Malignant middle cerebral artery stroke management in developing world-outcome predictors

@#Background & Objectives: Malignant middle cerebral artery (MCA) stroke constituting 5% of all strokes carries a high mortality across the world. We aimed to study predictors of malignant MCA stroke outcome, especially decompressive surgery in a developing country scenario. Methods: This was a prospective study design where patients with malignant MCA stroke (defined as imaging-CT/ MRI showing infarct involving >2/3rd MCA territory) admitted within 7 days of illness to SCTIMST, between January 2010 and December 2014 (5 years) were recruited. Clinical and imaging data, surgical details, in hospital complications and discharge outcome were collected. Follow-up data was collected at 3 and 12 months post-stroke. Results: We had 74 patients of malignant MCA territory strokes, 42 operated and 32 non-operated, who were comparable at baseline, except for age and stroke severity. At 3 months, deaths were more among the non-operated group (63% in non-operated vs 23% in operated group, p=0.02), while functional outcome was comparable. At 1 year follow-up, age below 60 years, lower stroke severity at onset and decompressive surgery were found to be independent predictors of good outcome. (p=0.04). Delayed surgery group, albeit small had a better 1 year outcome in comparison to the medical arm. Conclusions: Early functional outcome in the decompression group did not differ from the medically treated patients, other than mortality benefit. However, at 1 year, patients with age<60 years, lower stroke severity and decompressive surgery had a better morbidity and mortality outcome, indicating long term benefit of this life saving procedure in developing country scenario as well.

Preoperative determination of tibial nail length: An anthropometric study / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To assess the correlation between five anthropometric parameters and the distance from tibial tuberosity to medial malleolus in 100 volunteers.</p><p><b>METHODS</b>Six anthropometric parameters were measured in 50 male and 50 female medical students using a metallic scale: medial knee joint line to ankle joint line (K-A), medial knee joint line to medial malleolus (K-MM), tibial tuberosity to ankle joint (TT-A), tibial tuberosity to medial malleolus (TT- MM), olecranon to 5th metacarpal head (O-MH) and body height (BH). Nail size predicted based upon TT-MM measurement was chosen as ideal nail size. A constant was derived for each of the six anthropometric parameters which was either added or subtracted to each measurement to derive nail size. A regression equation was applied to BH measurements. Nail sizes calculated were compared with that obtained from TT-MM measurement and accuracy was evaluated. Accuracy of O-MH and BH regression equations recommended by other authors were calculated in our data.</p><p><b>RESULTS</b>Adding 11 mm to TT-A distance had highest accuracy (81%) and correlation (0.966) in predicting nails correctly. Subtracting 33 mm from K-MM measurement and 25 mm from K-A distance derived accurate sizes in 69% and 76% respectively. Adding 6 mm to O-MH distance had a poor accuracy of 51%. Nail size prediction based upon body height regression equation derived correct nail sizes in only 34% of the cases. Regression equation analysis by other authors based on O-MH and BH distances yielded correct sizes in 11% and 5% of the cases respectively.</p><p><b>CONCLUSION</b>TT-A, K-A and K-MM measurements can be used simultaneously to increase accuracy of nail size prediction. This method would be helpful in determining nail size preoperatively especially when one anatomic landmark is difficult to palpate.</p>

Nonoperatively treated infraglenoid tubercle avulsion / 中华创伤杂志(英文版)

Infraglenoid tubercle avulsion fractures are extremely rare injuries. We report a 38-year-old male with glenoid cavity fracture and infraglenoid tubercle avulsion of the left shoulder following a fall from bike. He refused surgery and was treated nonoperatively. Follow-up radiography and CT at 18 months revealed a malunited infraglenoid tubercle with signs of early glenohumeral osteoarthritis. He did not have shoulder instability or pain and had a fair-good functional outcome. There are no previously published data on the anatomic outcome of nonoperatively treated displaced infraglenoid tubercle avulsion fractures based on CT.

Baseline population survey data on the prevalence of risk factors for coronary artery disease among Kuwaitis aged 15 years and older

There are no baseline population survey data on the prevalence of risk factors for coronary artery disease [CAD] among normal, healthy Kuwaiti women upon which future interventional studies can be based. Subjects and We collected data on the prevalence of excessive weight, obesity, diabetes mellitus, dyslipidemia, current smoking and physical inactivity for 7,609 apparently healthy Kuwaitis aged 15 years and older by means of a household survey. Using a structured questionnaire, we collected demographic data from the respondents, measured their body weight and height, and collected blood samples for measurement of glucose, total cholesterol, high-density lipoprotein cholesterol [HDL-C], triglycerides, and apolipoproteins A1 and B. The prevalence of obesity among adult Kuwaitis was 23.5%. It was higher among women [30.0%] than among men [17.5%]. The combined prevalence of obesity and excessive weight in the population was 58% [63.4% among women and 53% among men]. Diabetes mellitus and hypercholesterolemia were slightly higher in women than in men [21.8 vs 17.7 and 36.6 vs 30.2% respectively] while hypertriglyceridemia and low HDL-C were higher in men than in women [44.1 vs 33.8 and 52.2 vs 21.8% respectively]. The prevalence of smoking was significantly higher in men [31.7%] than in women [1.4%], while the prevalence of physical inactivity was higher in women [71.4%] than in men [50.6%]. We conclude that Kuwaiti women, like men, have high risk factors for CAD and should receive equal attention in future programs to prevent CAD death among Kuwaitis