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1.
BMC Med Educ ; 22(1): 78, 2022 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-35120514

RESUMEN

BACKGROUND: Foot and ankle pathology if not treated appropriately and in a timely manner can adversely affect both disability and quality adjusted life years. More so in the low- and middle-income countries where ambulation is the predominant means of getting around for the majority of the population in order to earn a livelihood. This has necessitated the equipping of the new generation of orthopaedic surgeons with the expertise and skills set to manage these conditions. To address this need, surgeons from the British Orthopaedic Foot & Ankle Society (BOFAS) and College of Surgeons of Eastern, Central and Southern Africa (COSECSA) transferred the "Principles of Foot and Ankle Surgery" course to an African regional setting. The course was offered to surgical trainees from 14-member countries of the COSECSA region and previously in the UK. The faculty was drawn from practicing surgeons experienced in both surgical education and foot and ankle surgery. The course comprises didactic lectures, case-based discussions in small groups, patient evaluations and guided surgical dissections on human cadavers. It was offered free to all participants. The feasibility of the course was evaluated using the model defined by Bowen considering the eight facets of acceptability, demand, implementation, practicality, adaptation, integration, expansion and limited efficacy. At the end of the course participants were expected to give verbal subjective feedback and objective feedback using a cloud based digital feedback questionnaire. The course content was evaluated by the participants as "Poor", "Below average", "Average", "Good" and "Excellent", which was converted into a value from 1-5 for analysis. The non-parametric categorical data was analysed using the Two-sample Wilcoxon rank-sum (Mann-Whitney) test, and significance was considered to be p < 0.05. RESULTS: Six courses in total were held between 2018 and 2020. Three in the UK and three in the COSECSA region. There were 78 participants in the three UK courses and 96 in the three courses run in the COSECSA region. Hundred percent of the UK participants and 97% of the COSECSA participants completed the feedback. Male to female ratio was 4:1 for the UK courses and 10:1 for the COSECSA Courses. In both regions all the participants responded that they would recommend the course to their colleagues. Among the COSECSA participants 91% reported that the course was pitched at the right level, which is similar to the 89% of the UK participants (p = 0.28). CONCLUSION: The BOFAS Principles of Foot and Ankle Surgery course design provides core knowledge, with an emphasis on clinical examination techniques of the foot and ankle, while at the same time, caters for the anticipated difference in the local clinical case mix and resources. This study establishes that by attending the course surgical trainees can achieve their learning goals in foot and ankle surgery with the same high quality qualitative and quantitative feedback in both regions. This would improve their clinical practice and confidence. The multifaceted approach adopted in this course blending didactic teaching, small group discussions, interactive sessions, case-based discussions, cadaveric surgical skills training printed educational materials and feedback helped fulfil these educational objectives. Working in partnership with local expert orthopaedic surgeons from a number of Sub-Saharan countries, was key to adapting the course to local pathology and the COSECSA setting.


Asunto(s)
Tobillo , Cirujanos , África Austral , Tobillo/cirugía , Estudios de Factibilidad , Femenino , Humanos , Masculino , Encuestas y Cuestionarios
2.
Foot Ankle Surg ; 21(4): 266-8, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26564729

RESUMEN

BACKGROUND: Lower-limb immobilization has been implicated as an etiologic factor for a venous thromboembolism (VTE). Most of the current literature encourages the use of thromboprophylaxis with injectable low-molecular-weight heparin (LMWH) in trauma patients. Injectable anticoagulants have inherent problems of producing pain and bruising. They are also difficult to administer, leading to low compliance. Oral anticoagulants are therefore gaining popularity for use as thromboprophylactic agents in hip and knee arthroplasty patients. There are not enough studies in the literature, however, to support their use in ambulatory trauma patients whose ankle fractures are being managed nonoperatively on an outpatient basis. METHODS: This study evaluated the efficacy of oral anticoagulants for preventing VTE in ambulatory trauma patients who required temporary lower limb immobilization for non-operative management of their ankle fractures. A total of 200 consecutive patients who presented to the fracture clinic with an ankle fracture that was managed in a plaster cast were included in this study. These patients were assessed for risk of developing VTE and high risk patients were administered an oral anticoagulant to prevent VTE. RESULTS: There was only one case of an isolated distal DVT among the 200 patients. CONCLUSIONS: This study shows that an oral anticoagulant was a safe alternative to injectable LMWH as a thromboprophylactic agent for ambulatory trauma patients requiring temporary lower limb immobilization for non-operative management of an ankle fracture.


Asunto(s)
Fracturas de Tobillo/complicaciones , Anticoagulantes/administración & dosificación , Heparina de Bajo-Peso-Molecular/administración & dosificación , Tromboembolia Venosa/prevención & control , Administración Oral , Fracturas de Tobillo/terapia , Moldes Quirúrgicos , Humanos , Estudios Retrospectivos , Tromboembolia Venosa/etiología
3.
Nature ; 438(7070): 994-6, 2005 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-16355219

RESUMEN

Two short (< 2 s) gamma-ray bursts (GRBs) have recently been localized and fading afterglow counterparts detected. The combination of these two results left unclear the nature of the host galaxies of the bursts, because one was a star-forming dwarf, while the other was probably an elliptical galaxy. Here we report the X-ray localization of a short burst (GRB 050724) with unusual gamma-ray and X-ray properties. The X-ray afterglow lies off the centre of an elliptical galaxy at a redshift of z = 0.258 (ref. 5), coincident with the position determined by ground-based optical and radio observations. The low level of star formation typical for elliptical galaxies makes it unlikely that the burst originated in a supernova explosion. A supernova origin was also ruled out for GRB 050709 (refs 3, 31), even though that burst took place in a galaxy with current star formation. The isotropic energy for the short bursts is 2-3 orders of magnitude lower than that for the long bursts. Our results therefore suggest that an alternative source of bursts--the coalescence of binary systems of neutron stars or a neutron star-black hole pair--are the progenitors of short bursts.

4.
Foot Ankle Surg ; 17(3): 186-92, 2011 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21783082

RESUMEN

BACKGROUND: The Achillon jig permits the placement of sutures deep to the fascia cruris and the paratenon through the substance of the ruptured tendon, permitting a safe minimally invasive repair. Our experience has suggested that these two layers may not be as clearly delineated as first thought or may merge at an, as yet, undefined level. METHODS: We performed an anatomical and radiological (US and MRI) study of the layers of tissue superficial to the Achilles tendon in cadaveric specimens. RESULTS: The mean distance for the confluence of the fascia cruris and paratenon from the postero-superior calcaneal tubercle (PSCT) was found to be 37.3mm (range 17-58mm). Ultrasound examination was found to be less distinct than MRI scanning. CONCLUSIONS: We recommend careful identification of the fascia cruris and paratenon and insertion of the central branches of the jig adjacent to the tendon substance when using this method for repair.


Asunto(s)
Tendón Calcáneo/anatomía & histología , Tendón Calcáneo/diagnóstico por imagen , Imagen por Resonancia Magnética , Cadáver , Fascia , Humanos , Ultrasonografía
5.
Injury ; 50(8): 1483-1488, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31213306

RESUMEN

AIMS: Fractures and dislocations of the midfoot are relatively uncommon but can be life changing injuries. Within the literature, there has been scant specific reference to the identification and management of medial ray injuries in midfoot trauma. Moreover, it is appreciated that these injuries are associated with poor outcomes. We aim to clearly define these injury characteristics and demonstrate fixation techniques. PATIENTS AND METHODS: A retrospective review of the case notes and imaging was conducted for operatively treated midfoot injuries between January 2013 and January 2018. RESULTS: 161 patients were identified, 31 of these with imaging and operative diagnosis suggestive of medial ray injury. Studying these 31 injuries revealed five patterns of injury. CONCLUSION: When treating midfoot trauma, it is important to fully understand the injury pattern as this dictates the principles and techniques of fixation. Identification and knowledge of these five injury patterns will aid surgeons in future management of these injuries and may improve treatment outcomes.


Asunto(s)
Traumatismos de los Pies/clasificación , Fijación Interna de Fracturas/métodos , Fracturas Óseas/clasificación , Luxaciones Articulares/clasificación , Adolescente , Adulto , Anciano , Fenómenos Biomecánicos , Femenino , Traumatismos de los Pies/diagnóstico por imagen , Traumatismos de los Pies/fisiopatología , Traumatismos de los Pies/cirugía , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/fisiopatología , Fracturas Óseas/cirugía , Humanos , Luxaciones Articulares/diagnóstico por imagen , Luxaciones Articulares/fisiopatología , Luxaciones Articulares/cirugía , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos , Radiografía , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
6.
Science ; 365(6460): 1441-1445, 2019 09 27.
Artículo en Inglés | MEDLINE | ID: mdl-31604272

RESUMEN

Surveys have shown that super-Earth and Neptune-mass exoplanets are more frequent than gas giants around low-mass stars, as predicted by the core accretion theory of planet formation. We report the discovery of a giant planet around the very-low-mass star GJ 3512, as determined by optical and near-infrared radial-velocity observations. The planet has a minimum mass of 0.46 Jupiter masses, very high for such a small host star, and an eccentric 204-day orbit. Dynamical models show that the high eccentricity is most likely due to planet-planet interactions. We use simulations to demonstrate that the GJ 3512 planetary system challenges generally accepted formation theories, and that it puts constraints on the planet accretion and migration rates. Disk instabilities may be more efficient in forming planets than previously thought.

7.
Bone Joint J ; 100-B(2): 176-182, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29437059

RESUMEN

AIMS: Fractures of the navicular can occur in isolation but, owing to the intimate anatomical and biomechanical relationships, are often associated with other injuries to the neighbouring bones and joints in the foot. As a result, they can lead to long-term morbidity and poor function. Our aim in this study was to identify patterns of injury in a new classification system of traumatic fractures of the navicular, with consideration being given to the commonly associated injuries to the midfoot. PATIENTS AND METHODS: We undertook a retrospective review of 285 consecutive patients presenting over an eight- year period with a fracture of the navicular. Five common patterns of injury were identified and classified according to the radiological features. Type 1 fractures are dorsal avulsion injuries related to the capsule of the talonavicular joint. Type 2 fractures are isolated avulsion injuries to the tuberosity of the navicular. Type 3 fractures are a variant of tarsometatarsal fracture/dislocations creating instability of the medial ray. Type 4 fractures involve the body of the navicular with no associated injury to the lateral column and type 5 fractures occur in conjunction with disruption of the midtarsal joint with crushing of the medial or lateral, or both, columns of the foot. RESULTS: In order to test the reliability and reproducibility of this new classification, a cohort of 30 patients with a fracture of the navicular were classified by six independent assessors at two separate times, six months apart. Interobserver reliability and intraobserver reproducibility both had substantial agreement, with kappa values of 0.80 and 0.72, respectively. CONCLUSION: We propose a logical, all-inclusive, and mutually exclusive classification system for fractures of the navicular that gives associated injuries involving the lateral column due consideration. We have shown that this system is reliable and reproducible and have described the rationale for the subsequent treatment of each type. Cite this article: Bone Joint J 2018;100-B:176-82.


Asunto(s)
Traumatismos de los Pies/clasificación , Fracturas Óseas/clasificación , Huesos Tarsianos/lesiones , Traumatismos de los Pies/diagnóstico por imagen , Fracturas Óseas/diagnóstico por imagen , Humanos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Huesos Tarsianos/diagnóstico por imagen , Tomografía Computarizada por Rayos X
8.
Bone Joint J ; 98-B(6): 806-11, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-27235524

RESUMEN

AIMS: The purpose of this study was to compare symptomatic treatment of a fracture of the base of the fifth metatarsal with immobilisation in a cast. Our null hypothesis was that immobilisation gave better patient reported outcome measures (PROMs). The alternative hypothesis was that symptomatic treatment was not inferior. PATIENTS AND METHODS: A total of 60 patients were randomised to receive four weeks of treatment, 36 in a double elasticated bandage (symptomatic treatment group) and 24 in a below-knee walking cast (immobilisation group). The primary outcome measure used was the validated Visual Analogue Scale Foot and Ankle (VAS-FA) Score. Data were analysed by a clinician, blinded to the form of treatment, at presentation and at four weeks, three months and six months after injury. Loss to follow-up was 43% at six months. Multiple imputations missing data analysis was performed. RESULTS: At four weeks and six months, symptomatic treatment proved non-inferior in terms of primary outcome. TAKE HOME MESSAGE: Immobilisation is no better than symptomatic treatment in the management of a fracture of the base of the fifth metatarsal when judged by PROMs. Significant loss to follow-up with this injury could be expected in longer term. Cite this article: Bone Joint J 2016;98-B:806-11.


Asunto(s)
Moldes Quirúrgicos , Vendajes de Compresión , Fracturas por Avulsión/terapia , Inmovilización , Huesos Metatarsianos/lesiones , Adolescente , Adulto , Anciano , Femenino , Humanos , Perdida de Seguimiento , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Método Simple Ciego , Escala Visual Analógica , Adulto Joven
9.
Neurology ; 54(3): 552-7, 2000 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-10680782

RESUMEN

BACKGROUND: Oxidative stress has been implicated in inflammatory demyelination. The glutathione S-transferase (GST) supergene family encodes isoenzymes that appear to be critical in protection against oxidative stress. Certain GST loci are polymorphic, demonstrating alleles that are null (GSTM1/GSTT1), encode low activity variants (GSTP1), or are associated with variable inducibility (GSTM3). OBJECTIVES: To investigate the association between clinical outcome in MS and allelic variants of GSTM1, GSTM3, GSTT1, and GSTP1. METHODS: Four hundred patients with clinically definite MS were studied. Disability was measured using the Kurtzke Expanded Disability Status Scale (EDSS). Disability was graded as mild (EDSS 0-4), moderate (4.5-5.5), or severe (EDSS 6-10). PCR-based genotyping was performed using DNA extracted from lymphocytes. Significant associations between GST genotypes and clinical outcome were corrected for gender, onset age, and disease duration using logistic regression. RESULTS: We found that the GSTM3 AA genotype was associated with severe disability in patients with a disease duration of more than 10 years (p = 0.027, n = 177, OR = 2.4, 95% CI = 1.1-5.0). Homozygosity for both GSTM1*0 and GSTP1*Ile105 containing allele was associated with severe disability in patients with a disease duration greater than 10 years (p = 0.022, n = 179, OR = 5.0, 95% CI = 1.3-19.8). CONCLUSIONS: Our results suggest that long-term prognosis in MS is influenced by a genetically determined ability to remove the toxic products of oxidative stress.


Asunto(s)
Evaluación de la Discapacidad , Glutatión Transferasa/genética , Esclerosis Múltiple/genética , Esclerosis Múltiple/fisiopatología , Polimorfismo Genético/genética , Adulto , Edad de Inicio , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad
10.
J Neuroimmunol ; 129(1-2): 197-204, 2002 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-12161036

RESUMEN

We studied the association between clinical outcome in MS and allelic variants single nucleotide polymorphisms (SNPs) of interleukin-1alpha (IL-1alpha), IL-1beta and a variable number tandem repeat (VNTR) in IL-1 receptor antagonist (IL-1RN). A total of 377 patients with MS were studied. Significant associations between IL-1 genotypes and clinical outcome were found using logistic regression after correction for gender, onset age and disease duration. The same trends were subsequently demonstrated in a second independent group of 67 primary progressive patients. Our results suggest that genetically determined immunomodulation mediated by IL-1 influences long-term prognosis in multiple sclerosis (MS).


Asunto(s)
Adyuvantes Inmunológicos/genética , Predisposición Genética a la Enfermedad/genética , Interleucina-1/genética , Esclerosis Múltiple/genética , Esclerosis Múltiple/inmunología , Polimorfismo Genético/genética , Sialoglicoproteínas/genética , Adulto , Edad de Inicio , Estudios de Casos y Controles , Progresión de la Enfermedad , Femenino , Frecuencia de los Genes/genética , Genotipo , Homocigoto , Humanos , Proteína Antagonista del Receptor de Interleucina 1 , Interleucina-1/inmunología , Desequilibrio de Ligamiento/genética , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/fisiopatología , Polimorfismo Genético/inmunología , Factores Sexuales , Sialoglicoproteínas/inmunología
11.
J Neurol ; 248(4): 304-10, 2001 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-11374095

RESUMEN

The association between susceptibility to multiple sclerosis (MS) and the class II MHC allele HLA-DRB1*15 is well established although a possible relationship between this allele and outcome in MS is less clear. HLA-DRB1 typing was performed on 375 unrelated white patients with clinically definite MS and on 367 healthy controls. Putative associations of the gene with outcome were examined by dividing patients into two groups: those with an EDSS of 0-5.5 (mild/moderate disease) and those with an EDSS of 6-10 (severe disease). In order to minimise the effects of disease variability patients with a disease duration of at least 10 years or 15 years were examined. As subsidiary HLA-DRB1*03 and HLA-DRB1*04 associations have been previously reported, the effect of these alleles was also examined. As expected, HLA-DRB1*15 was found more frequently in patients than in controls (P < 0.000001). HLA-DRB1*15 positive patients had a significantly earlier age at onset than HLA-DRB1*15 negative patients. No significant associations were noted between HLA-DRB1*15 and outcome in the total patient group or in patients with a disease duration of 10 years or longer. In patients with a disease duration of at least 15 years HLA-DRB1*15 negative status was associated with a worse prognosis, although this did not remain significant after correction for multiple testing. It is thus likely that the contribution of HLA in MS is primarily towards onset and initial triggering mechanisms rather than influencing disease progression, chronicity and severity.


Asunto(s)
Predisposición Genética a la Enfermedad , Antígenos HLA-DR/genética , Esclerosis Múltiple/genética , Adulto , Edad de Inicio , Estudios de Casos y Controles , Enfermedad Crónica , Progresión de la Enfermedad , Femenino , Cadenas HLA-DRB1 , Humanos , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/inmunología , Esclerosis Múltiple/patología , Pronóstico , Índice de Severidad de la Enfermedad
16.
Clin Anat ; 18(4): 239-44, 2005 May.
Artículo en Inglés | MEDLINE | ID: mdl-15832327

RESUMEN

Bony or cartilaginous ossicles occur at the plantar aspect of the interphalangeal joint of the great toe. The variation in pattern, prevalence, and anatomic relationships of these structures is not clearly established in the literature, especially in a Caucasian population. Without this knowledge, pathology at this joint may be underestimated and surgical approaches may be poorly planned particularly as radiographs underestimate the incidence of ossicles at this joint. The aims of this study were to determine the incidence and pattern of ossicles at this joint and to establish their anatomic relationships to aid planning the approach for their excision. The interphalangeal joint of the left hallux was dissected in 40 British Caucasian cadavers and the pattern of nodules and their anatomic relationships were established. In 27.5% of subjects, there was no identifiable ossicle and, in these specimens, the tendon of flexor hallucis longus was adherent to the joint capsule. In the remaining specimens (72.5%), a bursa separated the tendon of flexor hallucis longus from the plantar joint capsule and nodules were found embedded within the joint capsule. More than half (52.5%) of the specimens had a single nodule located centrally within the plantar capsule and the remaining 20% had two nodules lying within the capsule. This study shows that a large proportion of the population have either one or two bony or cartilaginous ossicles at this joint. It has also shown that, when present, these structures do not lie within the tendon of flexor hallucis longus and may be most safely excised from a medial approach.


Asunto(s)
Enfermedades del Pie/patología , Enfermedades del Pie/cirugía , Cápsula Articular/patología , Articulación del Dedo del Pie/anatomía & histología , Articulación del Dedo del Pie/patología , Adulto , Cadáver , Calcinosis , Femenino , Hallux , Humanos , Incidencia , Masculino , Valores de Referencia , Huesos Sesamoideos , Articulación del Dedo del Pie/cirugía , Población Blanca
17.
J Gen Microbiol ; 121(1): 181-6, 1980 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-7019386

RESUMEN

Transport of radioactively labelled peptides has been used to characterize a common transport system for di- and tripeptides in Candida albicans. This permease is energy-dependent and has a requirement for L-amino acid residues, an alpha-linkage between residues and a free amino terminus. Transport was followed by the accumulation inside the cell of intact peptides and component amino acids. After transport of glycyl-[U-14C]phenylalanine the radioactive material was accumulated inside the cell and subsequently leaked into the medium under certain conditions.


Asunto(s)
Candida albicans/metabolismo , Péptidos/metabolismo , Aminoácidos/metabolismo , Transporte Biológico Activo , Candida albicans/enzimología , Dipéptidos/metabolismo , Cinética , Proteínas de Transporte de Membrana/metabolismo
18.
Artículo en Inglés | MEDLINE | ID: mdl-2448116

RESUMEN

When the EEG is averaged time-locked to blinks, and the part of the potential that is proportional to the EOG is subtracted, a signal (the 'residuum') remains which resembles an event-related potential (ERP). The blink time-locked average (BTA) was investigated to determine whether the components of the residuum are due to a cerebral blink-related potential or to artifacts of the EOG which subtraction failed to remove. The BTA was obtained from 12 subjects using voluntary blinking in the light and in complete darkness. Differences between the potentials in light and dark indicate that a major component of the residuum is a visual evoked response elicited by the off-on light stimulus associated with blink eye closure. The results are discussed in relation to attempts to correct blink artifacts in ERP experiments and, by drawing parallels between the residuum and the lambda potential associated with saccades, similar inferences are made for the correction of eye movement artifacts.


Asunto(s)
Parpadeo , Electroencefalografía , Potenciales Evocados Visuales , Adulto , Electrooculografía , Humanos
19.
Injury ; 28(4): 321-2, 1997 May.
Artículo en Inglés | MEDLINE | ID: mdl-9282192

RESUMEN

A new physical sign (the 'toe up' sign) is described in relation to an irreducible Lisfranc injury, the cause being the interposed lateral slip of the tibialis anterior tendon. Surgical exploration is advocated.


Asunto(s)
Luxaciones Articulares/diagnóstico , Articulaciones Tarsianas/lesiones , Traumatismos de los Tendones/diagnóstico por imagen , Tendones , Accidentes de Trabajo , Adulto , Humanos , Luxaciones Articulares/diagnóstico por imagen , Masculino , Examen Físico , Radiografía
20.
Clin Anat ; 16(6): 520-1, 2003 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-14566900

RESUMEN

We describe a patient who was found to have two sesamoid bones at the interphalangeal joint of the right great toe after radiographs for dislocation of the joint. Recognition of the sesamoids required careful scrutiny of the films. Interphalangeal sesamoids may cause painful callosities plantar to the joint or may become incarcerated in a dislocated joint. Our patient made a good recovery. The presence of sesamoid bones on the medial and lateral sides of the joint was unusual.


Asunto(s)
Luxaciones Articulares/diagnóstico por imagen , Huesos Sesamoideos/anomalías , Huesos Sesamoideos/diagnóstico por imagen , Articulación del Dedo del Pie/anomalías , Articulación del Dedo del Pie/lesiones , Adulto , Humanos , Masculino , Radiografía , Fútbol/lesiones , Articulación del Dedo del Pie/diagnóstico por imagen
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