A 3D-printed condom intrauterine balloon tamponade: Design, prototyping, and technical validation.

Post-partum haemorrhage is among the main causes of (preventable) mortality for women in low-resource settings (LRSs), where, in 2017, the mortality ratio was 462 out of every 100 000 live births, over 10 times higher than for high-resource settings. There are different treatments available for post-partum haemorrhage. The intrauterine balloon tamponade is a medical device that proved to be a simple and cost-effective approach. Currently, there are several balloon tamponades available, with different design and working principles. However, all these devices were designed for high-resource settings, presenting several aspects that could be inappropriate for many lower-income countries. This paper presents the results of a preclinical study aiming at informing the design, prototyping and validation of a 3D-printed intrauterine balloon tamponade concept, contributing towards the United Nation's Sustainable Development Goal 3: Good health and Well-being. Frugal engineering concepts and contextualised design techniques were applied throughout, to define the design requirements and specifications. The performance of the final prototype was validated against the requirements of the UK National Health System (NHS) technical guidelines and relevant literature, measuring the water leak and pressure drop over time, both open air and in a approximate uterus model. The resulting prototype is made up of six components, some of which are easy to retrieve, namely a water bottle, a silicone tube and an ordinary condom, while others can be manufactured locally using 3D printers, namely a modified bottle cap, a flow stopper and a valve for holding the condom in place. Validation testing bore promising results with no water or pressure leak open air, and minimal leaks in the approximate uterus model. This demonstrates that the 3D printed condom-based intrauterine balloon tamponade is performing well against the requirements and, when compared to the state of the art, it could be a more appropriate and more resilient solution to low-resource settings, as it bypasses the challenges in the supply of consumables and presents a greener option based on circular economy.

Go with the flow: An experimental analysis with tubing alternative with irrigation.

Background and Aims: Literature regarding alternative tubing for fluid delivery in irrigation and debridement procedures is lacking. The purpose of this study was to compare three different apparatuses with varying quantities of irrigation fluid to assess efficiency of administration and evaluate overall time for fluid administration. Methods: This model was designed to compare available methods of gravity irrigation used in practice. Fluid flow time was measured for three types of tubing: single-lumen cystoscopy tubing, Y-type double-lumen cystoscopy tubing, and nonconductive suction tubing. Irrigation times were assessed for varying volumes of 3, 6, and 9 L to investigate the relationship between bag changes and irrigation time. Bag changes were not conducted for the 3 L trial, but were for 6 and 9 L trials. Dimensions of cystoscopy tubing consisted of 4.95 mm internal diameter and 2.1 m length in both single-lumen and Y-type double-lumen apparatus. Nonconduction suction tubing dimensions were 6.0 mm internal diameter and standard 3.7 m in length. Results: The mean flow time for suction tubing was significantly faster than the cystoscopy tubing for the 3 and 9 L trials (p < 0.001). At 6 L, flow time for the suction tubing and the double lumen cystoscopy tubing were similar, 264 versus 260 s, respectively. At 9 L, the mean flow time for the suction tubing was 80 s faster (410 vs. 491 s) compared with single-lumen cystoscopy and was nearly 30 s faster compared with Y-type cystoscopy tubing. Conclusion: The results of this study provide insight into a faster, widely available, and cost-efficient alternative to commonly used cystoscopy tubing.

Comparative analysis between operative and non-operative acetabular labral tear injuries in division 1 collegiate athletes.

Acetabular labral tears have shown to be difficult to diagnose and manage in an active and competitive athletic population. The goal of this study was to compare NCAA Division 1 collegiate athletes undergoing operative and non-operative management of their labral injuries by assessing ability to return to competition and secondarily evaluate days lost from sport. A retrospective cohort analysis was conducted on Division 1 collegiate athletes from 2005 to 2020, incorporating all varsity university sports. Records showing MRI confirmed diagnosis were included in the cohort, as well as all pertinent clinical data. Data revealed 10/18 (55%) of individuals managed conservatively versus 23/29 (79%) surgically (p-value = 0.0834) were able to return to sport following treatment. Of those athletes, 22 surgical patients experienced a mean of 324 days ± 223 days lost from sport and nine conservatively managed patients experienced a mean of 27 days ± 70 lost days (p-value < 0.001) Seven of nine conservatively managed patients were able to continue competition while undergoing treatment. Findings suggest no statistical significance regarding operative vs non-operative management of acetabular labral tears. The majority of athletes returning to sport and treated conservatively were able to resume competition during treatment. Therefore, treatment of these injuries should be individualized based on athlete's symptoms.

Differences Between Patients With Diabetes Mellitus and Those Without in Cases of Necrotizing Fasciitis.

Purposes This study aims to evaluate further differences between patients with diabetes and those without who have been diagnosed with necrotizing fasciitis (NF) to assist clinicians in improving morbidity and mortality. Methods All patients diagnosed with NF of an extremity were retrospectively reviewed and divided into two groups based on a diagnosis of diabetes. Patient charts were reviewed to obtain multiple variables, which were compared between groups. Results From 2015 to 2021, 115 patients underwent surgical intervention due to concern for NF of an extremity with 92 patients included for data computation. Patients with diabetes had an average Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score of 9.02 compared to 7.24 (p=0.02). Patients with diabetes had a significantly higher rate of undergoing amputation when diagnosed with NF (p<0.0001). The mortality rate for diabetes and non-diabetes cohorts were 30.9% and 18.9%, respectively (p=0.2). Conclusion This study demonstrated that patients with diabetes with confirmed NF of an extremity had a significantly higher LRINEC score were more likely to undergo an amputation primarily, and were more likely to have a polymicrobial infection compared to those without. The overall mortality rate of NF was 26.1%.