibular molar and knife edge ridges and enhanced the rate of tooth movement. The absolute anterior dental anchorage for the desired orthodontic movement was achieved by utilisation of mini implants.

Determinants of Accuracy of Freehand, EVD Placement by Neurosurgical Trainees.

Background: The insertion of an external ventricular drain (EVD) is a fundamental neurosurgical procedure predominantly performed by junior neurosurgical trainees. It is vital for managing conditions like hydrocephalus, intracranial hypertension, traumatic brain injury, and others. The procedure's success heavily relies on the precise identification of anatomical landmarks and the trainee's experience. Objective: This study aims to assess the precision and safety of EVD placement in patients treated by first-year (R1) and second-year (R2) neurosurgical residents, evaluating the impact of the residents' experience levels on the outcomes of the procedure. Methods: Conducted at the Neurosurgery Department of Jinnah Post Graduate Medical Center, Karachi, from February to July 2022, this prospective cohort study involved individuals aged 18 years or older undergoing EVD placement for hydrocephalus. Exclusion criteria included patients with more than 5mm midline shift on initial scans or those without a post-EVD placement scan. Procedures were performed under senior resident supervision, with postoperative CT scans assessing catheter tip placement and potential complications. Statistical analyses utilized IBM SPSS Statistics for Windows, Version 25.0, with Student’s t-test, Chi-square, and Fisher exact tests applied as appropriate. Results: The study comprised 152 patients (mean age: 39.4 ± 10.7 years; 52.6% male). The initial GCS scores varied, with 44.7% scoring above 8. Most EVD placements (60.5%) were by residents in their fourth or fifth year. The average procedure duration was 43 ± 8.7 minutes, with an average of 1.44 ± 0.12 passes. Optimal placement (Kakarla Grade 1) was achieved in 59.2% of cases, with significant differences in placement accuracy between R1 and R2 residents (p&lt;0.05). Conclusion: The study highlights the significant role of experience and training in the successful placement of EVDs. The higher accuracy rates in more experienced residents underscore the need for enhanced training programs for junior neurosurgical trainees, focusing on anatomical landmark identification and procedural practice.

A Comprehensive Descriptive Analysis of Out-of-Session Meditation in a Residential Treatment Setting: Duration, Frequency, and Type of Practice

ObjectivesA nuanced examination of human behavior can yield valuable insights into whether a mindfulness-based intervention (MBI) promotes meditation practices and to what degree in various populations. This study aimed to offer a comprehensive analysis of meditation behaviors exhibited by individuals in response to a MBI in the context of an intensive residential treatment program for addiction recovery.MethodA total of 100 participants enrolled in a residential treatment program participated in an added MBI component to their routine care. We quantified the type, frequency, and duration of meditation practices outside of scheduled MBI sessions and conducted a descriptive analysis to investigate how these practices during the intervention predicted meditation behaviors 7 months later.ResultsAll seven common types of mindfulness meditation assessed, except the body scan, were performed an average of once per day during the MBI. The longest average duration of meditation practice was observed in the case of walking meditation, during both the MBI (M=20.30, SD=16.66 min) and 7-month follow-up (M=25.43, SD=20.85 min). Out-of-session meditation frequency (unstandardized beta, B=0.56, p<0.001) and duration (B=0.45, p=0.02) during the MBI significantly predicted subsequent meditation behaviors 7 months later, even after adjusting for treatment site discharge status and other clinical variables.ConclusionsMost participants in this addiction recovery sample consistently engaged in a variety of meditation practices outside of formal MBI class sessions while in residential living, performing them approximately once a day, with a particularly robust response to walking meditation. The persistence of meditation practice 7 months later suggests that the learned behaviors endure throughout addiction recovery.PreregistrationThis original trial is registered with clinicaltrials.gov (NCT02977988)

Virus-mediated cell fusion of SARS-CoV-2 variants

SARS-CoV-2 has the ability to form large multi-nucleated cells known as syncytia. Little is known about how syncytia affect the dynamics of the infection or severity of the disease. In this manuscript, we extend a mathematical model of cell–cell fusion assays to estimate both the syncytia formation rate and the average duration of the fusion phase for five strains of SARS-CoV-2. We find that the original Wuhan strain has the slowest rate of syncytia formation (6.4×10−4/h), but takes only 4.0 h to complete the fusion process, while the Alpha strain has the fastest rate of syncytia formation (0.36 /h), but takes 7.6 h to complete the fusion process. The Beta strain also has a fairly fast syncytia formation rate (9.7×10−2/h), and takes the longest to complete fusion (8.4 h). The D614G strain has a fairly slow syncytia formation rate (2.8×10−3/h), but completes fusion in 4.0 h. Finally, the Delta strain is in the middle with a syncytia formation rate of 3.2×10−2/h and a fusing time of 6.1 h. We note that for these SARS-CoV-2 strains, there appears to be a tradeoff between the ease of forming syncytia and the speed at which they complete the fusion process.

Application of the rectus abdominal muscle in reconstructive and recovery surgery of chest wall defects

Introduction. Autologous plastic tissues (muscles and greater omentum) are preferable in the reconstruction of chest wall defects in infectious and inflammatory diseases of the chest wall. Extended and deep defects can be eliminated by flaps of the rectus abdominis muscle.Aid. To study the effectiveness of various options for the use of flaps of the rectus abdominis muscle in plastic surgery of chest wall defects of infectious and inflammatory origin.Object and methods. A retrospective analysis of the results of treatment of 34 patients with osteomyelitis of the sternum and ribs of various etiologies was carried out for the period from January 1, 2012 to May 30, 2023. In 32 patients, the main diagnosis was poststernotomy mediastinitis, 2 patients had post-radiation osteomyelitis of the sternum and ribs after combined cancer treatment. mammary gland. The majority of patients (n = 29) underwent a two-stage approach to treatment using vacuum therapy at the stage of relief of acute inflammation. All patients underwent plasty with a flap of the rectus abdominis muscle. The options for surgical intervention and the outcome of treatment were studied.Results. The area of the defect to be repaired in patients ranged from 50 cm2 to 270 cm2 (mean 143.1 ± 15.3 cm2). There were no intraoperative complications in the patients. The postoperative period was complicated by various wound complications in 9 patients. Marginal necrosis of the skin part of the graft was revealed in 3 patients with full-thickness permanent graft plasty. In 3 patients, despite wound drainage, postoperative seromas were detected. Reoperations were performed in 2 patients: in one case, bleeding from the vein of the fullthickness flap was stopped, in the other case, partial necrosis of the full-thickness flap was detected, which required a second operation and revision of the flap. In 1 patient, the hematoma was emptied 3 days after the operation. The average duration of inpatient treatment of patients was 19.3 ± 2.8 days (range 17 to 38 days). There were no lethal outcomes in patients with muscle plasty with a permanent graft flap. In 1 patient, a postoperative hernia was formed in the region of the anterior abdominal wall. Recurrence of osteomyelitis of the ribs was diagnosed in 1 person 16 months after surgery.Conclusions. The rectus abdominis muscle as an isolated and full-thickness flap is the optimal plastic material for eliminating defects in both the lower part of the sternum and extensive defects in the anterior and lateral surfaces of the chest wall.