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1.
Injury ; 55(10): 111723, 2024 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-39018833

RESUMEN

INTRODUCTION: Displaced intracapsular neck of femur (NOF) fractures secondary to civilian gunshots are rare injuries with universally poor outcomes following surgical fixation. No studies have been published on fracture mapping in NOF fractures secondary to civilian gunshots. OBJECTIVES: We performed CT scan-based fracture mapping to identify the most common fracture patterns in these injuries. METHODS: Design: Retrospective search of prospectively collected data. SETTING: Single Level 1 Trauma hospital. Patient selection criteria: All patients presenting with gunshot fractures to the femur neck between 01 January 2009 and 31 December 2022 were identified. Once identified from Picture Archiving and Communication System (PACS), computed tomography (CT) scans in Digital Imaging and Communication in Medicine (DICOM) format were imported into Mimics 16 software and fracture fragments were segmented and three-dimensional (3D) reconstruction was generated. The reduced fractures were exported to 3-Matic software to merge the fragments and adjust the orientation in three planes. An uninjured femur model was used as a template for reduction. Fracture lines and heat maps were then generated. Our outcome measures were successful mapping of the identified fracture lines. RESULTS: A total of 25 intracapsular femur neck fractures were identified and suitable for CT scan mapping. All patients were male with an average age of 22 (range 18-32). Once generated, fracture maps were used to show the location, distribution and frequency of the fracture lines. In all but two cases the fracture line propagation remained within the confines of the hip joint capsule. In three cases there was fracture extension into the superior aspect of the femur head, and in one case extension into the inferior aspect. CONCLUSION: This is the first study to perform 3D fracture mapping for intracapsular femur neck fractures secondary to civilian gunshot injuries. The exercise has helped us better understand the commonest fracture patterns and assisted us with surgical planning and execution.


Asunto(s)
Fracturas del Cuello Femoral , Imagenología Tridimensional , Tomografía Computarizada por Rayos X , Heridas por Arma de Fuego , Humanos , Heridas por Arma de Fuego/diagnóstico por imagen , Fracturas del Cuello Femoral/diagnóstico por imagen , Fracturas del Cuello Femoral/cirugía , Estudios Retrospectivos , Masculino , Adulto , Adulto Joven , Fijación Interna de Fracturas/métodos , Adolescente , Centros Traumatológicos
2.
Int Orthop ; 46(1): 37-42, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-33834264

RESUMEN

BACKGROUND: The deleterious effects of hypoalbuminaemia in the peri-operative period are well documented. We aimed to review serum albumin levels in a cohort of orthopaedic trauma patients to determine the prevalence of hypoalbuminaemia. Secondarily, we aimed to identify factors associated with an increased risk of hypoalbuminaemia. METHODS: A retrospective cross-sectional study was performed of data collected prospectively at a regional hospital serving primarily a rural population in South Africa. RESULTS: Two hundred ninety-five patients were included in the study. Twenty-nine per cent of the cohort was found to have hypoalbuminaemia. Femur neck fractures (p < 0.001), intertrochanteric fractures (p = 0.004), tibial plateau fractures (p = 0.034) and polytrauma (p = 0.013) were associated with hypoalbuminaemia. The mean albumin level was lower in HIV-positive patients when compared to HIV-negative patients (35.7 g/L vs 37.5 g/L, p = 0.007). The presence of comorbidities other than HIV, like diabetes mellitus (p = 0.001), previous pulmonary tuberculosis (p = 0.034) and chronic renal failure (p = 0.007) was associated with hypoalbuminaemia. CONCLUSION: In this cohort of orthopaedic trauma patients from rural South Africa, we found a 29% prevalence of hypoalbuminaemia at the time of presentation. High-risk subgroups include patients with pre-existing comorbidities and increased age, as well as patients presenting with polytrauma, femoral neck, intertrochanteric femur or tibial plateau fractures.


Asunto(s)
Hipoalbuminemia , Ortopedia , Estudios Transversales , Hospitales Rurales , Humanos , Hipoalbuminemia/complicaciones , Estudios Retrospectivos , Sudáfrica/epidemiología
3.
S Afr Med J ; 111(7): 642-648, 2021 Jun 30.
Artículo en Inglés | MEDLINE | ID: mdl-34382547

RESUMEN

BACKGROUND: Empirical antibiotic strategies in the treatment of chronic osteomyelitis should ideally be based on local microbiological antibiograms. OBJECTIVES: To review the antibiogram profiles of bacterial isolates of patients undergoing surgical treatment for chronic osteomyelitis and identify the most appropriate empirical antibiotic strategy. METHODS: A retrospective review of clinical records and microbial culture reports was performed for all patients who underwent treatment for chronic osteomyelitis at two orthopaedic units in Western Cape Province, South Africa, between March 2016 and December 2019. Reported antibiotic susceptibility data were used to predict the potential efficacy of different empirical antibiotic regimens, according to underlying aetiology (fracture related, contiguous, haematogenous). RESULTS: Two hundred patients with chronic osteomyelitis of the appendicular skeleton underwent surgical management. Antibiogram profiles for 218 organisms, isolated from 169 patients, were evaluated. Staphylococcus aureus (41%) and Enterobacterales (30%) were the most common organisms isolated. The combinations of meropenem plus vancomycin, and piperacillin-tazobactam plus amikacin plus vancomycin, as empirical postoperative antibiotics would both effectively treat 78% of chronic osteomyelitis cases overall. The most effective practical oral combinations were co-amoxiclav plus ciprofloxacin (61%) and co-trimoxazole plus ciprofloxacin (61%). CONCLUSIONS: This study reports antibiogram profiles in the developing-world setting that could potentially guide empirical antibiotic choices in the management of chronic osteomyelitis.


Asunto(s)
Antibacterianos/uso terapéutico , Países en Desarrollo/estadística & datos numéricos , Pruebas de Sensibilidad Microbiana , Osteomielitis/microbiología , Adulto , Enfermedad Crónica , Extremidades , Femenino , Humanos , Masculino , Osteomielitis/tratamiento farmacológico , Osteomielitis/cirugía , Estudios Retrospectivos , Sudáfrica
4.
S Afr Med J ; 111(7): 655-660, 2021 Jun 30.
Artículo en Inglés | MEDLINE | ID: mdl-34382549

RESUMEN

BACKGROUND: South Africa (SA) has one of the highest gun-related mortality rates in the world - 20 people per day. The available data, however, do not reflect the substantial number of patients suffering non-lethal firearm injuries. Gunshot-related injury has been recognised as a highly costly healthcare problem by individual treating centres in SA and other countries; however, no 'national picture' has been examined in detail. OBJECTIVES: To explore the burden of gunshot-related orthopaedic injuries across SA. METHODS: A multicentre research network was established in SA, and 37 orthopaedic units across 9 provinces participated. A prospective, observational cohort study was performed during a 2-week period in 2019. Patients were screened, enrolled and reported by local orthopaedic teams. Patients were included if they had at least one acute gunshot-related orthopaedic fracture referred to the orthopaedic service. Patients were asked additional questions around baseline health-related quality-of-life (HRQOL) and personal circumstances. Follow-up was at 8 weeks after injury. RESULTS: Thirty-seven centres enrolled 135 patients over the 2-week study period. Western Cape Province had the highest number of reported cases (n=52; 39%), followed by Gauteng (n=35; 26%) and KwaZulu-Natal (n=29; 21%). The median age of patients was 30.5 years and the majority were male (89%). Forty-three percent of patients had been either shot or stabbed prior to this injury. Fifty-two percent of all patients required fracture fixation surgery and 11% required wound debridement without fracture fixation. HRQOL data were collected successfully at baseline, but follow-up data were available for <25% of cases. CONCLUSIONS: Gunshot-related orthopaedic injuries represent a significant burden of disease in the SA healthcare environment. This study highlights several areas for further research in the management of the injuries and associated outcomes.


Asunto(s)
Huesos/lesiones , Heridas por Arma de Fuego/epidemiología , Adulto , Huesos/cirugía , Desbridamiento , Femenino , Fijación de Fractura , Humanos , Masculino , Estudios Prospectivos , Sudáfrica/epidemiología , Heridas por Arma de Fuego/cirugía
5.
S Afr Med J ; 111(3): 240-244, 2021 03 02.
Artículo en Inglés | MEDLINE | ID: mdl-33944745

RESUMEN

BACKGROUND: The COVID-19 pandemic has impacted on the global surgery landscape. OBJECTIVES: To analyse and describe the initial impact of the COVID-19 pandemic on orthopaedic surgery at Groote Schuur Hospital, a tertiary academic hospital in South Africa. METHODS: The number of orthopaedic surgical cases, emergency theatre patient waiting times, and numbers of outpatient clinic visits, ward admissions, bed occupancies and total inpatient days for January - April 2019 (pre-COVID-19) were compared with the same time frame in 2020 (COVID-19). The COVID-19 timeframe included initiation of a national 'hard lockdown' from 26 March 2020, in preparation for an increasing volume of COVID-19 cases. RESULTS: April 2020, the time of the imposed hard lockdown, was the most affected month, although the number of surgical cases had started to decrease slowly during the 3 preceding months. The total number of surgeries, outpatient visits and ward admissions decreased significantly during April 2020 (55.2%, 69.1% and 60.6%, respectively) compared with April 2019 (p<0.05). Trauma cases were reduced by 40% in April 2020. Overall emergency theatre patient waiting time was 30% lower for April 2020 compared with 2019. CONCLUSIONS: COVID-19 and the associated lockdown has heavily impacted on both orthopaedic inpatient and outpatient services. Lockdown led to a larger reduction in the orthopaedic trauma burden than in international centres, but the overall reduction in surgeries, outpatient visits and hospital admissions was less. This lesser reduction was probably due to local factors, but also to a conscious decision to avoid total collapse of our surgical services.


Asunto(s)
COVID-19/epidemiología , Procedimientos Ortopédicos/estadística & datos numéricos , Neumonía Viral/epidemiología , Atención Ambulatoria/estadística & datos numéricos , Ocupación de Camas/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Hospitales Urbanos , Humanos , Tiempo de Internación/estadística & datos numéricos , Pandemias , SARS-CoV-2 , Sudáfrica/epidemiología , Centros de Atención Terciaria , Listas de Espera
6.
S Afr Med J ; 111(8): 747-752, 2021 Aug 02.
Artículo en Inglés | MEDLINE | ID: mdl-35227355

RESUMEN

BACKGROUND:  Initial local and global evidence suggests that SARS-CoV-2-infected patients who undergo surgery, and those who become infected perioperatively, have an increased mortality risk post surgery. OBJECTIVES: To analyse and describe the 30-day mortality, presurgical COVID-19 status and hospital-acquired SARS-CoV-2 infection rates of patients, both SARS-CoV-2-positive and negative, undergoing orthopaedic surgery at a tertiary academic hospital in South Africa (SA) during the first COVID-19 peak. METHODS: This single-centre, observational, prospective study included patients who underwent orthopaedic procedures from 1 April 2020 (beginning of the COVID-19 case increase in SA) to 31 July 2020 (first COVID-19 peak in SA). All patients were screened for COVID-19 and were confirmed positive if they had a positive laboratory quantitative polymerase chain reaction test for SARS-CoV-2 RNA on a nasopharyngeal or oral swab. Thirty-day mortality, presurgical COVID-19 status and hospital-acquired SARS-CoV-2 infection were assessed. RESULTS:  Overall, a total of 433 operations were performed on 346 patients during the timeframe. Of these patients, 65.9% (n=228) were male and 34.1% (n=118) were female. The mean (standard deviation) age was 42.5 (16.8) years (range 9 - 89). Of the patients, 5 (1.4%) were identified as COVID-19 patients under investigation (PUI) on admission and tested positive for SARS-CoV-2 before surgery, and 1 (0.3%) contracted SARS-CoV-2 perioperatively; all survived 30 days post surgery. Twenty-nine patients were lost to follow-up, and data were missing for 6 patients. The final analysis was performed excluding these 35 patients. Of the 311 patients included in the final 30-day mortality analysis, 303 (97%) had a follow-up observation ≥30 days after the operation. The overall 30-day mortality for these patients was 2.5% (n=8 deaths). None of the recorded deaths were of screened COVID-19 PUI. CONCLUSIONS: We report a low 30-day mortality rate of 2.5% (n=8) for patients undergoing orthopaedic surgery at our hospital during the first COVID-19 peak. None of the deaths were COVID-19 related, and all patients who tested SARS-CoV-2-positive, before or after surgery, survived. Our overall 30-day mortality rate correlates with several other reports of orthopaedic centres analysing over similar timeframes during the first peak of the COVID-19 pandemic. Regarding mortality and SARS-CoV-2 infection risk, we can conclude that with the appropriate measures taken, it was safe to undergo orthopaedic procedures at our hospital during the first peak of the COVID-19 pandemic in SA.


Asunto(s)
COVID-19/diagnóstico , COVID-19/epidemiología , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/epidemiología , Procedimientos Ortopédicos/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Prueba de COVID-19 , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Prospectivos , SARS-CoV-2 , Sudáfrica/epidemiología
7.
S Afr Med J ; 110(6): 532-536, 2020 May 29.
Artículo en Inglés | MEDLINE | ID: mdl-32880567

RESUMEN

BACKGROUND: Institutions are increasingly using technology to augment the class learning experience of medical students. Especially in Africa, local content is key to allow insights and knowledge to emerge and build transformative capacity for students and patients. There is currently no peer-reviewed video content produced by students with the aim of providing education on orthopaedic topics for medical students and patients in this region. OBJECTIVES: To evaluate the demographic and geographical viewership as well as video-specific statistics of orthopaedic teaching videos for medical students on a YouTube channel, with the expressed aim of informing future content production. METHODS: Videos were produced by South African (SA) medical students as a problem-based collaborative project. Student-owned smartphones and various types of free video editing software were used to produce these videos, which were then assessed by a group of orthopaedic specialists and uploaded onto a YouTube channel (UCTeach). The analytical reports of this channel generated by Google and YouTube were analysed regarding watch time per day (minutes), average view duration (minutes), most watched videos, top geographies, age and gender. RESULTS: A total of 83 videos were uploaded to the UCTeach Ortho channel during a 2-year period, with a total watch time of 857 062 minutes and 337 983 views. The majority of viewers were between the ages of 18 and 34 years (85%). India had the most views (n=69 089), followed by the USA (n=66 257) and SA (n=21 882). Most of the videos were watched on mobile phones (n=183 299) and computers (n=128 228). The most watched video, produced in April 2016, was on physiological and pathological gait, with 51 314 views. CONCLUSIONS: Our study provides proof of concept for a new educational material creation and dissemination strategy. A low-cost local collaborative orthopaedic video project by medical students for medical students can lead to high view counts and watch time on YouTube. It is accessible to audiences in low-, middle- and high-income countries. The students' educational videos also reached a global audience consistently over a 3-year period.


Asunto(s)
Educación de Pregrado en Medicina/métodos , Internet , Ortopedia/educación , Grabación en Video , África Austral , Evaluación Educacional , Femenino , Humanos , Masculino , Adulto Joven
8.
Sci Rep ; 8(1): 10983, 2018 Jul 20.
Artículo en Inglés | MEDLINE | ID: mdl-30030488

RESUMEN

Secondary cell wall (SCW) deposition in Arabidopsis is regulated among others by NAC transcription factors, where SND1 chiefly initiates xylem fibre differentiation while VND6 controls metaxylem vessel SCW development, especially programmed cell death and wall patterning. The translational relevance of Arabidopsis SCW regulation theory and the utility of characterized transcription factors as modular synthetic biology tools for improving commercial fibre crops is unclear. We investigated inter-lineage gene activation dynamics for potential fibre and vessel differentiation regulators from the widely grown hardwood Eucalyptus grandis (Myrtales). EgrNAC26, a VND6 homolog, and EgrNAC61, an SND1 homolog, were transiently expressed in Arabidopsis mesophyll protoplasts in parallel to determine early and late (i.e. 7 and 14 hours post-transfection) gene targets. Surprisingly, across the time series EgrNAC26 activated only a subset of SCW-related transcription factors and biosynthetic genes activated by EgrNAC61, specializing instead in targeting vessel-specific wall pit and programmed cell death markers. Promoters of EgrNAC26 and EgrNAC61 both induced reporter gene expression in vessels of young Arabidopsis plants, with EgrNAC61 also conferring xylem- and cork cambium-preferential expression in Populus. Our results demonstrate partial conservation, with notable exceptions, of SND1 and VND6 homologs in Eucalyptus and a first report of cork cambium expression for EgrNAC61.


Asunto(s)
Arabidopsis/genética , Eucalyptus/genética , Estructuras de las Plantas/crecimiento & desarrollo , Factores de Transcripción/farmacología , Activación Transcripcional/efectos de los fármacos , Xilema/crecimiento & desarrollo , Proteínas de Arabidopsis , Regulación de la Expresión Génica de las Plantas , Genes de Plantas , Proteínas de Plantas/genética , Estructuras de las Plantas/genética , Homología de Secuencia de Aminoácido , Factores de Tiempo , Xilema/genética
9.
S Afr Med J ; 107(10): 854-858, 2017 Sep 22.
Artículo en Inglés | MEDLINE | ID: mdl-29022528

RESUMEN

BACKGROUND: GeneXpert MTB/RIF is useful for the diagnosis of pulmonary TB in adults, but there is limited evidence on its usefulness in extrapulmonary TB. OBJECTIVES: To investigate the diagnostic accuracy of GeneXpert MTB/RIF in HIV-infected and HIV-uninfected patients with suspected musculoskeletal TB. METHODS: A prospective study of patients with suspected musculoskeletal (bone and joint) TB was undertaken. The diagnostic accuracy of GeneXpert MTB/RIF was compared with the reference standards of culture and histopathology. RESULTS: A total of 206 biopsies from 201 patients (23% HIV-infected) were evaluated. The sensitivity and specificity of GeneXpert MTB/RIF was 92.3% (84/91) and 99.1% (114/115), respectively. GeneXpert MTB/RIF detected 8.8% more cases than culture (84/91 (92.3%) v. 76/91 (83.5%), respectively; p=0.069). GeneXpert MTB/RIF also detected all 4 multidrug-resistant TB cases and an additional 2 rifampicin-resistant cases in culture-negative samples. The sensitivity of GeneXpert MTB/RIF in HIV-infected patients was 96.9% (31/32) v. 89.6% (43/48) in HIV-uninfected patients (p=0.225). CONCLUSION: GeneXpert MTB/RIF is an accurate test for the detection of TB in tissue samples of HIV-infected and HIV-uninfected patients with suspected musculoskeletal TB. A positive GeneXpert MTB/RIF result should be regarded as microbiological confirmation of TB.

10.
Orthop Traumatol Surg Res ; 103(5): 801-807, 2017 09.
Artículo en Inglés | MEDLINE | ID: mdl-28546049

RESUMEN

A growing burden of gunshot injuries demands evidence-based ballistic trauma management. No comprehensive systematic overview of the current knowledge is available to date. This study aims to identify and analyze the most influential publications in the field of orthopedic ballistic trauma research. All databases available in the Thomson Reuters Web of Knowledge were searched to conduct this bibliometrical study. The most cited orthopedic ballistic trauma articles published between 1950 and 2015 were identified by use of a multi-step approach. Publications with ten citations and more were analyzed for citations, journal, authorship, geographic origin, area of research, anatomical site, study type, study category, and level of evidence. Citations of the 128 included studies ranged from 113 to 10. These were published in fifty different journals between 1953 and 2011. Most publications (n=106; 83%) originated from the USA, were retrospective (n=85; 66.4%), level IV studies (n=90; 70.3%), reported on spinal gunshot injuries (n=49; 38.33%) and were published between 1980 and 2000 (n=111; 86.7%). This bibliometric study provides the first comprehensive overview of influential publications in the field of orthopedic ballistic trauma research. More prospective studies and high-quality systematic reviews are needed. Centres with a high burden of gunshot injuries from the developing world need to share their experience in form of international publications, to provide a more comprehensive picture of the global gun-related orthopedic injury burden. TYPE OF STUDY: bibliometric analysis: level III.


Asunto(s)
Bibliometría , Ortopedia , Publicaciones Periódicas como Asunto/estadística & datos numéricos , Esqueleto/lesiones , Heridas por Arma de Fuego/complicaciones , Humanos
11.
S. Afr. med. j. (Online) ; 107(10): 854-858, 2017.
Artículo en Inglés | AIM (África) | ID: biblio-1271144

RESUMEN

Background. GeneXpert MTB/RIF is useful for the diagnosis of pulmonary TB in adults, but there is limited evidence on its usefulness in extrapulmonary TB.Objectives. To investigate the diagnostic accuracy of GeneXpert MTB/RIF in HIV-infected and HIV-uninfected patients with suspected musculoskeletal TB.Methods. A prospective study of patients with suspected musculoskeletal (bone and joint) TB was undertaken. The diagnostic accuracy of GeneXpert MTB/RIF was compared with the reference standards of culture and histopathology.Results. A total of 206 biopsies from 201 patients (23% HIV-infected) were evaluated. The sensitivity and specificity of GeneXpert MTB/RIF was 92.3% (84/91) and 99.1% (114/115), respectively. GeneXpert MTB/RIF detected 8.8% more cases than culture (84/91 (92.3%) v. 76/91 (83.5%), respectively; p=0.069). GeneXpert MTB/RIF also detected all 4 multidrug-resistant TB cases and an additional 2 rifampicin-resistant cases in culture-negative samples. The sensitivity of GeneXpert MTB/RIF in HIV-infected patients was 96.9% (31/32) v. 89.6% (43/48) in HIV-uninfected patients (p=0.225).Conclusion. GeneXpert MTB/RIF is an accurate test for the detection of TB in tissue samples of HIV-infected and HIV-uninfected patients with suspected musculoskeletal TB. A positive GeneXpert MTB/RIF result should be regarded as microbiological confirmation of TB


Asunto(s)
Exactitud de los Datos , Infecciones por VIH , Enfermedades Musculoesqueléticas , Rifampin , Sudáfrica , Análisis de Matrices Tisulares , Tuberculosis Pulmonar
12.
Bone Joint J ; 98-B(10): 1382-1388, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27694593

RESUMEN

AIMS: Patients undergoing femoral lengthening by external fixation tolerate treatment less well when compared to tibial lengthening. Lengthening of the femur with an intramedullary device may have advantages. PATIENTS AND METHODS: We reviewed all cases of simple femoral lengthening performed at our unit from 2009 to 2014. Cases of nonunions, concurrent deformities, congenital limb deficiencies and lengthening with an unstable hip were excluded, leaving 33 cases (in 22 patients; 11 patients had bilateral procedures) for review. Healing index, implant tolerance and complications were compared. RESULTS: In 20 cases (15 patients) the Precice lengthening nail was used and in 13 cases (seven patients) the LRS external fixator system. The desired length was achieved in all cases in the Precice group and in 12 of 13 cases in the LRS group. The mean healing index was 31.3 days/cm in the Precice and 47.1 days/cm in the LRS group (p < 0.001). This was associated with an earlier ability to bear full weight without aids in the Precice group. There were more complications with LRS lengthening, including pin site infections and regenerate deformity. Implant tolerance and the patients' perception of the cosmetic result were better with the Precice treatment. CONCLUSION: Femoral lengthening with the Precice femoral nail achieved excellent functional results with fewer complications and greater patient satisfaction when compared with the LRS system in our patients. Cite this article: Bone Joint J 2016;98-B:1382-8.


Asunto(s)
Clavos Ortopédicos , Fijadores Externos , Fémur/cirugía , Diferencia de Longitud de las Piernas/cirugía , Osteogénesis por Distracción/métodos , Tibia/cirugía , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
13.
J Phys Condens Matter ; 27(40): 405302, 2015 Oct 14.
Artículo en Inglés | MEDLINE | ID: mdl-26402441

RESUMEN

We study amorphous Ge quantum dots embedded in a crystalline Si matrix through structure modeling and simulation using ab initio density functional theory including spin-orbit interaction and quasiparticle effects. Three models are generated by replacing a spherical region within diamond Si by Ge atoms and creating a disordered bond network with appropriate density inside the Ge quantum dot. After total-energy optimisations of the atomic geometry we compute the electronic and optical properties. We find three major effects: (i) the resulting nanostructures adopt a type-I heterostructure character; (ii) the lowest optical transitions occur only within the Ge quantum dots, and do not involve or cross the Ge-Si interface. (iii) for larger amorphous Ge quantum dots, with diameters of about 2.0 and 2.7 nm, absorption peaks appear in the mid-infrared spectral region. These are promising candidates for intense luminescence at photon energies below the gap energy of bulk Ge.

14.
Hand Surg ; 20(1): 67-72, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25609277

RESUMEN

Due to its mostly motor content, repair of the radial nerve is considered to yield favourable results. This is despite the fact that there are limited studies looking at the outcomes of end-to-end repair secondary to sharp penetrating trauma. We retrospectively reviewed the outcome of a series of repaired level 2 and level 3 radial nerves following penetrating stab injuries. Twenty-seven cases with adequate follow-up were included. All the patients underwent direct end-to-end repair. We evaluated the motor recovery of the target muscles using the British Medical Research Council (MRC) grading system. Wrist extension recovered in 93% of cases at a mean of six months. Finger extension recovered in 74% and thumb extension in 52% of cases within the follow-up period. We conclude that end-to-end repair is possible in the majority of level 2 and level 3 radial nerve lacerations secondary to penetrating stab injuries. Acceptable results can be expected.


Asunto(s)
Laceraciones/cirugía , Nervio Radial/lesiones , Nervio Radial/cirugía , Heridas Punzantes/cirugía , Adulto , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recuperación de la Función , Estudios Retrospectivos , Resultado del Tratamiento
15.
Bone Joint J ; 96-B(10): 1366-9, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25274923

RESUMEN

The lack of an accurate, rapid diagnostic test for mycobacterium tuberculosis (TB) is a major handicap in the management of spinal TB. GeneXpert, a new, rapid molecular diagnostic test is recommended as the first line investigation for suspected pulmonary TB in areas with a high prevalence of HIV or drug resistance, yet it has not been validated for the diagnosis of musculoskeletal TB. The aim of this study was to assess the accuracy of GeneXpert in diagnosing spinal TB. A prospective clinical study of 69 consecutive adults with suspected spinal TB was conducted at a tertiary hospital in an area with the highest incidence and prevalence of TB in the world. GeneXpert was used on tissue samples of the enrolled patients and its diagnostic accuracy compared with a reference standard of tissue in liquid culture. A total of 71 spine samples from 69 patients (two re-biopsies) were included in the study. The GeneXpert test showed a sensitivity of 95.6% and specificity of 96.2% for spinal TB. The results of the GeneXpert test were available within 48 hours compared with a median of 35 days (IQR 15 to 43) for cultures. All cases of multi-drug resistant TB (MDR TB) were diagnosed accurately with the GeneXpert test. The MDR TB rate was 5.8%.


Asunto(s)
Líquido Cefalorraquídeo/microbiología , ADN Bacteriano/análisis , Mycobacterium tuberculosis/genética , Reacción en Cadena de la Polimerasa/métodos , Vértebras Torácicas , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis de la Columna Vertebral/diagnóstico , Adulto , Biopsia , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Prevalencia , Estudios Prospectivos , Reproducibilidad de los Resultados , Sudáfrica/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/líquido cefalorraquídeo , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis de la Columna Vertebral/líquido cefalorraquídeo , Tuberculosis de la Columna Vertebral/epidemiología
16.
J Microsc ; 250(3): 166-78, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23550616

RESUMEN

Malaria is a worldwide health problem with 225 million infections each year. A fast and easy-to-use method, with high performance is required to differentiate malaria from non-malarial fevers. Manual examination of blood smears is currently the gold standard, but it is time-consuming, labour-intensive, requires skilled microscopists and the sensitivity of the method depends heavily on the skills of the microscopist. We propose an easy-to-use, quantitative cartridge-scanner system for vision-based malaria diagnosis, focusing on low malaria parasite densities. We have used special finger-prick cartridges filled with acridine orange to obtain a thin blood film and a dedicated scanner to image the cartridge. Using supervised learning, we have built a Plasmodium falciparum detector. A two-step approach was used to first segment potentially interesting areas, which are then analysed in more detail. The performance of the detector was validated using 5,420 manually annotated parasite images from malaria parasite culture in medium, as well as using 40 cartridges of 11,780 images containing healthy blood. From finger prick to result, the prototype cartridge-scanner system gave a quantitative diagnosis in 16 min, of which only 1 min required manual interaction of basic operations. It does not require a wet lab or a skilled operator and provides parasite images for manual review and quality control. In healthy samples, the image analysis part of the system achieved an overall specificity of 99.999978% at the level of (infected) red blood cells, resulting in at most seven false positives per microlitre. Furthermore, the system showed a sensitivity of 75% at the cell level, enabling the detection of low parasite densities in a fast and easy-to-use manner. A field trial in Chittagong (Bangladesh) indicated that future work should primarily focus on improving the filling process of the cartridge and the focus control part of the scanner.


Asunto(s)
Automatización de Laboratorios/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Malaria Falciparum/diagnóstico , Microscopía/métodos , Parasitemia/diagnóstico , Parasitología/métodos , Plasmodium falciparum/citología , Bangladesh , Plasmodium falciparum/aislamiento & purificación , Sensibilidad y Especificidad
17.
Opt Lett ; 29(7): 736-8, 2004 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-15072375

RESUMEN

Comparison of two illumination modes for wide-field optical coherence tomography has revealed that spatially coherent illumination generates coherent cross talk, causing significant image degradation, and that spatially incoherent illumination, with an adequate interferometer design, provides an efficient mechanism for suppression of coherent cross talk. This is shown by comparison of a pulsed laser with a thermal light source for a U.S. Air Force resolution target covered with a scattering solution made from microbeads as well as for an ex vivo tooth.


Asunto(s)
Artefactos , Iluminación , Modelos Teóricos , Tomografía de Coherencia Óptica , Diseño de Equipo , Interferometría/instrumentación , Rayos Láser , Microesferas , Dispersión de Radiación , Tomografía de Coherencia Óptica/instrumentación
18.
Opt Lett ; 28(24): 2476-8, 2003 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-14690119

RESUMEN

A simple method for the calibration of optical path difference modulation in low-coherence interferometry is presented. Spectrally filtering a part of the detected interference signal results in a high-coherence signal that encodes the scan imperfections and permits their correction. The method is self-referenced in the sense that no secondary high-coherence light source is necessary. Using a spectrometer setup for spectral filtering allows for flexibility in both the choice of calibration wavelength and the maximum scan range. To demonstrate the method's usefulness, it is combined with a recently published digital spectral shaping technique to measure the thickness of a pellicle beam splitter with a white-light source.


Asunto(s)
Calibración , Interferometría , Modelos Teóricos , Valores de Referencia , Análisis Espectral
19.
Opt Lett ; 26(23): 1915-7, 2001 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-18059736

RESUMEN

An extension of the well-known technique for spectral phase interferometry for direct electric-field reconstruction (SPIDER) has been developed that permits the reconstruction of the spectral amplitude and the spectral phase of ultrashort laser pulses from the acquisition of only one spectrum. Temporal intensity and temporal phase can therefore easily be retrieved. The characterization of pulses from a Ti:sapphire oscillator by use of an extended SPIDER is discussed. Advantages and drawbacks of the modified technique are also discussed.

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