Exploring the reasons of unsuccessful attempts in examination during postgraduate clinical training.

Objective: To explore the reasons of unsuccessful attempt in examination during postgraduate clinical training in Pakistan. METHODS: The qualitative, exploratory study was conducted at the Allied Hospital, Faisalabad, Pakistan, from December 1, 2022, to February 25, 2023, and comprised postgraduate trainees from different departments who had at least one unsuccessful attempt in examination during their residency programme. Data was collected through direct interviews that were recorded. The data was subjected to thematic narrative analysis. RESULTS: Of the 14 participants, 10(71.4%) were males and 4(28.5%) were females. The maximum number of unsuccessful attempts were 7(7%), followed by 6(14%), 4(7%), 3(14%), 2(42%) and 1(14%). There were 3 main themes; personal factors, training factors, and exam factors. All the themes had subthemes. Conclusion: At the start of the residency programme, postgraduate trainees must be provided with adequate guidance, and a support system must be present during the programme to help them cope with the stress during training.

THE IMPACT OF ROUTINE CARDIAC TROPONIN I-BASED CARDIOTOXICITY SCREENING ON CLINICAL OUTCOMES IN PATIENTS ON CANCER IMMUNOTHERAPY.

Purpose: Immune checkpoint inhibitors (ICI) used as cancer therapy have been associated with a range of cardiac immune-related adverse events (irAEs), including fulminant myocarditis with a high case fatality rate. Early detection through cardiotoxicity screening by biomarker monitoring can lead to prompt intervention and improved patient outcomes. In this study, we investigate the association between cardiotoxicity screening with routine serial troponin I monitoring in asymptomatic patients receiving ICI, cardiovascular adverse event (CV AE) detection, and overall survival (OS). Methods: We instituted a standardized troponin I screening protocol at baseline and with each ICI dose (every 2-4 weeks) in all patients receiving ICI at our center starting Jan 2019. We subsequently collected data in 825 patients receiving ICI at our institution from January 2018 to October 2021. Of these patients, 428 underwent cardiotoxicity screening with serial troponin I monitoring during ICI administration (Jan 2019-Oct 2021) and 397 patients were unmonitored (Jan 2018-Dec 2018). We followed patients for nine months following their first dose of ICI and compared outcomes of CV AEs and OS between monitored and unmonitored patients. Additionally, we investigated rates of CV AEs, all-cause mortality, and oncologic time-to-treatment failure (TTF) between patients with an elevated troponin I value during the monitoring period versus patients without elevated troponin I. Results: We found a lower rate of severe (grades 4-5) CV AEs, resulting in critical illness or death, in patients who underwent troponin monitoring (0.5%) compared to patients who did not undergo monitoring (1.8%), (HR 0.17, 95% CI 0.02-0.79, p = 0.04). There was no difference in overall CV AEs (grades 3-5) or OS between monitored and unmonitored patients. In the entire cohort, patients with at least one elevated troponin I during the follow up period, during routine monitoring or unmonitored, had a higher risk of overall CV AEs (HR 10.96, 95% CI 4.65-25.85, p<0.001) as well as overall mortality (HR 2.67, 95% CI 1.69 - 4.10, p<0.001) compared to those without elevated troponin. Oncologic time-to-treatment failure (TTF) was not significantly different in a sub-cohort of monitored vs. unmonitored patients. Conclusions: Patients undergoing cardiotoxicity screening with troponin I monitoring during ICI therapy had a lower rate of severe (grade 4-5) CV AEs compared patients who were not screened. Troponin I elevation in screened and unscreened patients was significantly associated with increased CV AEs as well as increased mortality. Troponin I monitoring did not impact oncologic time-to-treatment-failure in a sub-cohort analysis of patients treated with ICI. These results provide preliminary evidence for clinical utility of cardiotoxicity screening with troponin I monitoring in patients receiving ICI therapy.

Comparative arrhythmia patterns among patients on tyrosine kinase inhibitors.

BACKGROUND: Tyrosine kinase inhibitors (TKIs) are widely used in the treatment of hematologic malignancies. Limited studies have shown an association between treatment-limiting arrhythmias and TKI, particularly ibrutinib, a Bruton's tyrosine kinase (BTK) inhibitor. We sought to comprehensively assess the arrhythmia burden in patients receiving ibrutinib vs non-BTK TKI vs non-TKI therapies. METHODS: We performed a retrospective analysis of consecutive patients who received long-term cardiac event monitors while on ibrutinib, non-BTK TKIs, or non-TKI therapy for a hematologic malignancy between 2014 and 2022. RESULTS: One hundred ninety-three patients with hematologic malignancies were included (ibrutinib = 72, non-BTK TKI = 46, non-TKI therapy = 75). The average duration of TKI therapy was 32 months in the ibrutinib group vs 64 months in the non-BTK TKI group (p = 0.003). The ibrutinib group had a higher prevalence of atrial fibrillation (n = 32 [44%]) compared to the non-BTK TKI (n = 7 [15%], p = 0.001) and non-TKI (n = 15 [20%], p = 0.002) groups. Similarly, the prevalence of non-sustained ventricular tachycardia was higher in the ibrutinib group (n = 31, 43%) than the non-BTK TKI (n = 8 [17%], p = 0.004) and non-TKI groups (n = 20 [27%], p = 0.04). TKI therapy was held in 25% (n = 18) of patients on ibrutinib vs 4% (n = 2) on non-BTK TKIs (p = 0.005) secondary to arrhythmias. CONCLUSIONS: In this large retrospective analysis of patients with hematologic malignancies, patients receiving ibrutinib had a higher prevalence of atrial and ventricular arrhythmias compared to those receiving other TKI, with a higher rate of treatment interruption due to arrhythmias.

Optimizing electroactive membrane performance for microalgae harvesting: A response surface methodology study of membrane formulation and operating parameters for electro filtration.

Developing electroactive membranes for filtration has gained importance owing to their effectiveness in mitigating the long-lasting issue of fouling faced with traditional membranes. Here, we developed thin electroactive metallic films on to stainless steel mesh (SSM) using electrodeposition method and evaluated their performance for microalgae harvesting via electro filtration. The effect of electrodeposition parameters on membrane formulation and operating parameters for electro filtration, both in continuous and intermittent modes, were evaluated and optimum values were obtained using response surface methodology (RSM). The optimal combination of electrodeposition parameters is 1000 µA/cm2 and 5 min for deposition current density and time, respectively. Whereas the electric field strength of 20 V/mm with an application time of 1 min is suggested to be the optimal combination of electro filtration parameters for maximized flux recovery and corresponding experimental rejection efficiency of more than 90%. Overall, this research contributes to a better understanding of the parameters governing electro-filtration and offers insights for improving the performance of membrane-based microalgae harvesting systems.

Exacerbation of Very Late-Onset Darier Disease With COVID-19 Infection: A Case Report.

Darier disease is an uncommon hereditary skin disorder characterized by the presence of hyperkeratotic papules and plaques affecting seborrheic areas. The uniqueness of this case lies in the exceptionally late-onset pattern of Darier disease, involving an 82-year-old female patient, and its correlation with COVID-19 infection. The patient had a history of a scaly and itchy rash limited to her arms, initially misdiagnosed as dermatitis, which persisted and worsened over three months. The manifestation of classical features of Darier disease coincided with her recent contraction of COVID-19. This instance emphasizes the varying manifestations of Darier disease that appear very late in life, which could result from new mutations or partial penetrance. Additionally, this case points out the potential worsening of Darier disease when combined with a COVID-19 infection. It highlights the need to be aware of atypical clinical progressions and the potential for increased severity of skin disorders during COVID-19. More studies are essential to grasp the relationship between COVID-19 and inherited skin conditions, aiming to improve patient treatment and care approaches.

Atrial fibrillation ablation outcome prediction with a machine learning fusion framework incorporating cardiac computed tomography.

BACKGROUND: Structural changes in the left atrium (LA) modestly predict outcomes in patients undergoing catheter ablation for atrial fibrillation (AF). Machine learning (ML) is a promising approach to personalize AF management strategies and improve predictive risk models after catheter ablation by integrating atrial geometry from cardiac computed tomography (CT) scans and patient-specific clinical data. We hypothesized that ML approaches based on a patient's specific data can identify responders to AF ablation. METHODS: Consecutive patients undergoing AF ablation, who had preprocedural CT scans, demographics, and 1-year follow-up data, were included in the study for a retrospective analysis. The inputs of models were CT-derived morphological features from left atrial segmentation (including the shape, volume of the LA, LA appendage, and pulmonary vein ostia) along with deep features learned directly from raw CT images, and clinical data. These were merged intelligently in a framework to learn their individual importance and produce the optimal classification. RESULTS: Three hundred twenty-one patients (64.2 ± 10.6 years, 69% male, 40% paroxysmal AF) were analyzed. Post 10-fold nested cross-validation, the model trained to intelligently merge and learn appropriate weights for clinical, morphological, and imaging data (AUC 0.821) outperformed those trained solely on clinical data (AUC 0.626), morphological (AUC 0.659), or imaging data (AUC 0.764). CONCLUSION: Our ML approach provides an end-to-end automated technique to predict AF ablation outcomes using deep learning from CT images, derived structural properties of LA, augmented by incorporation of clinical data in a merged ML framework. This can help develop personalized strategies for patient selection in invasive management of AF.

Occurrence and risk evaluation of endocrine-disrupting chemicals in wastewater and surface water of Lahore, Pakistan.

The current study highlights the occurrence, spatial distribution, and risk assessment of 16 endocrine-disrupting chemicals (EDCs) including their transformation products (TPs) in the wastewater and surface water of Lahore, Pakistan, using solid-phase extraction followed by liquid chromatography-mass spectrometry and gas chromatography-mass spectrometry. The parent EDCs include bisphenol A (BPA), triclosan (TCS), triclocarban (TCC), estrone (E1), estradiol (E2), estriol (E3), ethinylestradiol (EE2), 4-n-octylphenol (4n-OP), and 4-n-nonylphenol (4n-NP). The TPs include two TPs each of BPA, TCC, and estrogens along with a TP of TCS. Most EDCs showed 100% detection frequency in the wastewater with highest median concentration of 1310 ng/L for E3. In the surface water, the highest median concentration was, however, observed for BPA (54.6 ng/L). Spatial variations in terms of sum of concentration due to all EDCs and their TPs were observed at different sampling points which suggest contamination due to industrial waste from nearby industrial estate. Risk evaluation in terms of risk quotient (RQ) and estradiol equivalent factor (EEQ) showed that most of EDCs and their TPs could pose high risk and estrogenicity to the surrounding environment. From the results of the current study, it is observed that the environment of Pakistan is deteriorating and is potential risk for endocrine disruption. It is, therefore, recommended to take stringent measures to make it sustainable for current as well as for future generations.

Rhamnopyranoside-Based Fatty Acid Esters as Antimicrobials: Synthesis, Spectral Characterization, PASS, Antimicrobial, and Molecular Docking Studies.

The most widely used and accessible monosaccharides have a number of stereogenic centers that have been hydroxylated and are challenging to chemically separate. As a result, the task of regioselective derivatization of such structures is particularly difficult. Considering this fact and to get novel rhamnopyranoside-based esters, DMAP-catalyzed di-O-stearoylation of methyl α-l-rhamnopyranoside (3) produced a mixture of 2,3-di-O- (4) and 3,4-di-O-stearates (5) (ratio 2:3) indicating the reactivity of the hydroxylated stereogenic centers of rhamnopyranoside as 3-OH > 4-OH > 2-OH. To get novel biologically active rhamnose esters, di-O-stearates 4 and 5 were converted into six 4-O- and 2-O-esters 6-11, which were fully characterized by FT-IR, 1H, and 13C NMR spectral techniques. In vitro antimicrobial assays revealed that fully esterified rhamnopyranosides 6-11 with maximum lipophilic character showed better antifungal susceptibility than antibacterial activity. These experimental findings are similar to the results found from PASS analysis data. Furthermore, the pentanoyl derivative of 2,3-di-O-stearate (compound 6) showed better antifungal functionality against F. equiseti and A. flavus, which were found to be better than standard antibiotics. To validate the better antifungal results, molecular docking of the rhamnose esters 4-11 was performed with lanosterol 14α-demethylase (PDB ID: 3LD6), including the standard antifungal antibiotics ketoconazole and fluconazole. In this instance, the binding affinities of 10 (-7.6 kcal/mol), 9 (-7.5 kcal/mol), and 7 (-6.9 kcal/mol) were better and comparable to fluconazole (-7.3 kcal/mol), indicating the likelihood of their use as non-azole type antifungal drugs in the future.

Dynamic hip screws versus cephalocondylic intramedullary nails for unstable extracapsular hip fractures in 2021: A systematic review and meta-analysis of randomised trials.

Background: Extracapsular hip fractures comprise approximately half of all hip fractures and the incidence of hip fractures is exponentially increasing. Extramedullary fixation using a dynamic hip screw (DHS) has been the gold standard method of operative treatment for unstable extracapsular fractures, however, in recent years, intramedullary nails (IMN) have become a popular alternative. IMN versus DHS is continuously discussed and debated in literature. Therefore, the purpose of this systematic review and meta-analysis is to directly compare the peri- and post-operative outcomes of these two techniques to provide an up-to-date analysis of which method of fixation is superior. Methods: The MEDLINE/PubMed, Embase and Web of Science Database were searched for eligible studies from 2008 to April 2022 that compared peri- and post-operational outcomes for patients undergoing IMN or DHS operations for fixation of unstable extracapsular hip fractures (PROSPERO registration ID:CRD42021228335). Primary outcomes included mortality rate and re-operation rate. Secondary outcomes included operation time, blood loss, transfusion requirement, complication, and failure of fixation rate. The risk of bias and quality of evidence were assessed using the Cochrane RoB 2.0 tool and GRADE analysis tool, respectively. Results: Of the 6776 records identified, 22 studies involving 3151 patients were included in the final review. Our meta-analysis showed no significant differences between mortality rates (10 studies, OR 0.98; 95% CI 0.80 to 1.22, p = 0.88) or re-operation rates (10 studies, OR 1.03; 95% CI 0.64 to 1.64, p = 0.91) between the two procedures. There were also no significant differences found between complication rates (17 studies, OR 1.29; 95% CI 0.79 to 2.12, p = 0.31) and failure of fixation rates (14 studies, OR 1.32; 95% CI 0.74 to 2.38, p = 0.35). However, DHS operations had a significantly longer operation time (p < 0.0001) and blood loss (p < 0.00001) than IMN operations. Conclusion: Overall, based on the outcomes assessed, this review has demonstrated that there is no significant difference in the post-operative outcomes for DHS vs IMN, however a significant difference exists in two of the intraoperative outcomes assessed in this review.

Removal of Chromium Species by Adsorption: Fundamental Principles, Newly Developed Adsorbents and Future Perspectives.

Emerging chromium (Cr) species have attracted increasing concern. A majority of Cr species, especially hexavalent chromium (Cr(VI)), could lead to lethal effects on human beings, animals, and aquatic lives even at low concentrations. One of the conventional water-treatment methodologies, adsorption, could remove these toxic Cr species efficiently. Additionally, adsorption possesses many advantages, such as being cost-saving, easy to implement, highly efficient and facile to design. Previous research has shown that the application of different adsorbents, such as carbon nanotubes (carbon nanotubes (CNTs) and graphene oxide (GO) and its derivatives), activated carbons (ACs), biochars (BCs), metal-based composites, polymers and others, is being used for Cr species removal from contaminated water and wastewater. The research progress and application of adsorption for Cr removal in recent years are reviewed, the mechanisms of adsorption are also discussed and the development trend of Cr treatment by adsorption is proposed.

Tyrosine kinase inhibitor-associated ventricular arrhythmias: a case series and review of literature.

BACKGROUND: Tyrosine kinase inhibitors (TKIs) have been increasingly used as first-line therapy in hematologic and solid-organ malignancies. Multiple TKIs have been linked with the development of cardiovascular complications, especially atrial arrhythmias, but data on ventricular arrhythmias (VAs) is scarce. METHODS: Herein we describe five detailed cases of VAs related to TKI use in patients with varied baseline cardiovascular risk factors between 2019 and 2022 at three centers. Individual chart review was conducted retrospectively. RESULTS: Patient ages ranged from 43 to 83 years. Three patients were on Bruton's TKI (2 ibrutinib and 1 zanubrutinib) at the time of VAs; other TKIs involved were afatinib and dasatinib. Three patients had a high burden of non-sustained ventricular tachycardia (NSVT) requiring interventions, whereas two patients had sustained VAs. While all patients in our case series had significant improvement in VA burden after TKI cessation, two patients required new long-term antiarrhythmic drug therapy, and one had an implantable defibrillator cardioverter (ICD) placed due to persistent VAs after cessation of TKI therapy. One patient reinitiated TKI therapy after control of arrhythmia was achieved with antiarrhythmic drug therapy. CONCLUSIONS: Given the expanding long-term use of TKIs among a growing population of cancer patients, it is critical to acknowledge the association of TKIs with cardiovascular complications such as VAs, to characterize those at risk, and deploy preventive and therapeutic measures to avoid such complications and interference with oncologic therapy. Further efforts are warranted to develop monitoring protocols and optimal treatment strategies for TKI-induced VAs.

Racial, ethnic, and sex disparities in atrial fibrillation management: rate and rhythm control.

BACKGROUND: Atrial fibrillation (AF) affects around 6 million Americans. AF management involves pharmacologic therapy and/or interventional procedures to control rate and rhythm, as well as anticoagulation for stroke prevention. Different populations may respond differently to distinct management strategies. This review will describe disparities in rate and rhythm control and their impact on outcomes among women and historically underrepresented racial and/or ethnic groups. METHODS: This is a narrative review exploring the topic of sex and racial and/or ethnic disparities in rate and rhythm management of AF. We describe basic terminology, summarize AF epidemiology, discuss diversity in clinical research, and review landmark clinical trials. RESULTS: Despite having higher rates of traditional AF risk factors, Black and Hispanic adults have lower risk of AF than non-Hispanic White (NHW) patients, although those with AF experience more severe symptoms and report lower quality-of-life scores than NHW patients with AF. NHW patients receive antiarrhythmic drugs, cardioversions, and invasive therapies more frequently than Black and Hispanic patients. Women have lower rates of AF than men, but experience more severe symptoms, heart failure, stroke, and death after AF diagnosis. Women and people from diverse racial and ethnic backgrounds are inadequately represented in AF trials; prevalence findings may be a result of underdetection. CONCLUSION: Race, ethnicity, and gender are social determinants of health that may impact the prevalence, evolution, and management of AF. This impact reflects differences in biology as well as disparities in treatment and representation in clinical trials.

Multifunctional Smart ZnSe-Nanostructure-Based Fluorescent Aptasensor for the Detection of Ochratoxin A.

Herein, we present a comprehensive investigation of rationally designed zinc selenide (ZnSe) nanostructures to achieve highly negatively charged ZnSe nanostructures. A Microwave-assisted hydrothermal synthesis method was used to synthesize three types of ZnSe nanostructures, i.e., nanorods, µ-spheres and nanoclusters, as characterized by a zeta potential analyzer, X-ray diffraction (XRD), scanning electron microscopy (SEM), Raman spectroscopy and BET, which were labeled as type A, B and C. Three different solvents were used for the synthesis of type A, B and C ZnSe nanostructures, keeping other synthesis conditions such as temperature, pressure and precursors ratio constant. Based on two heating time intervals, 6 and 9 h, types A, B and C were further divided into types A6, A9, B6, B9, C6 and C9. ZnSe nanostructures were further evaluated based on their fluorescent quenching efficiency. The maximum fluorescence quenching effect was exhibited by the ZnSe-B6 type, which can be attributed to its highly negative surface charge that favored its strong interaction with cationic dye Rhodamine B (Rh-B). Further, the optimized ZnSe-B6 was used to fabricate an aptasensor for the detection of a food-based toxin, ochratoxin-A (OTA). The developed aptasensor exhibited a limit of detection of 0.07 ng/L with a wide linear range of 0.1 to 200 ng/L.

Melamine-derived N-rich C-entrapped Au nanoparticles for sensitive and selective monitoring of dopamine in blood samples.

Several neurological disorders, including Parkinson's disease, schizophrenia, human immunodeficiency virus infection, and restless leg syndrome, majorly result from disruption in the dopamine (DA) level. Thus, useful information about the treatment and prevention of various genetic majorly mental health problems can be obtained through precise and real-time monitoring of DA. Herein, we report the fabrication of novel N-rich carbon-coated Au nanoparticles (NC@Au-NPs) by deriving from melamine-crosslinked citrate-stabilized Au NPs. NC@Au-NPs offer fast electro-oxidation efficacy towards DA, because of strong electrostatic attraction between negatively charged NC@Au-NPs and positively charged DA. The catalytic efficacy and shelf life of the designed system were further boosted by applying a mixture of polydopamine (PDA) and benzimidazolium-1-acetate ionic liquid (IL) as a sandwich between the working electrode surface (graphitic pencil electrode: GPE) and the designed nanohybrid NC@Au-NPs as a redox mediator. The results indicate that the designed novel NC@Au/PDA-IL/GPE exhibits excellent sensitivity, selectivity, and reproducibility over a wide linear range (50-1000 nm) and a low detection limit of 0.002 µM ± 0.001 as well. The developed sensor was successfully applied to monitor DA in the blood of COVID-19 quarantined patients and pharmaceutical samples with high accuracy, thus suggesting a powerful tool for the diagnosis of mental problems.

Tension Band Suture Fixation of Fifth Metatarsal Tuberosity Fracture: A Case Report.

Tuberosity fractures of the fifth metatarsal are common. The majority of these fractures are treated nonoperatively with good outcome. Surgery is indicated for nonunions, delayed unions, comminuted fractures, and displaced fractures. The surgical modalities include screw fixation, suture anchor fixation, Kirschner wires, tension band wiring, and locking plates. We report a case of a symptomatic nonunion of a displaced fracture of the tuberosity of the fifth metatarsal in a young patient treated with a tension band suture fixation that to our knowledge has not been described before.

Machine Learning-Enabled Multimodal Fusion of Intra-Atrial and Body Surface Signals in Prediction of Atrial Fibrillation Ablation Outcomes.

BACKGROUND: Machine learning is a promising approach to personalize atrial fibrillation management strategies for patients after catheter ablation. Prior atrial fibrillation ablation outcome prediction studies applied classical machine learning methods to hand-crafted clinical scores, and none have leveraged intracardiac electrograms or 12-lead surface electrocardiograms for outcome prediction. We hypothesized that (1) machine learning models trained on electrograms or electrocardiogram (ECG) signals can perform better at predicting patient outcomes after atrial fibrillation ablation than existing clinical scores and (2) multimodal fusion of electrogram, ECG, and clinical features can further improve the prediction of patient outcomes. METHODS: Consecutive patients who underwent catheter ablation between 2015 and 2017 with panoramic left atrial electrogram before ablation and clinical follow-up for at least 1 year following ablation were included. Convolutional neural network and a novel multimodal fusion framework were developed for predicting 1-year atrial fibrillation recurrence after catheter ablation from electrogram, ECG signals, and clinical features. The models were trained and validated using 10-fold cross-validation on patient-level splits. RESULTS: One hundred fifty-six patients (64.5±10.5 years, 74% male, 42% paroxysmal) were analyzed. Using electrogram signals alone, the convolutional neural network achieved an area under the receiver operating characteristics curve (AUROC) of 0.731, outperforming the existing APPLE scores (AUROC=0.644) and CHA2DS2-VASc scores (AUROC=0.650). Similarly using 12-lead ECG alone, the convolutional neural network achieved an AUROC of 0.767. Combining electrogram, ECG, and clinical features, the fusion model achieved an AUROC of 0.859, outperforming single and dual modality models. CONCLUSIONS: Deep neural networks trained on electrogram or ECG signals improved the prediction of catheter ablation outcome compared with existing clinical scores, and fusion of electrogram, ECG, and clinical features further improved the prediction. This suggests the promise of using machine learning to help treatment planning for patients after catheter ablation.

Novel Anticoagulants and Hip Fractures in the Elderly.

Introduction Early surgery is recommended in hip fractures to reduce morbidity and mortality. Surgery is often delayed in patients on novel direct oral anticoagulants (DOACs). The purpose of our study was to investigate the impact of DOACs on patients with hip fractures. Methods A retrospective comparative analysis was performed. A total of 766 patients presented with neck of femur fractures in the study period. Patients under the age of 60, those managed conservatively and those on alternative anticoagulation (including warfarin, clopidogrel and aspirin) were excluded. Forty-seven (6.1%) patients were on DOACs, to which a group of 47 patients was matched for age, gender, fracture type and intervention to minimise confounding. Primary outcome data on time to surgery (TTS), pre-/postoperative haemoglobin, haemoglobin drop, length of stay (LOS) and 30-day mortality were collected, as well as secondary outcome data on blood transfusion and wound complications. The Charlson Comorbidity Index (CCI) was calculated for all patients. Results The mean Charlson Comorbidity Index was significantly increased in the DOAC group (p<0.0001). The mean time to surgery was 49.5 hours in the DOAC group versus 31.3 hours in the control group (p=0.0002). Haemoglobin drop for DOAC patients was 16.9 g/L and 15.9 g/L for control patients (p=0.6). Similarly, no significant increase in transfusion was required (p=0.74). Six DOAC patients and two control group patients died within 30 days of surgery (p=0.13). Wound complications were seen in five (10.6%) patients on DOAC and two (4.2%) patients in the control group (p=0.02). Conclusion The results demonstrate statistically significantly higher comorbidities, delay in surgery and higher wound complications in patients on DOAC but no significant difference in haemoglobin drop, blood transfusion and mortality.

Long-term functional outcomes following paediatric traumatic elbow dislocation, a clinical retrospective cohort study.

BACKGROUND: Paediatric traumatic elbow dislocation occurs in 6 per 100,000 children per year and if not treated promptly can result in a poor outcome. Despite this, the long-term clinical and functional outcome of these injuries has not been well described using modern patient-reported outcome tools. The aim of our study was present the outcome of these injuries in the long term. METHODS: Twenty children with an acute traumatic elbow dislocation who presented between February 2007 to February 2016 were included in our study. Patient demographics, management and complications were recorded from the clinical notes. Ten children had associated fractures and were managed surgically, while the remaining were managed with closed reduction and immobilisation. Functional outcomes were assessed with Kim's elbow performance score. RESULTS: The mean age was 12 years (7 -15) and follow-up was 8 years (4 - 13). There was one (5%) re-dislocation requiring surgery and one (5%) ulna nerve neurapraxia that resolved within one month. The average Kim's scores were 87.5 (65 - 100) and 77.5 (60 - 100) in the closed reduction and open reduction groups, respectively (P=0.08). 80% (16/20) reported good or excellent outcome with a Kim's score of greater than 75 points with no cases of poor functional outcome reported in our series. CONCLUSIONS: Traumatic elbow dislocations in children, with or without associated fracture, have a good long-term functional outcome with appropriate early management.