Clinical and Radiological Outcomes of Paediatric Forearm Fractures of the Radius and Ulna Following Fixation by Intramedullary Nailing or Plating: A Systematic Review.

Ipsilateral forearm fractures of both the radius and ulna in children are one of the most common forms of injuries in this population. They often result from axial loading on the hand and wrist following a fall on an outstretched hand. These injuries can often be managed either conservatively or operatively. Non-operative management involves the use of cast immobilisation after satisfactory closed reduction. Most fractures managed conservatively have been noted to have a successful outcome. Surgical options of management include the use of intramedullary nailing (IMN), plates and screws, hybrid techniques and rarely external fixators. The purpose of this systematic review is to critically analyse the functional and radiological outcomes as well as the probability of developing a complication in children that have undergone either IMN or plating of both the radius and ulna in the paediatric population. A comprehensive electronic database search from April 2014 until April 2022 was conducted. Studies from PubMed, EMBASE and Cochrane electronic databases were retrieved. A total of 260 cohort studies with children between the ages of 5 to 17 years old were identified. After the application of both inclusion and exclusion criteria, six articles with a total of 409 patients relevant to this review were identified and analysed. There were no significant inconsistencies statistically in functional and radiological outcomes. Overall complication rate and time to fracture union were similar. Intramedullary nailing was noted to have a shorter operative and anaesthetic time, longer fluoroscopic exposure, and a better cosmetic outcome. Differences in bowing, radial bow magnitude and location had no overall bearing on rotation and daily activity. Considering the methodological limitations of this study, a larger sample size and higher level of evidence such as randomized control studies will yield a more conclusive result to resolve controversies. Based on currently available evidence, both plating and intramedullary nailing are excellent treatment modalities in both-bone forearm fractures.

Risk factors for SARS-CoV-2 infection among health workers in India: a case control study.

Background: COVID-19 was declared as a Public Health Emergency of International Concern on 30th January 2020. Compared to the general population, healthcare workers and their families have been identified to be at a higher risk of getting infected with COVID-19. Therefore, it is crucial to understand the risk factors responsible for the transmission of SARS-CoV-2 infection among health workers in different hospital settings and to describe the range of clinical presentations of SARS-CoV-2 infection among them. Methodology: A nested case-control study was conducted among healthcare workers who were involved in the care of COVID-19 cases for assessing the risk factors associated with it. To get a holistic perspective, the study was conducted in 19 different hospitals from across 7 states (Kerala, Tamil Nadu, Andhra Pradesh, Karnataka, Maharashtra, Gujarat, and Rajasthan) of India covering the major government and private hospitals that were actively involved in COVID-19 patient care. The study participants who were not vaccinated were enrolled using the incidence density sampling technique from December 2020 to December 2021. Results: A total of 973 health workers consisting of 345 cases and 628 controls were recruited for the study. The mean age of the participants was observed to be 31.17 ± 8.5 years, with 56.3% of them being females. On multivariate analysis, the factors that were found to be significantly associated with SARS-CoV-2 were age of more than 31 years (adjusted odds ratio [aOR] 1.407 [95% CI 1.53-1.880]; p = 0.021), male gender (aOR 1.342 [95% CI 1.019-1.768]; p = 0.036), practical mode of IPC training on personal protective equipment (aOR 1. 1.935 [95% CI 1.148-3.260]; p = 0.013), direct exposure to COVID-19 patient (aOR 1.413 [95% CI 1.006-1.985]; p = 0.046), presence of diabetes mellitus (aOR 2.895 [95% CI 1.079-7.770]; p = 0.035) and those received prophylactic treatment for COVID-19 in the last 14 days (aOR 1.866 [95% CI 0.201-2.901]; p = 0.006). Conclusion: The study was able to highlight the need for having a separate hospital infection control department that implements IPC programs regularly. The study also emphasizes the need for developing policies that address the occupational hazards faced by health workers.

Limb Salvage vs. Amputation: Factors Influencing the Decision-Making Process and Outcomes for Mangled Extremity Injuries.

In the setting of acute severe limb injury, the clinical decision to either attempt limb salvage or to perform a primary amputation presents a significant challenge to the trauma team. The initial step in the management of a mangled limb is invariably resuscitation and stabilisation of the patient and an evaluation of the limb. However, the decision-making process on whether to amputate vs attempt limb salvage is dependent on a range of complex factors. This includes assessing the degree of injury to the components of the limb architecture, essential skeletal stability, soft tissues, vasculature, and neurological structures. Whether or not the patient would survive an attempt to limb salvage is of course not the only variable to be taken into account. The likely and expected outcomes of attempted salvage in each individual case must be considered and furthermore, what the acceptable side-effect profile including the risk of failure would be for each individual patient should be assessed against the importance, real or perceived, that limb function is maintained. Finally, the patient's choice should also be taken into account alongside their occupation and pre-morbid functional status. How the surgeon makes this life-changing, or life-threatening decision, is of great clinical significance, and there are myriad scoring systems published that purport to assist in this matter. However, the changing structures of the trauma system, expansion and advancement of skillsets and technology means an updated review is required to help weigh up the challenging decision of limb amputation vs salvage, which usually takes place in a time-pressured and highly emotional emergency setting. An evidence-based, standardised structure to assist in these calculations could support surgeons and improve outcomes for these patients.

Inverted Internal Limiting Membrane Flap vs Complete Internal Limiting Membrane Peeling for Large Macular Holes in Nonposturing Surgery.

Purpose: This study compared anatomical and functional outcomes of the inverted internal limiting membrane flap (ILMF) technique with complete ILM peeling (ILMP) in nonposturing surgery for large, full-thickness macular holes (MHs). Methods: This was a retrospective, comparative, single-surgeon study. Eyes with idiopathic large full-thickness MHs (minimum diameter > 400 µm) were included. A total of 46 patients including 22 ILMF cases and 24 ILMP cases were analyzed. No positioning instructions were advised postoperatively. Results: Primary hole closure was achieved in all patients (100%) in both groups. Mean logMAR visual acuity (VA) improved significantly in both groups compared with the preoperative values (ILMF: 0.60 [SD, 0.26] postoperatively, vs 0.93 [SD, 0.3] preoperatively, P = .032; ILMP: 0.43 [SD, 0.22] postoperatively vs 0.83 [SD, 0.16] preoperatively, P < .01). However, ILMP showed a statistically significant improvement in VA compared with ILMF (P = .02). Conclusions: All MHs in both groups closed after surgery (100%). There was a statistically significant improvement of VA in the ILMP group compared with the ILMF group (P = .02). Not posturing after surgery did not compromise surgical success in both groups.

Management of Cervical Spine Fractures: A Literature Review.

The unique anatomy and flexibility of the cervical spine predispose it to a risk of injury. Trauma to the cervical spine encompasses a wide range of injuries from minor muscular strains to life-threatening fracture-dislocations associated with spinal cord lesions. Initial assessment and management should follow the Advanced Trauma Life Support (ATLS) protocols with adequate protection of the cervical spine through triple immobilisation to prevent any unnecessary movement, which can make the patient susceptible to further neurological injuries. Although the presence of cervical spine injury is very often overt, reliance on clinical examination alone is sometimes not sufficient and potentially requires further imaging. Clinical decision rules such as the Canadian C-Spine Rule are frequently used to risk-stratify patients needing radiography. The level of cervical spine instability and knowledge of their unique classification systems is of paramount importance and assists in the decision-making process to guide definitive management. In this review, we also propose an algorithm to aid the initial management of a patient with suspected cervical spine injury in the emergency department.

The London Major Trauma Network System: A Literature Review.

Trauma is one of the leading causes of death and disability worldwide and is a major global public health problem. The provision of trauma care has been substandard in England and Wales prior to the implementation of an inclusive major trauma network system in London in 2010 and subsequently across the rest of England two years later. The implementation of the London trauma system has brought about improvements to the delivery of trauma care by decreasing the overall morbidity and mortality significantly. This framework encompasses the collaboration of emergency services, designated Major Trauma Centres (MTCs), Trauma Units (TUs) and community providers which have been optimized with the expertise and resources to provide the best outcomes for major trauma patients. Specific triage protocols, consultant-led trauma service and on-the-spot access to radiology services and operating theatres have played a pivotal role in the improvement of trauma care. In spite of several strengths, however, the London major trauma network system is by no means without its limitations. The emergence of the new coronavirus disease 2019 (COVID-19) pandemic has created major barriers to the smooth running of trauma services by exhausting resources due to infection control measures, reduced theatre space and re-deployment of medical staffs. In addition, the cancellation of elective surgeries has impacted directly on the training of surgical trainees by leaving them with significantly reduced surgical exposure. As a results of this ever changing surgical landscape, a need to urgently review these traditional surgical training methods with a view to modernize the curriculum. Although the London trauma system has evolved significantly since its implementation, its limitations should be recognized and addressed to enhance performance and improve patient outcomes.

Multi potent aromatic nano colloid: synthesis, characterization and applications.

In this study the aromatic nanocolloids (CANCs) are synthesized using the noble metal silver by using Citronella extract and confirmed through physio chemical analysis. The synthesised CANCs were evaluated for its antimicrobial activity and antibiofilm activity against pathogenic biofilm forming E. coli. In addition, synthesized CANCs were evaluated for the expression of virulent genes encoding AmpC and CTX-M-15. The results confirmed that CANCs showed effective antimicrobial activity through its bacteriostatic, bactericidal and quorum quencher activity and downregulated CTX-M-15 gene. CANCs were validated as alternate to the commercial fungicides to control plant pathogenic fungi such as A. niger MTCC (281), Fusarium graminearum MTCC (2089) and F. udum MTCC (2204). Furthermore, analysis of CANCs on breast cancer (MCF-7) cells under in vitro condition showed that the cytotoxicity of CANCs is dose dependent. Thus, the multifunctional CANCs can be utilized as potential antimicrobial, antifungal and anticancer agent.

Factors Influencing Sex-Related Differences in the Quality of Life of Patients With Atrial Fibrillation: A Systematic Review.

Atrial fibrillation (AF) is a growing public health concern, the impact of which is frequently underestimated. It has a profound effect on the quality of life (QoL) which appears to be disproportionately lower in female patients compared to men. We aim to explore the factors contributing to sex-related disparities in the QoL of AF patients by conducting a systematic review using the PubMed electronic search database. We used the following combination of medical subject heading (MeSH) parameters: "atrial fibrillation" and "sex" and "quality of life" with specific inclusion and exclusion criteria. We identified 13 relevant studies published between 2010 and 2020 for our review. These studies evaluated sex-related differences in QoL scores, symptom burden, and AF-related complications originating across different continents in Asia, Europe, and North America. We found that female patients reported a reduced QoL as compared to men and they were more likely to be older with multiple co-morbidities at presentation. Women also reported more frequent and severe symptoms, potentially explained by the greater prevalence of anxiety and depression and thus enhancing symptom perception. Moreover, they were less likely to be managed by anti-arrhythmic medications and invasive rhythm control strategies such as catheter ablation. Female patients with AF experienced more severe strokes, but no sex disparities were found in AF-related cognitive decline. We determined that the more prominent contributory factors towards a lowered QoL in female AF patients appear to be secondary to a higher burden and perception of symptoms as well as under-utilization of invasive treatment modalities. However, further studies are warranted to confirm these findings.

Association of Interleukin-10 (A1082G) gene polymorphism with Oral squamous cell carcinoma in north Indian population.

The functional polymorphism A1082G in the gene (IL10) for interleukin-10 associated with risk of oral squamous cell carcinoma (OSCC). The present case-control study was to evaluate the possible association between IL10 A1082G gene and OSCC in north Indian population. Analysis of IL10 A1082G genotype in 232 OSCC cases and 221 healthy controls of comparable age, gender, smokers, tobacco chewing and alcohol consumption. IL10 A1082G status in cases and controls were evaluated by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). The frequencies of IL10 A1082G polymorphism AA, AG, GG genotypes were 29.74, 68.10 and 2.15% in OSCC cases and 57.46, 42.08 and 0.45% in healthy controls. The average frequency of G mutant allele was 36.20% in OSCC cases compared with 21.50% among the controls and this allele was associated with increased risk for OSCC cases. Heterozygous AG genotype was found statistically significant in OSCC cases than in controls (OR = 1.6, 95% CI = 1.1-2.2, P = 0.003), whereas homozygous mutant GG genotype was not found significant (OR = 4.7, 95% CI = 0.55-41.1, P = 0.2). Moreover, we found that G allele was significant in OSCC cases of tobacco chewing. The frequency of IL10 A1082G polymorphism G allele and AG genotype is associated with OSCC cases as compared with controls; this may be due to smoking and tobacco chewing. Our findings showed that in IL10 A1082G gene polymorphism AG genotype and G allele may participate in the progression of OSCC.

Effects of season (summer & winter) on electrical characteristics of skeletal muscle membranes of the spiny-tailed lizard, Uromastix hardwickii.

This study deals with the observation of changes with temperature variations of the seasons in the muscular electrical excitability in the reptile Uromastix hardwickii. Freshly captured adult animals of both the sexes were used in all the experiments, and the gastrocnemius (skeletal) muscles were dissected out. The muscle samples were digested with digestive fluid (pepsin & Hcl), stirred, settled and supernatant was removed, till whitish fluid having clear cells obtained for patch clamp recording of ionic currents and potentials. Resting membrane potentials and action potentials of reptilian cell membranes were measured in whole cell current mode. The glass microelectrodes, with a tip diameter 2-3 microm and tip resistance 5-6 MW (when filled with intracellular solution) were used in these experiments. The present study was carried out to investigate the electrical characteristics of the skeletal muscles of this species of Uromastix, which are not studied earlier. The average mean values of resting membrane potential, action potential and its durations showed no significant changes with the change in the season, but other components of action potential including threshold potential, after-potential and its duration were found to be increased significantly (P < 0.05) in summer as compared to winter. Temperature dependency of these parameters with seasonal variation, are studied for the first time in the gastrocnemius (skeletal) muscles of Uromastix hardwickii. Hence seasonal changes in the components of action potential are invariably associated with changes in environmental temperature, and may be responsible for changes in the activities and homeostasis of these animals; and possibly indicating underlying mechanism of hibernation.