History Of Surgical Intervention Research Articles

Anarcha, Lucy, and Betsey: The Mothers of Modern Gynecology

As urologic surgeons, it is critical that we acknowledge the prevalence of medical experimentation in the history of surgical intervention. In many situations, vulnerable populations, such as enslaved people, immigrants, people of color, and women, have been subject to experimentation (Fig. 1).1-5 Historically, the appalling nature of these experiments was justified by medical gain—though these gains may have been overstated or mischaracterized. The cumulative result is the prevailing sentiment of medical mistrust that persists today, notably among Black men and women.

Patient-Reported Outcome Measurement Information System (PROMIS) Scores in Pediatric Patients With Arthrogryposis.

Arthrogryposis multiplex congenita (AMC) is a clinical term that is used to describe congenital contractures that lead to childhood deformities. Treatment aims are to maximize function while minimizing pain and disability. Few studies have explored patient-reported outcomes in the pediatric arthrogrypotic population, particularly concerning mobility. The aim of this study was to report scores for the Patient-Reported Outcome Measurement Information System (PROMIS) questionnaire for pediatric patients with arthrogryposis with regards to mobility, upper extremity (UE) function, pain interference, and peer relationships. A retrospective chart review of 76 patients with AMC aged 5 to 17 who completed the PROMIS questionnaire between January 1, 2017 to March 24, 2020 was performed. Results were collected for four domains: mobility, UE function, pain interference, and peer relationships. Outcomes were stratified by type of arthrogryposis: Amyoplasia (Am), Distal Arthrogryposis (DA), and Other Diagnoses (OD). Results of subjects with isolated upper or lower extremity involvement were compared with subjects with involvement of upper and/or lower extremities. Outcomes were correlated with history of surgical intervention. Children with Am and OD demonstrated moderate impairment of mobility (average: 35.2 and 35.9, respectively), while those with DA reported only mild impairment (average: 44.9). UE function was severely impaired for children with Am (average: 23.0), moderately impaired for OD (average: 33.0), and mildly impaired for DA (average: 43.4). All patient groups reported normal ranges of pain interference, as well as good peer relationships. A moderate negative correlation between number of surgical interventions and mobility scores, and a weak negative correlation between number of surgeries and pain interference scores were found. Children with AMC experience limited mobility and UE function, but normal levels of pain interference and good peer relationships. The average values provided in this study will serve as a baseline from which to evaluate the efficacy of both nonoperative and surgical interventions. Level II-prognostic study; retrospective study.

The Feasibility Study of C1 Posterior Arch Crossing Screw Fixation in Adult Thai Population: A Computed Tomographic Morphometric Analysis Study

Objective: Atlantoaxial instability can be caused by various etiologies and surgical fixation is often required. Various methods have been described for atlantoaxial fixation. Screw fixation is associated with an increased risk of vertebral artery injury especially in patients with an anomalous vertebral artery location or abnormal bony anomalies. A new C1 posterior arch crossing screw fixation technique was proposed to reduce the risk of vertebral artery injury. The present study aimed to assess morphometric CT analysis of atlas for C1 posterior arch crossing screw fixation in Thai people. Materials and Methods: The present research was an observational study that reviewed 150 computed tomography (CT) scans of the patients who had neck trauma or any other complaint requiring craniocervical investigations. Atlantoaxial articulation deformities due to trauma, infections, neoplasm, congenital anomaly, inflammatory disease, incomplete CT scan analysis, and history of surgical intervention of the cervical spine were excluded. All the images were measured for the height of the posterior tubercle, the width of the posterior arch was measured bilaterally in three parts on the axial plane, part 1: medial of the VA groove, where the arch transforms into the VA groove, part 2: the middle part between the posterior tubercle and medial of the VA, and part 3: posterior tubercle, length of the screw, and the screw projection angle was calculated. Results: Out of the 139 CT scans analyzed, the mean measurement of posterior arch height was 7.45±1.03 mm, wherein 73.3% exceed 7 mm. The mean width of the left posterior arch in part 1, 2, and 3 was 4.50±0.70 mm, 4.90±0.70 mm, and 5.70±0.80 mm, respectively, and the width of the right posterior arch in part 1, 2, and 3 was 4.50±0.70 mm, 4.80±0.70 mm, and 5.60±0.80 mm, respectively. The mean crossing screw length of the Left and Right was 17.02±3.04 mm and 17.37±2.75 mm, respectively. The mean angle of screw of the Left and Right was 24.62±3.38 degrees and 24.78±3.57 degrees, respectively. There were no significant differences in these variables between gender or sides (p>0.05) except the mean angle of the screw between gender (p<0.05). Conclusion: C1 posterior arch screw fixation is feasible in the adult Thai population. Preoperative thin-cut CT is essential for planning successful posterior arch crossing screws placement. Keywords: C1 posterior arch, Computed tomography, Crossing screw fixation

High prevalence of asymptomatic nosocomial candiduria due to Candida glabrata among hospitalized patients with heart failure: a matter of some concern?

Background and Purpose: Heart failure is a leading cause of hospitalization, and asymptomatic candiduria is common in hospitalized patients with low morbidity. However, in most patients, it is resolved spontaneously on the removal of the catheter. Despite the publication of guidelines, there are still controversies over the diagnosis and management of candiduria. However, in hospitalized patients with heart failure, the decision to treat candiduria is especially important since the nosocomial infections are associated with an increase in morbidity, mortality, length of hospital stay, and healthcare costs. Some species of Candida, such as Candida glabrata, are increasingly resistant to the first-line and second-line antifungal medications. The present study aimed to investigate the incidence of asymptomatic Candida urinary tract infection due to C. glabrata and antifungal susceptibility of Candida isolates in hospitalized patients with heart failure.Materials and Methods: In total, 305 hospitalized patients with heart failure were studied to identify asymptomatic nosocomial candiduria during 2016-17 in one private hospital in the north of Iran. The Sabouraud’s dextrose agar culture plates with a colony count of >104 colony-forming unit/ml of urine sample were considered as Candida urinary tract infection. Candida species were identified based on the morphology of CHROMagar Candida (manufactured by CHROMagar, France) and PCR-RFLP method with MspI restriction enzyme. Antifungal susceptibility testing of the isolates was performed using five mediations, including itraconazole, voriconazole, fluconazole, amphotericin B, and caspofungin by broth microdilution method according to CLSI M27-S4.Results: In this study, the rate of asymptomatic Candida urinary tract infection was 18.8%, which was more common in people above 51 years old and females (70%). In addition to the urinary and intravascular catheter, the occurrence of candiduria in hospitalized patients had significant relationships with a history of surgical intervention, diastolic heart failure, and use of systemic antibiotics (P>0.05). Among Candida spp., non-albicans Candida species was the most common infectious agent (59.7%). Moreover, C. glabrata (n=27, 40.3%) (alone or with other species) and Candida albicans (n=27, 40.3%) were the most common agents isolated in Candida urinary tract infection. Based on the results of the in vitro susceptibility test, the C. glabrata isolates were 15%, 59%, 70%, 74%, and 85% susceptible to caspofungin, amphotericin B, itraconazole, voriconazole, and fluconazole, respectively.Conclusion: According to the findings, there was a high prevalence of asymptomatic Candida urinary tract infection in hospitalized patients with heart failure. Besides, it was suggested that there was a shift towards non-albicans Candida, especially C. glabrata, in these patients. Therefore, asymptomatic candiduria in hospitalized patients with heart failure should be considered significant. Furthermore, the identification of Candida species along with antifungal susceptibility is essential and helps the clinicians to select the appropriate antifungal agent for better management of such cases.

A comparison of handheld ultrasound versus traditional ultrasound for acquisition of RUSH views in healthy volunteers.

Few studies evaluate the use of handheld ultrasound devices for point‐of‐care ultrasonography in the emergency department. We hypothesized that image acquisition time and image quality are similar between a handheld device and a traditional device. We compared these 2 types of devices in healthy, non‐pregnant adults with using a crossover non‐inferiority design while acquiring Rapid Ultrasound for Shock and Hypotension (RUSH) view. We excluded those with a history of surgical intervention or known abnormality to the lungs, abdomen, or pelvis. Images were compiled into a de‐identified video clip reviewed for image quality by 2 blinded reviewers. Cohen's Kappa was used to determine interrater agreement. Disagreements were adjudicated by an independent physician. Imaging time was compared using a paired Student's t test. Of 59 screened participants, 9 were excluded. Most subjects (N = 30, 60%) were female with a mean age of 39 (Range: 19–67) years. The median time to complete the RUSH exam did not differ (handheld 249.4, interquartile range 33.5 seconds); traditional 251.4, interquartile range 66.3 seconds); [P = 0.81]). Agreement between ultrasound reviewers was good (agreement 83%; k = 0.69; 95% CI, 0.49–0.88). Images were determined to be of adequate quality for interpretation in 41/50 (82%) and 43/50 (86%) in the handheld and traditional devices, respectively (P = 0.786). Neither time to image acquisition nor image quality differed between the handheld and traditional devices. The handheld device may be an alternative for use in RUSH exams.

The role of infectious pathogens in etiopathogenesis of degenerative intervertebral disc disease

Objective. To analyze the presence of infectious pathogens in the intervertebral disc tissues as possible pathogenetic factor in the development of degenerative diseases of the spine. Material and Method. In 2017–2018, a prospective exploratory research was conducted, which included 64 patients with degenerative disease of the spine who met the following inclusion criteria: the presence of clinically and instrumentally proven hernias of the intervertebral discs in the lumbosacral spine, the absence of a history of surgical interventions on the spine, non-intake of antibacterial drugs for the year before surgery, and Modic I and /or II type changes on MRI. All patients underwent interventions with sampling of intervertebral disc material; a total of 80 discs were examined. The obtained materials were subjected to microbiological and histopathological studies.Results. Out of 64 patients, only 1 (1.6 %) revealed the presence of bacterial flora in the intervertebral disc tissue (Propionibacterium acnes strain). It can be assumed that the identified bacterial flora is the result of contamination. It is also possible that the infectious agent joined already during the development of degenerative disease of the spine. If the bacterial flora was a pathogenetic factor, then it can be assumed that the pathogenesis of the disease is polyetiological and includes the infectious process as a rare event.Conclusions. Given the high interest of specialists in the pathogenesis of degenerative diseases, it seems appropriate to conduct further studies in this direction using various laboratory diagnostic methods with high sensitivity and specificity.

P1793MICROBIAL URETERAL STENT COLONIZATION IN KIDNEY TRANSPLANTATION: INCIDENCE AND IMPACT IN URINARY TRACT INFECTION AND RENAL FUNCTION

Abstract Background and Aims Ureteral stent insertion is nowadays a common practice in kidney transplantation, leading to a dramatic reduction of surgical issues. On the other hands, urinary tract infections are the most common complication in the first months after transplant. Main scope of our study was to analyze the incidence of stent colonization and its impact on the development of urinary tract infection (UTI) in the first six months after transplantation Method Prospective observational study including 23 consecutively recruited patients at one single center. Patients with a previous history of surgical intervention on urinary tract before transplant were excluded. Pigtail stents were removed as for local protocol between 3 and 4 weeks after transplantation in aseptic condition and were cut in a half (proximal and distal) and analyzed separately. Stent colonization were detected by sonication method. Urine culture timing are depicted in Figure 1. In case of clinical symptoms, extra urine cultive were performed as for clinical practice. Patient were followed for 6 months, and results of stent colonization were blinded to clinicians. Results Table 1 shows main characteristic of our cohort. Conclusion

Effect of parental pressure on emergency physicians for computerized tomography imaging request in children with head trauma.

Both minor and major head traumas constitute an important proportion of childhood emergency admissions. In this study, the findings of cranial computed tomography (CCT) scans performed as a result of the parental pressure were evaluated. The frequency and findings of CCT scans performed as a result of parental pressure were examined in a separate subgroup. A total of 227 patients were included in the study; 158 (69.9%) patients had undergone CCT scans; a pathological finding was detected in 24 (10.6%) of these patients and undergone a consultation by the neurosurgeon (most common finding was isolated linear fracture; n = 12; 50%). The patients undergoing CCT scans were divided in two subgroups: the PECARN group [n = 123 (77.8%)] and the Parental pressure group [n = 33 (22.2%)]. One third of the parents of children who presented to the emergency department with head trauma and had no indication for CCT according to PECARN rules insisted on CCT imaging, and none of these cases showed ciTBI, surgical operation, or mortality. None of the patients in the parental pressure group had a history of surgical intervention or mortality within one month after discharge.

Pineal gland calcifications in patients with benign and malignant tumors of the larynx, pharynx, paranasal sinuses and auditory nerve

Calcifications of the brain – pineal gland, choroid plexuses of the lateral ventricles – are a long-known phenomenon. Calcification in such functionally important organs as the pineal gland and choroid plexuses of the lateral ventricles cannot be physiological (it is enough to recall the formation of stones in the gallbladder, kidneys, prostate gland, calcinosis of the heart valves and coronary vessels) or relatively neutral process in the body and not affect the activity of these organs. The purpose of the investigation is to study the nosological predisposition of calcifications and the incidence of calcification of the pineal gland and choroid plexuses of the lateral ventricles in benign and malignant tumors of the larynx, pharynx, paranasal sinuses and auditory nerve. Material and research methods. The analysis of CT images of 425 persons was carried out (data archive of the Institute): 50 practically healthy persons from 22 to 60 years without any chronic diseases of the head and neck and a history of surgical interventions; 23 – from 61 to 74 years with normal body aging, not taking any medications, with healthy lifestyle; 235 – from 22 to 74 years with maxillary sinus cysts; 61 – from 28 to 71 years with acoustic neuromas; 56 – from 14 to 74 years with benign and malignant tumors of the larynx, nasal pharynx and paranasal sinuses. Conclusions. Pineal gland calcifications – can be considered as: mobile depot or cemetery of calcium; the result of an organ and/or a tumor-bearing organism protective reaction; a sign of a normal or decreased pineal gland function. The formation and growth of calcifications of the pineal gland and choroid plexuses of the lateral ventricles is associated with the growth and development of the body, benign and malignant tumors of the larynx, pharynx, paranasal sinuses and the auditory nerve (very likely, the tumors of other localizations as well). The formation and growth of calcifications of the pineal gland and choroid plexuses of the lateral ventricles indicates an increase of the heterogeneity of the human body tissues and organs with age and the acquisition of diseases.

Medical imaging of textile iatrogenic foreign bodies in abdomen and pelvis

Aim. To systematize modern literature data on medical imaging of textile iatrogenic foreign bodies.Materials and methods. We analyzed the articles about the identification of textile iatrogenic foreign bodies, published until 2019.Discussion. Foreign body detection should be included in the differential diagnostic algorithm for patients who have a history of surgical interventions and unexplained symptoms. In all cases of suspected iatrogenic foreign body, it is desirable to use at least two available techiques of medical imaging: ultrasound, X-ray, MDCT, MRI.Conclusions. Left foreign body entails medical and legal consequences that adversely affect both the reputation of the surgeon and the reputation of the medical institution, as they are considered a classic example of iatrogenic damage and indicate a violation of the quality standards of medical care. The article presents data on the features of medical imaging of textile iatrogenic foreign bodies left in the patient’s body as a result of planned and emergency surgical interventions, and determining the optimal tactics for examination and treatment of this category of patients.

CASE REPORT: ODONTOGENIC CUTANEOUS FISTULA IN THE SUBMANDIBULAR CERVICAL SKIN IN TWO DOGS

Odontogenic cutaneous fistula is commonly misdiagnosed by practitioners, leading to incorrect and unnecessary treatment. Here, we present two cases. Case 1 involved an eight-year-old intact male Maltese with a submandibular cutaneous abscess following 2 weeks of antibiotic treatment who was later diagnosed, using dental radiography, with odontogenic cutaneous fistula. Case 2 involved an eight-year-old neutered female Maltese with a submandibular cutaneous nodule and general skin problems following 6 months of oral antibiotics and a history of surgical intervention who was finally diagnosed, using dental radiography and computed tomography, with an odontogenic cutaneous fistula that resolved completely following tooth extraction. These two cases highlight the importance of odontogenic infection in the differential diagnosis of typical lesions in the head and neck.

Long-term toxicity following radiation therapy for head and neck squamous cell carcinoma: A retrospective study analyzing the effect of concurrent chemotherapy and advanced t-stage on late treatment-induced toxicities.

e17560 Background: There are approximately 436,000 survivors of head and neck squamous cell carcinoma (HNSCC) in the U.S. Toxicities related to definitive chemoradiation or radiation therapy can persist for many years, with some toxicities not presenting clinically until five or more years after definitive treatment. Long-term management of late radiotherapy effects is thus warranted. Methods: This retrospective chart review has three aims: (1) comprehensively assess overall late effects of definitive radiation and chemoradiation; (2) compare treatment-related toxicities between definitive radiation and chemoradiation; and (3) compare treatment-related toxicities between patients with TNM stage T1/T2 tumors to T3/T4 tumors. Late term effects were assessed using 17 toxicity categories including xerostomia, dysphagia, and neck fibrosis. HNSCC patients included in the study were those seen by a single practitioner for follow-up of definitive radiation or chemoradiation, without a history of surgical intervention to the primary site, between June 2017 and June 2018 (N = 49). Results: The median time from the end of treatment to the most recent follow-up was 8.53 years (1.17-24.08 years). In the total cohort, the most common late effect was xerostomia (78%, N = 38), followed by dysphagia (43%, N = 21), and neck fibrosis (27%, N = 13). For the majority of toxicity categories (11 of 17), the cohort that received definitive chemoradiation had higher rates of toxicity than the cohort that received definitive radiation alone. Additionally, for the majority of toxicity categories (10 of 17), the cohort of T3/T4 tumors had higher rates of long-term toxicity than the cohort of T1/T2 tumors. Conclusions: Although the patient population in this study has excellent locoregional control after definitive radiation or chemoradiation, the majority of patients suffer from long-term treatment-related toxicities. Long-term follow up care is needed to manage the late effects of radiotherapy that can develop and persist for years after treatment completion.

Foot deformities and gait deviations in children with arthrogryposis

Objectives: Arthrogryposis multiplex congenita is a congenital condition characterized by joint contractures with resulting foot deformities and gait deviations. The aim of this study was to describe gait deviations and foot deformities in children with arthrogryposis objectively and quantitatively with detailed gait analysis, including multisegment foot kinematics and foot pressure analysis. Materials and Methods: Children with arthrogryposis were evaluated retrospectively. Their data were compared to data from typically developing children. Comprehensive data presented include results of a full gait analysis with multisegment or single-segment foot kinematics, kinetics, pedobarograph, physical examination, and radiographic measurements. Children were grouped by age, orthotic use, and history of surgical intervention. Results: Forty-two children with arthrogryposis (2–20 years old) were reviewed. Physical examination and kinematic data showed that children walked with a crouched gait; exhibited stiffness in the hips, knees, and ankles; and showed limitations in their gross motor functioning. Power generation was low at the ankle and was high at the hip. Multisegment foot kinematics revealed stiffness in hindfoot plantar flexion and residual forefoot adduction. Foot pressure showed reduced heel impulse, excessive midfoot contact, and overall varus foot position. Categorization by age revealed greater stiffness at the hips and knees in older children. Children with knee–ankle–foot orthosis showed the most stiffness. Conclusions: Three-dimensional motion analysis and plantar pressure measurements are able to quantify the empirical observations of children with arthrogryposis walking with a crouched, stiff gait and having foot deformities. The use of these technologies in conjunction with clinical examination and functional tests is, therefore, recommended to monitor treatment efficacy and natural progression of gait deviations and joint deformities in arthrogryposis.

Mammographic screening patterns in Sokoto, Northwestern Nigeria

Background: Screening mammography is a radiographic examination of the breast performed for early detection of breast cancer in asymptomatic women. The American College of Radiology recommends that women should have mammography at the age of 40 years and annually thereafter. However, those who are at increased risk of breast cancer should start screening mammography earlier. These include patients with a strong family history of breast cancer or those who had radiotherapy to the chest wall. Objective: This study is aimed at evaluating the mammographic outcomes among 77 Nigerian females who had screening mammographic breast examination. Materials and Methods: From December 2010 and November 2012, 77 females had routine screening mammography in the department with the general electric alpha-RT machine with model number MGF-101 (manufactured 2010). All the participants had to fill a mammographic form consisting of variables such as age, sex, occupation, family history of breast cancer, tribe, contraception, parity and caffeine consumption, history of surgical intervention (lumpectomy, biopsy, and/or mastectomy), previous mammography, and last childbirth. Mediolateral-oblique and cranial-caudal views were done for the breast examination though additional were occasionally employed. Results: Seventy-seven females had screening mammography. The minimum age recruited was 40 years. The mammographic outcome for those who had screening was normal in 51 (66.2%) and abnormal in 26 (33.8%) participants. The abnormal mammographic outcomes were architectural distortion in either or both breasts in 13 (16.9%) participants, masses in either or both breast in 11 (14.3%) participants, while isolated calcification in either or both breast among 2 (2.6%) participants. Two (18.2%) of the subjects with masses had associated macrocalcification. No masses with malignant features were seen. Conclusion: Screening mammography was found out to be useful in detecting various forms of breast pathologies which were mostly breast masses, calcifications, and architectural distortions. Screening mammography is, therefore, advised yearly and routinely for women age 40 years and above.

ЧРЕСКОЖНАЯ ЭНДОСКОПИЧЕСКАЯ ГАСТРОСТОМИЯ С УЗ-НАВИГАЦИЕЙ, КАК МЕТОД ВЫБОРА ДЛЯ ОБЕСПЕЧЕНИЯ ЭНТЕРАЛЬНОГО ПИТАНИЯ У ПАЦИЕНТОВ В ХРОНИЧЕСКОМ КРИТИЧЕСКОМ СОСТОЯНИИ

Цель. Анализ эффективности УЗ-навигации при чрескожной эндоскопической гастростомии для повышения безопасности метода обеспечения пути доставки энтерального питания.Материалы и методы. Чрескожная эндоскопическая гастростомия методикой «на себя» (pull), дополненная УЗ навигацией, была выполнена 115 пациентам с последствиями тяжелой черепно-мозговой травмы (ЧМТ) и церебральными инсультами, находящимся в длительном (хроническом) критическом состоянии и имеющим стойкую дисфагию в период их реабилитации в ФНКЦ РР. Результаты. Все пациенты перенесли операцию удовлетворительно и уже через сутки могли получать энтеральное питание. У двух пациентов (1,7%) наблюдалось осложнение в виде пневмоперитонеума, которое потребовало дополнительного назначения антибактериальной терапии и благополучно разрешилось через 7–10 дней, без дополнительных хирургических вмешательств. Добавление в методику УЗИ области, определенной по диафаноскопии, оправдало себя в 15-ти случаях (13,0%): из них с частотой 73,0% в определенной для пункции точки выявлен край печени, и с частотой 27,0% выявлена поперечно-ободочная кишка. Выводы. 1. Чрескожная эндоскопическая гастростомия по методике «pull» с добавлением УЗ-навигации является адекватным способом обеспечения пути энтерального питания у пациентов в длительном (хроническом) критическом состоянии.2. Проведение УЗ-навигации области, определенной диафаноскопией, непосредственно перед пункцией желудка, особенно у пациентов с гепатомегалией, избыточной массой тела и у пациентов, имеющих в анамнезе оперативные вмешательства на брюшной полости, позволило избежать послеоперационных тяжелых осложнений в 13,0% случаев, что доказывает целесообразность применения исследования, как часть чрескожной эндоскопической гастростомии.3. Выполняя чрескожную эндоскопическую гастростомию под УЗ-навигацией, удалось снизить число осложнений.

Initiating a women's health physician–run rehabilitation clinic in the United States

Pelvic dysfunction can lead to persistent impairment and disability when left untreated. While some diagnoses overlap with those seen in a general Physical Medicine and Rehabilitation (PM&R) outpatient setting and Obstetrics/Gynecology (Ob/Gyn), management varies with changes in biomechanics and function in contexts of fecundity, gravidity, post-partum status, post-menopause, history of surgical intervention, or history of sexual trauma. PM&R initiated a collaboration with Ob/Gyn to create a physician-run Women's Health Rehabilitation specialty clinic embedded within an established Ob/Gyn clinic at an academic university hospital in the United States. The clinic focuses on pelvic floor disorders and musculoskeletal issues associated with pregnant or post-partum women. Over 50 referrals were made from Ob/Gyn in the initial months of clinic launch. Diagnoses included low back pain and sacroiliac joint dysfunction related to pregnancy, pelvic floor instability, dyspareunia, post-partum thoracic back pain, and coccydynia. Management included education of biomechanics, referral to Pelvic Floor-specialized Physical Therapy (PFPT), medications, referral to Psychology, and injections. Despite significant enthusiasm from Ob/Gyn and the patients, initial referrals were delayed due misunderstanding regarding difference between PM&R and PT, failure to recall initiation of clinic, and flawed protocol with ancillary staff on scheduling process. Despite infrastructure of a large academic institution in a metropolitan area, there was a paucity of availability of PFPT multiple sites within the academic affiliation or the metropolitan area. Comprehensive Women's Health Rehabilitation lead by physiatrists can address biomechanical issues, treat pain, perform interventional procedures, and coordinate care with PFPT and other professionals to address contributing factors, like mood disturbances and life situations. Our clinic aim is to expand collaborations with increased marketing, face-to-face interaction, and visibility at multidisciplinary events. We expect to increase referral sources and numbers as well as educate more of the medical community about our specialty.

Prevalence of Shoulder Labral Injury in Collegiate Football Players at the National Football League Scouting Combine.

Background:Labral tears confirmed by magnetic resonance imaging (MRI) are a relatively common injury among collegiate athletes and can influence a player’s ability to compete at the professional level.Purpose:To determine the prevalence of MRI-confirmed shoulder labral injuries in collegiate football players entering the National Football League (NFL) Combine and to further describe these injuries by tear location, player position, history of surgical intervention, and associated concomitant shoulder injuries.Study Design:Descriptive epidemiology study.Methods:Data from 2009 to 2015 were retrospectively collected through review of the injury data registry available to the medical and training staff of all NFL teams following the completion of the NFL Combine. After players with potential labral tears were identified through history and examination, their MRIs were reviewed by 2 fellowship-trained orthopaedic sports medicine surgeons. Players diagnosed with a labral tear confirmed by MRI were separated for further analysis.Results:A total of 2285 players were analyzed for the presence of labral tears at the NFL Combine. Overall, 377 shoulders (in 340/2285 players; 14.9%) demonstrated MRI evidence of labral tear; whereas linebackers had the highest rate of labral tear (19.2%), linemen had significantly higher risk for labral injury in at least 1 shoulder (odds ratio, 1.31; 95% CI, 1.02-1.67; P = .029) compared with nonlinemen. Of the 377 shoulders analyzed, 115 (30.5%) exhibited an anterior labral tear, 131 (34.7%) had a posterior labral tear, and 131 (34.7%) had combined anterior and posterior tears. One hundred twenty (31.8%) shoulders had superior labral anterior-posterior (SLAP) tears. A total of 203 (53.8%) shoulders demonstrated evidence of previous surgical intervention on imaging.Conclusion:Injury involving the labrum is relatively common among participants at the NFL Combine, especially linebackers and linemen. Further investigation is necessary to determine the impact these injuries have on player draft position and NFL performance.

Demographic characteristics of patients suffering from low back pain attending outpatient department in Burdwan Medical College and Hospital

Background: Chronic low back pain is a multidimensional issue which is expensive due to necessary spending towards repeated treatment. LBP is considered to be the most common, and costly disabling musculo-skeletal condition. Materials and Methods: Study area: Burdwan Medical College, Department of Orthopedics and Radiodiagnosis. Study population: The patients attending the OPD of Burdwan Medical College & Hospital with complaint of LBP. Inclusion criteria: Age group: 20-60 years Sex: Both sexes. Duration: More than 3 weeks. Exclusion criteria: Traumatic back pain Patient having history of surgical interventions. Patient having any co-morbid conditions like hypertension, diabetes mellitus, etc. Patient having other musculo-skeletal pain like cervical spondylosis, etc. Study period: January 2015 - October 2016 Sample size: One hundred (n=100) Study design: Hospital based cross sectional socio-demographic study. Study tools: Preformed questionnaire. Weighing machine. Measuring tape. Skiagram of LS spine. MRI of LS spine. Data analysis: Data analysis was done accordingly. Result analysis: There was a female preponderance among the study population (1.3:1=Female:Male). LBP was found to be most common in the age group of 31-40 with mean age of population was 41.82. Distribution of the study population according to BMI revealed equal distribution. LBP was found to be most common in the heavy lifestyle(48%). LBP was most common in the lower socio-economic status(61%). A total of 41% population suffering from LBP is in mental stress and victim of depression. Majority of the patients with depression were of low socio-economic status. Conclusion: In conclusion, female population who tend to be over-weight and from a low socio-economic background with a definite psychosocial component is at risk. The study is small and direct association cannot be assessed but the epidemiological parameters clearly indicate preponderance of different factors associated with LBP. From this understanding, diagnosis, treatment and rehabilitation protocol can be planned and prevention can be achieved.

Sero-prevalence and Correlates of Hepatitis B and C Co-infection Among HIV-infected Individuals in Two Regional Hospitals in Cameroon.

Background:Liver disease related to Hepatitis B (HBV) and C (HCV) infection has become a major cause of morbidity and mortality in HIV/AIDS patients. Data on the prevalence of HBV and HCV in Cameroon remains inconclusive.Objective:We aimed to determine the sero-prevalence and correlates of Hepatitis markers in HIV/AIDS patients in two Regional Hospitals.Methods:A cross-sectional study carried out from December 2014 to March 2015. HIV/AIDS patients aged 21 were included and above, receiving care at HIV treatment centres. Data was collected using a structured questionnaire. Blood samples were collected to screen for Hepatitis with HBsAg and anti HCV antibody rapid immunochromatographic test kits. Correlates of hepatitis were investigated by logistic regression. STATA was used for data analysis.Results:We included 833 HIV/AIDS patients,78.8% (657) were female. Mean age was 44(SD 11) years. Prevalence of Hepatitis in general (total of two viral markers tested) was 8.9% (74/833), with 6.1% for HBsAg and 2.8% for Anti-HCV antibodies. From multivariate analysis, the likelihood of having hepatitis was independently increased by a history of surgical interventions [OR: 1.82(1.06-3.14)], and of sexually transmitted infections [OR: 2.20(1.04-4.67)].Conclusion:Almost one in ten participants with HIV/AIDS attending the BRH and LRH tested positive for either HBsAg or anti HCV antibodies. Screening for HBV and HCV should therefore be integrated to the existing guidelines in Cameroon as it can influence management. More studies are needed to evaluate the extent of liver disease and magnitude of HIV suppression in hepatitis and HIV coinfection in this setting.

Sudden cardiac death in adults with congenitally corrected transposition of the great arteries.

BackgroundCongenitally corrected transposition of the great arteries (ccTGA) is a rare congenital heart disease. There have been only few reports of sudden cardiac death (SCD) in patients with ccTGA and reasonable ventricular function.MethodsA retrospective review of the medical records of all patients attending our adult congenital heart centre, with known ccTGA.ResultsFrom a database of over 3500 adult patients with congenital heart disease, we identified 39 (∼1%) with ccTGA and ‘two-ventricle’ circulations. 65% were male. The mean age at diagnosis was 12.4±11.4 years and the mean age at last time of review was 34.3±11.3 years. 24 patients (56%) had a history of surgical intervention. 8 (19%) had had pacemaker implantation and 2 had had a defibrillator implanted for non-sustained ventricular tachycardia (NSVT). In 544 years of patient follow-up, there had been five cases of SCD in our population; 1 death per 109 patient-years. Two of these patients had had previously documented supraventricular or NSVT. However, they were all classified as New York Heart Association (NYHA) class I or II, and systemic (right) ventricular function had been recorded as normal, mildly or mildly–moderately impaired, at most recent follow-up.ConclusionsOur experience suggests the need for improved risk stratification and/or surveillance for malignant arrhythmia in adults with ccTGA, even in those with reasonable functional class on ventricular function.