Urban-Rural Differences in the Prevalence of Diabetes Among Adults in Haryana, India: The ICMR-INDIAB Study (ICMR-INDIAB-18).

INTRODUCTION: Diabetes is a multifactorial disease with far-reaching consequences. Environmental factors, such as urban or rural residence, influence its prevalence and associated comorbidities. Haryana-a north Indian state-has undergone rapid urbanisation, and part of it is included in the National Capital Region (NCR). The primary aim of the study is to estimate the prevalence of diabetes in Haryana with urban-rural, NCR and non-NCR regional stratification and assess the factors affecting the likelihood of having diabetes among adults. METHODS: This sub-group analysis of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study (a nationally representative cross-sectional population-based survey) was done for Haryana using data from 3722 participants. The dependent variable was diabetes, while residence in NCR/non-NCR and urban-rural areas were prime independent variables. Weighted prevalence was estimated using state-specific sampling weights and standardized using National Family Health Survey-5 (NFHS-5) study weights. Associations were depicted using bivariate analysis, and factors describing the likelihood of living with diabetes were explored using a multivariable binary logistic regression analysis approach. RESULTS: Overall, the weighted prevalence of diabetes in Haryana was higher than the national average (12.4% vs. 11.4%). The prevalence was higher in urban (17.9%) than in rural areas (9.5%). The prevalence of diabetes in rural areas was higher in the NCR region, while that of prediabetes was higher in rural non-NCR region. Urban-rural participants' anthropometric measurements and biochemical profiles depicted non-significant differences. Urban-rural status, age and physical activity levels were the most significant factors that affected the likelihood of living with diabetes. CONCLUSIONS: The current analysis provides robust prevalence estimates highlighting the urban-rural disparities. Urban areas continue to have a high prevalence of diabetes and prediabetes; rural areas depict a much higher prevalence of prediabetes than diabetes. With the economic transition rapidly bridging the gap between urban and rural populations, health policymakers should plan efficient strategies to tackle the diabetes epidemic.

The use of artificial intelligence for persons with disability: a bright and promising future ahead.

Artificial intelligence (AI) driven solutions have the potential to significantly impact individuals with disabilities by providing assistance in their daily activities and facilitating the acquisition of new abilities. The utilisation of AI technology in assisting individuals with disabilities has novel prospects for enhancing accessibility, fostering inclusivity throughout society, and enabling autonomous living, which would otherwise pose considerable challenges or remain unattainable. As the field of AI continues to progress, it holds the potential to facilitate the development of increasingly sophisticated and groundbreaking approaches to tackle the multifaceted obstacles encountered by individuals with disabilities. Consequently, AI has the capacity to foster greater inclusivity for this population.

AI driven solutions have the potential to significantly impact individuals with disabilities by providing assistance in their daily activities and facilitating the acquisition of new abilities.Several solutions are being currently developed by numerous startups as well as corporate conglomerates like Google, Microsoft and Apple.An independent and self-sustaining life will be the future normal for persons with disability (PwD) with these rapidly progressing developments.

Injury pattern of road traffic accident cases attending trauma centre of tertiary care hospital of North India.

Introduction: Injury is a significant global health burden and can result in mortality if not attended to on time. Trauma system refers to a collection of services provided by various super-specialties. According to the WHO-World Bank Report, RTA will rise from ninth place to the third biggest cause of mortality. Materials and Methods: The study was done at Advanced Trauma Centre (ATC) at PGIMER, a teaching hospital of north India. Study included area from most of the patient come for treatment (rural/urban) and injury patterns seen in these patients, which included mode of injury, type of injury, type of road accidents and location of injury. Results and Observations: In maximum cases, 60.2% (245) of the mode of injury was RTA. It was seen that the maximum number of patients, 44.4%, (115) had motorbike/scooter collisions with vehicles. In most patients, the type of injury seen was 35.9% (147) head, neck and back injuries, and in maximum cases, the location of the accident site was road/street 63.2%. Discussion: In our country, where the trauma delivery system is poorly developed, teaching hospitals have to bear the burden of treating many patients. No concept of emergency medicine or trauma care is in use, even in urban areas. As a result, teaching hospitals' emergency departments receive many referrals for emergency conditions.

Does robotic-assisted surgery improve outcomes of total hip arthroplasty compared to manual technique? A systematic review and meta-analysis.

BACKGROUND: Robot-assisted total hip arthroplasty (THA) is an emerging technology that claims to position implants with very high accuracy. However, there is currently limited data in literature on whether this improved accuracy leads to better long-term clinical outcomes. This systematic review compares the outcomes of THA done with the help of robotic assistance (RA) to those done with conventional manual techniques (MTs). METHODS: Four electronic databases were searched for eligible articles that directly compared robot-assisted THA to manual THA and had data on the radiological or clinical outcomes of both. Data on various outcome parameters were collected. Meta-analysis was conducted using a random-effects model with 95% CIs. RESULTS: A total of 17 articles were found eligible for inclusion, and 3600 cases were analysed. Mean operating time in the RA group was significantly longer than in the MT group. RA resulted in significantly more acetabular cups being placed inside Lewinnek's and Callanan's safe zones (p<0.001) and had significantly reduced limb length discrepancy compared with MT. There were no statistically significant differences in the two groups in terms of incidence of perioperative complications, need for revision surgery and long-term functional outcome. CONCLUSION: RA leads to highly accurate implant placement and leads to significantly reduced limb length discrepancies. However, the authors do not recommend robot-assisted techniques for routine THAs due to lack of adequate long-term follow-up data, prolonged surgical times and no significant differences in the rate of complications and implant survivorship compared with conventional MTs.

Does the residual displacement of pelvic ring affect the functional outcome in pelvic ring injures?

PURPOSE: The effects of residual displacement on the functional outcome of the patient are not distinctly known and the acceptability criteria of residual displacement of the pelvic ring remain disputed. The purpose of this study is to evaluate the effect of residual displacement on functional outcome in pelvic ring injuries. MATERIALS AND METHODS: A total of 49 patients with pelvic ring injuries (both operative and non-operative) were followed up for six months. Anteroposterior (AP), Vertical and rotational displacements were measured at admission, after surgery and at six months. Resultant displacement (vector addition of AP and vertical displacement) was taken for comparison. Displacement was graded as excellent, good, fair and poor according to Matta's criteria. Functional outcome assessment was done at six months using Majeed score. Work adjusted Majeed score was calculated for non-working patients by taking the percentage score. RESULTS: We compared the means of residual displacement with functional outcome (Excellent/Good/Fair) and found that there was no significant difference between the groups in operative (P=0.33) or non-operative patients (P=0.09). This showed that patients with relatively higher residual displacement also had satisfactory functional outcomes. The functional outcomes were compared after dividing the residual displacement into 2 groups: <10 mm and >10 mm and no significant difference was found in outcomes for either operative or non-operative patients. CONCLUSION: Up to 10 mm of residual displacement is acceptable in pelvic ring injuries. More prospective studies with a longer follow up are needed for determination of correlation between reduction and functional outcome.

Comparison of outcomes of retrograde intramedullary nailing versus locking plate fixation in distal femur fractures: A Systematic Review and Meta-analysis of 936 patients in 16 studies.

Background: The surgical treatment for distal femur fractures has evolved over time, and it depends upon certain factors; open or closed fracture type, the pattern of fracture, presence of metaphyseal comminution, intra-articular extension, and the bone quality are some of the crucial ones. Both retrograde intramedullary nails (RIMN) and locking plates (LP) can be used for the fixation of these fractures. However, the optimal method among the two devices is still a topic of debate, the superiority of one over the other being unclear. Hence, this systematic review and meta-analysis was conceptualized to compare the outcomes of RIMN with distal femur LP. Methods: The primary electronic search was conducted on Medline (PubMed), Scopus, Embase, Cinahl, and Cochrane Library databases for the published literature from the inception to 25th February 2022. The studies compared outcomes of RIMN versus LP fixation of the acute supracondylar or distal femur fracture (AO/OTA type-33A, B, and C) and reported at least one primary (mean fracture union time, complications, implant-related complications, and re-operation rate) or secondary outcome (duration of surgery, intra-operative blood loss, and knee range of motion), were included. Results: Six randomized control trials, 2 prospective and 8 retrospective studies with 936 patients with 8 bilateral cases (467: RIMN; 477: LP) were included. Our analysis demonstrated no statistically significant difference in terms of mean fracture union time, overall complications, implant-related complications, re-operation rates, and duration of surgeries. Although a better knee range of motion was seen in the LP group, however, it also showed more nonunion and infection than the RIMN group. Conclusion: The present review shows that there are significantly lesser nonunions and infections, in the RIMN group as compared to LP for distal femur fractures, although a better postoperative knee range of motion was seen in the latter. However, in terms of fracture union time, the overall rate of complications, re-operation rates, and duration of surgeries, there is no difference between the two surgical options.

Core decompression combined with intralesional autologous bone marrow derived cell therapies for osteonecrosis of the femoral head in adults: A systematic review and meta-analysis.

BACKGROUND: Core decompression (CD) is beneficial in the early stage of osteonecrosis of the femoral head (ONFH). Adjunctive bone marrow derived cell therapies (BMDCT) have been advocated which potentially aid the regenerative process. QUESTION/PURPOSE: This study was conducted to determine potential benefit of CD + BMDCT in ONFH, in terms of disease progression, conversion to arthroplasty (primary outcomes), and functional outcomes and complication rates (secondary outcomes). METHODS: A systematic review of literature was performed on 3 databases. Studies reporting CD + BMDCT (intralesional instillation) in ONFH, with a minimum follow up of 1 year and reporting the pre-defined outcome measures were included in the review. Meta-analysis consisted of two different arms: a comparative arm, to compare CD + BMDCT to CD alone, and a non-comparative meta-analysis arm, to determine pooled rates of disease progression, conversion to arthroplasty and complication rates. RESULTS: A total of 18 studies were included in the systematic review. CD + BMDCT had lower rates of disease progression (OR 0.19 [95% CI, 0.09, 0.40]) and conversion to arthroplasty (OR 0.20 [95% CI, 0.11, 0.40]) as compared to CD alone. Functional score (MD = -7.07 [95% CI, -12.28, -1.86]) and visual analog scale also showed better improvement with the use of CD + BMAC (MD = -10.39 [95% CI, -12.87, -7.90]). Increasing age and post-collapse stage at presentation were noted to have an adverse effect on the outcomes. CONCLUSION: CD + BMDCT was found to decrease disease progression and conversion to arthroplasty, and was noted to have better functional outcome scores as compared to CD alone.

Wound alpha defensin levels are significantly higher in patients with fracture related infection: A pilot, prospective cohort study.

BACKGROUND: In absence of frank purulence, wound cultures represent 'gold-standard' for diagnosis of fracture related infection (FRI). However, these are time-intensive, and may be falsely negative, necessitating the need for accurate and rapid biomarker-based diagnosis. We conducted this study to determine the accuracy of 3 wound-based biomarkers for the diagnosis of FRI. METHODS: This was a prospective cohort study on adult patients who underwent an operative procedure for an upper or lower limb fracture. Wound fluid levels of alpha-defensin (AD), neutrophil elastase (NE) and IL-6 were evaluated on post-operative day 2, and patients were followed up for one month. Patients were categorized as cases (FRI) or controls (no FRI), on the basis of the consensus definition of FRI. Univariate analysis, along with receiver operating characteristic (ROC) analysis was performed. RESULTS: 48 patients were included. AD levels showed a 2.6-fold elevation in cases (n = 26, Median = 23.74 µg/ml) as compared to controls (n = 22, Median = 8.78 µg/ml). The area under the curve for this variable was 0.71 (95% Confidence Intervals = 0.56 - 0.86). The levels of NE and IL-6 were not significantly different between cases and controls. CONCLUSION: Wound AD levels are significantly elevated in patients with FRI. However, these results need to be validated in a larger cohort of patients before it can be used as a biomarker of FRI.

Complications and mid to long term outcomes for hip resurfacing versus total hip replacement: a systematic review and meta-analysis.

INTRODUCTION: The long-term results of total hip replacement (THR) are excellent; however, it has higher failure rates in young and active patients. Hip resurfacing arthroplasty (HRA) is an alternative in such patients and gaining popularity. This review was done to compare complications and outcomes between HRA and THA by assessing the latest level 1 studies comparing the two from the past 10 years. METHOD: A systematic review and meta-analysis was conducted using three databases (PubMed, EMBASE and SCOPUS) to compare the complications between THR and HRA in medium to long term follow up. The primary outcome of interest included the complication and revision rate between the two techniques. Functional outcomes and ionic levels at follow up were also compared as secondary outcomes. Risk of bias assessment was done using the Cochrane risk of bias tool. RESULT: The present review included 6 level 1 studies. These included 308 THR and 304 HRA. On meta-analysis, overall complications rates were significantly lower in HRA compared to the THA group with an Odds ratio (OR) of 2.17 (95% CI 1.21, 3.88; p = 0.009). No difference was seen between the two groups in terms of revision rate (OR 1.06 95% CI 0.57, 1.99; p = 0.85). Functional outcomes in both the groups were satisfactory but the Harris Hip Score was found to be significantly better in the resurfacing group (MD 2.99 95% CI - 4.01, - 1.96, p < 0.00001). There were increased cobalt and chromium ions in the resurfacing group but no detrimental effect was seen in terms of reported poisoning. CONCLUSION: Despite similar function and revision rates, HRA was seen to have lesser associated complications and ionic levels may not be a detrimental issue. Hip resurfacing provides relative ease during revisions, especially in younger patients and it may be an alternative to THR in the younger population.

A Cost-Effective Novel Surgical Technique of Core Decompression with Bone Marrow Aspiration Concentrate: A Preliminary Cadaveric Study.

Introduction: Core decompression supplemented by stem cell incorporation is an upcoming field of research in avascular necrosis of the femoral head. Plugging the canal to avoid loss of the concentrate injected has been recognized as a crucial step to improve the efficacy of the procedure. We describe a new surgical technique that results in native bone plug formation and eliminates the need for any additional blocker. Methodology: This pilot study was performed on 4 cadaveric proximal femurs. The standard technique was used for core decompression and bone marrow aspirate concentrate (BMAC) injection. Additionally, two more tracts were drilled, superolateral, and inferomedial to the primary tract. Results: No leakage of the radiopaque dye was observed from the entry point of the primary tract, ensuring its complete blockage in all 4 cadaveric proximal femurs. This was confirmed by sectioning the femur specimens which manifested bone plug formation at the confluence of the three tracts. Conclusion: Our technique is a unique and economical method of preventing leakage of BMAC through the entry point in the proximal femoral metaphysis. This may not only benefit patients but can also provide the groundwork for further research in this field.

Efficacy and Safety of Novel Non-steroidal Mineralocorticoid Receptor Antagonist Finerenone in the Management of Diabetic Kidney Disease: A Meta-analysis.

Background: Data are scant on use of finerenone in diabetic kidney disease (DKD). We undertook this meta-analysis to address this knowledge gap. Methods: Electronic databases were searched for randomized controlled trials (RCTs) involving diabetes patients receiving finerenone compared to controls. The primary outcome was changes in urine albumin-creatinine ratio (UACR). Secondary outcomes were time to kidney failure (decline in GFR by >40% from baseline over 4 weeks), time to end-stage kidney disease, hospitalization for any cause, death and adverse events reported. Results: From initially screened 79 articles, data from 7 RCTs involving 13,783 patients were analyzed (3 in active control group [ACG] defined as having eplerenone/spironolactone as active comparator; 4 in passive control group [PCG] defined as having placebo as controls). Patients receiving finerenone had greater percentage lowering of UACR from baseline as compared to PCG [MD23.82% (95%CI: -24.87 to -22.77); P < 0.01; I 2 = 96%] at 90 days, after 2 years [MD 37.9% (95%CI: -38.09 to -37.71); P < 0.01] and 4 years [MD 25.20%(95%CI: -25.63 to -24.77);P < 0.01] of treatment. Patients receiving finerenone has lower chance of >40% decline in GFR (OR 0.83 [95%CI: 0.75 to 0.92];P < 0.01; I 2 = 0%). Patients receiving finerenone had lower occurrence of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke or hospitalization for heart failure, as compared to placebo/eplerenone (OR0.86 [95%CI: 0.78 to 0.95]; P = 0.003; I 2 = 0%). TAEs was similar (RR0.97 [95%CI: 0.88-1.07]; P = 0.56; I 2 = 0%), but SAEs significantly lower (RR0.91 [95%CI: 0.84 to 0.97]; P < 0.01; I 2 = 0%) in finerenone-group compared to controls. Conclusion: This meta-analysis provides reassuring data on beneficial impact of finerenone in reducing UACR and GFR decline as compared to placebo. We still lack head-to-head comparison of renal outcomes of finerenone vs eplerenone/spironolactone in DKD.

Preoperative Forced-Air Warming Strategy: Is It Effective in Averting Intraoperative Hypothermia in Elderly Trauma Surgical Patients?

Background and objectives Inadvertent perioperative hypothermia is expected in the elderly during central neuraxial anesthesia. We aimed to compare the incidence of intraoperative hypothermia (< 36-degree celsius) between preoperative forced-air warming for 30 minutes and non-warming groups. Also, we compared the time to develop hypothermia, perioperative shivering, duration of intraoperative active warming, metabolic acidosis, surgical site infections, coagulation derangements, and post-anesthesia care unit (PACU) stay. Material and methodology A total of 100 American Society of Anesthesiologists (ASA) I-III (Age > 60 years) patients scheduled to undergo femur fracture surgeries under central neuraxial anesthesia were enrolled in this single-blinded prospective randomized study. They were randomly allocated into Group A (active forced-air warming for 30 minutes in the preoperative period) and Group B (without forced-air warming). Then, patients were transferred to the operation theatre, where central neuraxial anesthesia was administered for surgery. An infrared tympanic membrane thermometer measured the core body temperature during the different study points. Results The intraoperative hypothermia incidences were 26.0% and 68.0% in groups A and B, respectively. The mean time for developing hypothermia was found to be 143.08 ± 26.26 min and 25.88 ± 9.25 min in groups A and B, respectively. The mean duration of intraoperative active warming was observed to be 15.6 minutes and 103.6 minutes in groups A and B, respectively. The shivering and surgical site infection (SSI) grades were lower in group A. Conclusion A preoperative forced-air warming strategy for 30 minutes helps in reducing the incidence of intraoperative hypothermia and shivering in elderly patients undergoing femur fracture surgeries under central neuraxial anesthesia.

Excision Versus Replacement in Unrepairable Comminuted Fractures of the Radial Head: A Systematic Review of Outcomes and Complications.

Background: The radial head fractures comprise approximately 4% of all fractures around the elbow. The outcomes of open reduction and internal fixation are poor in fractures with more than three fragments, and the excision of radial head is considered a viable surgical treatment option. However, it is associated with its own set of complications. The radial head prosthetic replacement has emerged as an alternative in management of these fractures with constraints of cost and related complications. Hence, the treatment for the unrepairable comminuted radial head fractures still remains controversial. Aims and Objectives: This systematic review and meta-analysis was conducted to compare the post-operative outcomes of the radial head excision versus prosthetic replacement in comminuted Mason type-III fractures of radial head. Methodology: Three databases of Medline (PubMed), Scopus, and Embase were searched for comparative studies on the study question and relevant studies which mentioned at least one of the outcomes of interest (functional outcome scores and number of complications) were included. Results: Six studies were part of this review with 82 excisions and 99 prosthetic replacements. There was no significant difference between the two groups in terms of number of complications (OR 0.65; 0.08-5.07); and measures of functional outcomes; Mayo elbow performance score or MEPS (mean difference - 6.56; - 23.45 to 10.33). The incidence of elbow osteoarthritis, heterotrophic ossification, stiffness, and instability were similar in both groups. The flexion extension arc in degrees was better in excision group (mean difference 9.93; 1.31-18.55; p = .02). Conclusion: Excision is a reasonable surgical option for isolated comminuted radial head fractures with similar results of function and associated rates of complications as prosthetic replacements. The arc of motion is also better with excisions. There have been reports of more osteoarthritis with excision and arthroplasty has been advised in younger patients; however, we had no quantitative proof of that in this review.

Does the femoral neck system provide better outcomes compared to cannulated screws fixation for the management of femoral neck fracture in young adults? A systematic review of literature and meta-analysis.

Background: Management of neck of femur fractures depend upon the age of presentation and it ranges from internal fixation to arthroplasty. In a relatively young population, anatomical reduction with stable internal fixation is the preferred treatment modality; the choice of implants available are multiple cannulated cancellous screws, dynamic hip screws, and the newly devised femoral neck system. The fracture configuration and pattern dictate the ideal implant to be utilized, with the femoral neck system documented to be apt for all the fracture types, while the cannulated screws are deemed better for stable fractures. Methods: A primary electronic search was conducted on databases of Medline, Scopus, Scopus, Cochrane Library, and Embase, to look for articles published between 1st January 2010 to 22nd November 2021. Studies including adults with femoral neck fractures treated with internal fixation with femoral neck system and comparing them with internal fixation with cannulated cancellous screws in terms of variables like mean surgical duration, loss of blood, length of incision, fluoroscopy time, duration of hospital stay and outcomes like union time, complications, functional outcomes, Visual Analogue Score, and femoral neck shortening, were included. Results: 6 retrospective studies with 371 patients (224 males,147 females) (164: FNS; 207: CCS) were included. Our analysis demonstrated no statistically significant difference in terms of duration of surgery, incision length, and length of hospital stay, there was more blood loss in FNS, but less fluoroscopy time. The fracture union time was lesser for the FNS group and also the femoral shortening was lesser in it. There was no difference in terms of complications, pain relief, and functional outcomes. Conclusion: Femoral neck system is a new and effective implant for femoral neck fractures in the young with faster union rates and lesser neck shortening through an incision similar to the conventional multiple cancellous screws. It has additional advantages of lesser fluoroscopy exposure to the patient and the OT personnel. However, the rates of complications like implant failure, non-unions, and avascular necrosis are similar to the cannulated screws and either of the implants do not offer any advantage in the final functional status and pain relief to the patient over each other.

Association of Specific Genetic Polymorphisms with Atraumatic Osteonecrosis of the Femoral Head: A Narrative Review.

Introduction: Atraumatic ONFH is one of the leading cause of hip morbidity in the working-age group. It is a multi-factorial disease whose root cause can be attributed to single-nucleotide polymorphism. Identifying such polymorphisms could pave the way for new modalities of treatment for ONFH. Methodology: Two databases were electronically searched for relevant articles. The articles were screened through titles, abstract and full texts to include the relevant studies. A secondary search was done through the reference list of selected articles. Results: A total of 52 studies were included among the 181 hits. All 181 were case-control studies. Summary of these studies identifies multiple SNPs which can cause ONFH. There were 117 SNPs in all 181 studies, of which 92 were associated with the causation of ONFH and 25 were protective against ONFH. Conclusion: SNPs play an essential role in causing atraumatic ONFH. Identification of SNP that contribute to causing ONFH may help reduce the disease burden by early identification, diagnosis and treatment, including targeted gene therapy.

Effects of type 2 diabetes on the viscoelastic behavior of human trabecular bone.

Type 2 diabetes (T2D) is a well-known disease that impaired bone mechanical properties and increases the risk of fragility fracture. The bone tissue is a viscoelastic material that means the loading rate determines its mechanical properties. This study investigates the impact of T2D on the viscoelastic properties of human bone and its association with microstructure and biochemical properties. INTRODUCTION: Viscoelasticity is an important mechanical property of bone and for this the interaction of individual constituents of bone plays an important role. The viscoelastic nature of bone can be affected by aging and diseases, which can further influence its deformation and damage behavior. METHODS: The present study investigated the effects of T2D on the viscoelastic behavior of trabecular bone. The femoral heads of T2D (n = 26) and non-T2D (n = 40) individuals with hip fragility fractures were collected for this investigation. Following the micro-CT scanning of all bone samples, the stress relaxation and dynamic mechanical analysis (DMA) tests were performed to quantify the viscoelasticity of bone. Further, a correlation analysis was performed to investigate the effects of alteration in bone microstructural and biochemical parameters on viscoelasticity. RESULTS: The stress relaxation and frequency sweep responses of T2D and non-T2D trabecular bone specimens were not found significantly different. However, the storage modulus, initial stiffness, and initial stress were found lower in T2D bone. The significant correlation of percentage stress relaxed is obtained between the mineral content (r= - 0.52, p-value = 0.003), organic content (r = 0.40, p-value = 0.02), and mineral-to-matrix ratio (r = - 0.43, p-value = 0.009). Further, storage and loss modulus were correlated with bone volume fraction (BV/TV) for both groups. The stress relaxation and frequency sweep characteristics were not found significantly connected with the other chemical, structural, or clinical parameters. CONCLUSION: This study suggests that T2D does not affect the time-dependent response of human femoral trabecular bone. The viscoelastic properties are positively correlated with organic content and negatively correlated with mineral content.

Spinopelvic fixation for vertically unstable AO type C pelvic fractures and sacral fractures with spinopelvic dissociation- A systematic review and pooled analysis involving 479 patients.

BACKGROUND: Posterior pelvic ring injuries can be fixed using iliosacral screws, plates or bars. Another promising modality is spinopelvic fixation or triangular osteosynthesis, indicated in vertical instability and sacral fractures associated with spinopelvic dissociation. QUESTION/PURPOSE: This systematic review and pooled analysis was conducted to analyze the outcomes (functional and radiological) of the use of spinopelvic fixation, as well as assess the associated complications and neurological recovery. METHODS: A systematic review of literature was performed from the PubMed/Medline, EMBASE and the SCOPUS databases. All studies reporting on spinopelvic fixations, with a minimum follow up of 1 year were included in the review. Pooled analysis was done for the outcome and complication rates. The MINORS Tool was used for assessing the risk of bias. RESULTS: A total of 22 studies were included with average follow-up between 12 and 86.4 months. There were 7 prospective and 15 retrospective case series. The functional outcomes were excellent/good in 90% cases, across 8 studies (95% CI 84-95%); radiological outcomes were excellent/good in 97% cases (95% CI 94-100%) across 5 studies. The most commonly reported complications were hardware prominence in 21.3% (95% CI 11.6,30.9%) and infections in 7.2% cases (95% CI 4.8,9.5%). 73% of the patients reported partial or complete improvement in their neurological condition. CONCLUSION: Spinopelvic fixation is an effective method in vertical instability of the pelvis and sacral fractures with spinopelvic dissociations, with good to excellent radiological and functional outcomes. However, adequate precautions are needed to avoid infections and wound complications.

Fire incidents in Bed-head panels: Causes and recommendations for prevention.

Disaster incidents leading to massive obliterations often bring to the forefront the inadequacies of the systems, infrastructure as well as personages. In healthcare settings, these imperfections are usually exhibited specifically during fire disasters. This case report details a true fire incident that erupted in a patient bed-head panel of an emergency complex room and describes the real-life challenges encountered by the emergency staff in preserving both life and property. Bed-head units encompass both electrical and medical gases: a structural component quite common in modern hospitals. Precautionary measures should be implemented to mitigate such incidents, as well as specific attention, should be made during the designing and installation of these bed-head panels. Better coordination, scheduled training, and fire drills can improve the overall outcomes and minimize the possibility of these potentially fatal problems, thereby, making a safer healthcare environment for every worker and patient.