Factors associated with unexplained sudden deaths among adults aged 18-45 years in India - A multicentric matched case-control study.

BACKGROUND OBJECTIVES: In view of anecdotal reports of sudden unexplained deaths in India's apparently healthy young adults, linking to coronavirus disease 2019 (COVID-19) infection or vaccination, we determined the factors associated with such deaths in individuals aged 18-45 years through a multicentric matched case-control study. METHODS: This study was conducted through participation of 47 tertiary care hospitals across India. Cases were apparently healthy individuals aged 18-45 years without any known co-morbidity, who suddenly (<24 h of hospitalization or seen apparently healthy 24 h before death) died of unexplained causes during 1 st October 2021-31 st March 2023. Four controls were included per case matched for age, gender and neighborhood. We interviewed/perused records to collect data on COVID-19 vaccination/infection and post-COVID-19 conditions, family history of sudden death, smoking, recreational drug use, alcohol frequency and binge drinking and vigorous-intensity physical activity two days before death/interviews. We developed regression models considering COVID-19 vaccination ≤42 days before outcome, any vaccine received anytime and vaccine doses to compute an adjusted matched odds ratio (aOR) with 95 per cent confidence interval (CI). RESULTS: Seven hundred twenty nine cases and 2916 controls were included in the analysis. Receipt of at least one dose of COVID-19 vaccine lowered the odds [aOR (95% CI)] for unexplained sudden death [0.58 (0.37, 0.92)], whereas past COVID-19 hospitalization [3.8 (1.36, 10.61)], family history of sudden death [2.53 (1.52, 4.21)], binge drinking 48 h before death/interview [5.29 (2.57, 10.89)], use of recreational drug/substance [2.92 (1.1, 7.71)] and performing vigorous-intensity physical activity 48 h before death/interview [3.7 (1.36, 10.05)] were positively associated. Two doses lowered the odds of unexplained sudden death [0.51 (0.28, 0.91)], whereas single dose did not. INTERPRETATION CONCLUSIONS: COVID-19 vaccination did not increase the risk of unexplained sudden death among young adults in India. Past COVID-19 hospitalization, family history of sudden death and certain lifestyle behaviors increased the likelihood of unexplained sudden death.

Preventing pressure ulcers from paediatric femoral traction: use of an audit cycle to assess a new concise manual and a daily care chart.

INTRODUCTION: Femoral shaft fractures are common in children up to 14 years of age and traction is frequently used during their treatment. A lack of training and unfamiliarity of junior doctors and nursing staff with this treatment modality may lead to unfavourable skin complications, especially in the absence of regular monitoring. We introduced and audited a simple and reproducible way of monitoring these patients. METHODS: An initial audit was conducted of all children with femoral shaft fracture treated in skin traction. A new traction manual and daily care chart were introduced, and a re-audit was performed. A parallel survey regarding skin traction in children was conducted involving 33 hospitals in the United Kingdom. RESULTS: The initial audit showed three patients (23%) developed grade 2 pressure sores with a mean duration of traction of 8.5 days. A pressure sites check was documented in only 7.7%. A re-audit, after introduction of the traction manual and daily care chart showed a mean duration of traction of 8.4 days and only one patient (12.5%) developed a grade 1 sore. Pressure site monitoring improved significantly with 75% documentation. No daily care chart was used among the 33 centres in the survey and only 27% of centres had access to a manual in the ward. CONCLUSIONS: Introduction of a single-page traction manual and a daily care chart into patient care notes to effectively monitor for pressure areas in children on skin traction helps reduce the incidence of serious skin complications.

Rigid intramedullary nail fixation of femoral fractures in adolescents: what evidence is available?

BACKGROUND: Femoral fracture in adolescents is a significant injury. It is generally agreed that operative fixation is the treatment of choice, and rigid intramedullary nail fixation is a treatment option. However, numerous types of rigid nails to fix adolescent femoral fractures have been described. Hence, the aim of this paper was to collate and evaluate the available evidence for managing diaphyseal femoral fractures in adolescents using rigid intramedullary nails. MATERIALS AND METHODS: A literature search was undertaken using the healthcare database website ( http://www.library.nhs.uk/hdas ). Medline, CINAHL, Embase, and the Cochrane Library databases were searched to identify prospective and retrospective studies of rigid intramedullary nail fixation in the adolescent population. RESULTS: The literature search returned 1,849 articles, among which 51 relevant articles were identified. Of these 51 articles, 23 duplicates were excluded, so a total of 28 articles were reviewed. First-generation nails had a high incidence of limb length discrepancy (Küntscher 5.8 %, Grosse-Kempf 9 %), whilst second-generation nails had a lower incidence (Russell-Taylor 1.7 %, AO 2.6 %). Avascular necrosis was noted with solid Ti nails (2.6 %), AO femoral nails (1.3 %) and Russell-Taylor nails (0.85 %). These complications have not been reported with the current generation of nails. CONCLUSIONS: Rigid intramedullary nail fixation of femoral fractures in adolescents is a useful procedure with good clinical results. A multiplanar design and lateral trochanteric entry are key to a successful outcome of titanium alloy nail fixation.

Clinical outcome following a modified approach for psoas lengthening for coxa saltans in adults.

Internal snapping often resolves with conservative treatment but persistent significant symptoms may require surgical treatment. Different surgical approaches have been suggested in the literature with varying results. We describe a modified surgical approach for internal snapping of hip in adults with good results. Patients who failed conservative treatment for internal snapping over 11/2 years were included. A skin crease incision was made just lateral to the ASIS in supine position. The psoas tendon was reached sub-periosteally along the internal iliac surface and a hole was made in periosteum. Then the tendon was hooked into the wound and divided releasing its musculotendinous junction. The patients were allowed to mobilise as able in the postoperative period. There were 8 snapping hips (7 patients, 6 females) with average age of 30 years (17-51 yrs). The mean follow-up was 11 months. The average duration of symptoms before operation was 4.5 years (range 2-10 years). Painful symptomatic clicking was relieved in all patients. Two patients felt slight weakness of hip flexion. One patient had temporary neuropraxia of lateral cutaneous nerve of thigh. The diagnosis is made by ultrasound or examination for a palpable click. Surgical correction of snapping is considered after failure of conservative treatment. Different extrapelvic (medial and iliofemoral) and intrapelvic extraperitoneal approaches have been described with varying results. With our slightly modified intrapelvic and subperiosteal approach through oblique inguinal incision in adults, psoas muscle release at musculotendinous junction seems a safe and effective method and could be used as an alternative surgical approach for treatment of internal snapping of hip in adults.

An uncommon cause of back pain in pregnancy.

Back pain is a major cause of disability worldwide. A case of a 29 year old Caucasian woman with low back pain secondary to an uncommon benign condition called osteitis condensans ilii is presented and the literature is reviewed. Limited information in the literature combined with poor awareness across the specialty and among the primary care physicians leads to an extensive investigation and misdiagnosis of this benign condition. This report emphasis the salient features and the differential diagnosis in diagnosing and managing this rare condition.

Phalangeal metastasis secondary to an occult breast carcinoma.

We report a case of a silent, highly malignant tumour of the breast, which presented as an atraumatic deformity of the finger secondary to a phalangeal metastasis.

Non-Hodgkin's lymphoma as an unexpected diagnosis in a hip arthroplasty.

Total hip replacement is routinely performed for osteoarthritis of the hip joint. We report a case of Non-Hodgkin's lymphoma as an unexpected diagnosis after routine pathological examination of the bone block harvested during total hip replacement in an asymptomatic patient. Although controversies exist regarding the cost effectiveness of routine specimen evaluation during total hip replacement, we suggest that histological analysis of any unusual-looking surgical tissues is appropriate and should be performed in all the patients who have suspicious surgical findings. To our knowledge, this is the first case of lymphoma detected during primary total hip replacement.

Mechanical testing of the wire clamping characteristics of the Fixclip internal fixation system.

Stainless steel wires (Kirschner's wires) have been used for over 60 years to fix internally a wide range of osteotomies and fractures in bones. Fixclips (Corifix, Cirencester, UK) shaped like winged washers have been used to clamp pairs of K wires of diameters ranging from 0.8 to 3.0 mm to standard orthopaedic screws and to fix bones internally in more than 400 patients. The system has proved to be biologically and mechanically very effective. This paper describes the design and some biomechanical test results of the Fixclip. Preliminary strength tests conducted using a Hounsfield Tensometer show that the pull-out force, reflecting the grip of the clip on the wire, is dependent on the wire size and, throughout the clinically relevant range, increases linearly with increasing screw torque. Changing the surface finish of the clip did not confer any advantage over the existing polished clip in terms of grip strength.

FixclipsTM - biological internal fixator for upper femoral osteotomies in cerebral palsy.

We describe the technique and results of 63 proximal femoral osteotomies in 39 cerebral palsy patients performed with the Fixclip (Corifix, Cirencester, UK) internal fixator system. Post-operative splintage was determined by soft tissue requirements and not to protect the femoral osteotomy. Three patients needed revision surgery for readjustment of the device and two patients had superficial infections. All osteotomies except one healed by 12-16 weeks. There were no mal-unions, or avascular necrosis. One patient had a non-union that united after revision surgery. The Fixclip system is modular and easily adjustable. The fixation, sitting just off the bone, is less disturbing to the periosteal blood supply and lateralises the fixation, like a wave plate, to load both the medial and lateral femoral cortices on weight-bearing. Compared to the other available fixation implants, Fixclips are biologically and mechanically very effective and well suited in cerebral palsy patients where rigid fixation with a plate can cause extensive loss of bone mass. (Hip International 2002; 12: 314-9).

An unusual neurological complication following internal fixation of pertrochanteric fracture neck of the femur.

Fracture of the femoral neck is a common injury in the elderly population and may be associated with significant morbidity. More than 25,000 patients per year in the UK receive treatment for femoral neck fractures. Neurological injury associated with pertrochanteric fracture of the neck of the femur is rare. Sciatic nerve injury following isolated pertrochanteric femoral neck fractures is very rare and has not previously been reported in the literature. We describe a case of foot drop secondary to sciatic nerve injury following fracture of neck of the femur, with recovery after surgical exploration and nerve release. (Hip International 2002; 4: 400-2).