Correlation between carriers of Methicillin-resistant Staphylococcus aureus and the incidence of MRSA surgical site infections in orthopedic surgery patients.

OBJECTIVE: Surgical site infection (SSI) is a devastating complication in orthopedic surgery. Methicillin-resistant Staphylococcus aureus (MRSA) is a notorious organism in SSI, especially in orthopedic patients. We aimed to understand the association between MRSA carriers and the rate of SSI caused by MRSA in orthopedic patients. PATIENTS AND METHODS: We prospectively performed a cohort investigation on patients admitted to the Department of Orthopedic between April and August 2023. Samples were taken preoperatively from the nose and post-operatively in surgical wounds. All samples were grown in MeReSa Agar and defined as positive with MRSA characteristics. Data analysis was performed using SPSS Statistics. A significant difference between groups was assessed using either the Chi-square test or Fisher's exact test. Statistical significance was set at p<0.05. RESULTS: We obtained 526 nasal swabs of patients, and 140 (26.6%) samples were positive for MRSA. Our study revealed significant associations between MRSA carriers and the following factors: history of recent hospitalization (OR: 1.81; 95% CI: 1.172-2.795; p=0.007), smoking history (OR: 1.55; 95% CI: 1.011-2.383; p=0.044), and antibiotic exposures (OR: 2.19; 95% CI: 1.305-3.703; p=0.003). Our findings showed a significant association between SSI and the following factors: history of antibiotic exposures (OR: 2.89; 95% CI: 1.264-6.566; p=0.003), blood loss volume >500 ml (OR: 2.522; 95% CI: 1.245-5.108; p=0.008) and contaminated surgical wounds (OR: 5.97; 95% CI: 2.907-12.266; p=0.001). Patients with MRSA carriers tended to have an increased risk of having an MRSA SSI with an odds ratio of 3.44 (95% CI: 1.13-10.48; p=0.047). CONCLUSIONS: Our study highlights the increased risk of MRSA carriage in patients with a history of smoking, recent hospital admission, or antibiotic exposure. Our reports also identify potential risk factors for SSI, such as previous antibiotic exposure, blood loss, and contaminated wounds. Furthermore, our research establishes an association between MRSA colonization and MRSA SSI, which emphasizes the criticality of decolonization strategies. A further prospective multicenter study is needed to elaborate on our study findings.

The role of neutrophil to lymphocyte ratio in predicting lung metastasis in giant cell tumor of the extremities.

OBJECTIVE: Inflammation has a vital role in tumor development and metastasis. Changes in blood count parameters have been associated with tumor prognosis. We aimed to evaluate the prognostic significance of neutrophil to lymphocyte ratio (NLR) in predicting lung metastasis of giant cell tumors of the bone (GCTB) of the extremities. PATIENTS AND METHODS: 34 GCTB patients (22 males and 12 females) were included in the study. Patients were divided into two groups. The metastasis group (n = 7) included GCTB patients with lung metastasis, while the non-metastasis group (n = 27) included those without lung metastasis. Descriptive statistics and frequency distribution were calculated [age, white blood cell (WBC), neutrophil, lymphocyte, platelets, neutrophil to lymphocyte ratio (NLR), and platelets to lymphocytes ratio (PLR)]. Continuous normal variables were expressed as mean ± standard deviation and compared using Student's t-tests. The receiver operating characteristic (ROC) curve analysis was used to evaluate the ability of NLR and PLR to predict lung metastasis. The factors were considered to be statistically significant at p < 0.05. RESULTS: There were no significant differences between the lymphocyte count (1.81 vs. 2.23 103/mm3), platelet count (436 vs. 364 103/mm3), and PLR values (247 vs. 190) of the two groups (p > 0.05). The WBC count (11.8 vs. 8.95 103/mm3), neutrophil count (8.78 vs. 5.69 103/mm3), and NLR levels (5.45 vs. 2.81) (p < 0.05) were significantly higher in the metastasis group. The presence of an NLR cut-off value of 3.7 significantly predicted the existence of lung metastasis (AUC = 0.857 [95%CI = 0.714-1], p = 0.004) with a sensitivity of 85% and specificity of 82%. CONCLUSIONS: NLR may serve as a promising prognostic marker for predicting lung metastasis in GCTB patients.

Predicting the peroneus longus tendon autograft size in ACL reconstruction by using anthropometric parameters: A study in South Sulawesi population.

INTRODUCTION: Some literature use peroneus longus tendon (PLT) as the alternative to anterior cruciate ligament (ACL) reconstruction to overcome inadequate autograft size potential risk by using hamstring tendon (HT) autograft. Among the available methods to predict PLT measurements, anthropometric parameters are one of the most accessible and feasible methods. The objective of this prospective study was to predict the PLT autograft sizes in single bundle ACL reconstruction by using preoperative anthropometric measurement. METHOD: Anthropometric parameters, including age, gender, height, weight, body mass index (BMI), true leg length (TLL), shank circumference and shank length of 20 patients with primary ACL reconstruction was measured before surgery. Univariate analysis, independent-sample t-test, Pearson correlation test, and logistic regression to evaluate the influence of these anthropometric variables on the diameter and length of the PLT autograft obtained. RESULT: Pearson correlation test has shown that body weight and height correlates to PLT length and diameter also autograft's length and diameter significantly (p < 0.05). The linear regression analysis showed that height, weight, TLL and shank length were signifcantly related to autograft diameter. While height and TLL were significantly related to autograft length. CONCLUSION: Height, weight, TLL and shank length can use to predict PLT autograft diameter. While height and TLL can use to predict PLT autograft length.

Revision single-bundle anterior cruciate ligament reconstruction with over-the-top route procedure.

PURPOSE: In revision anterior cruciate ligament reconstruction (ACLR), the single-stage technique and the over-the-top route (OTTR) procedure were usually selected for cases where the bone tunnel cannot be created at an anatomical position due to tunnel enlargement and overlap with the mal-positioned tunnel of primary reconstruction. The purpose of this study was to evaluate the clinical results of revision single-bundle ACL reconstruction using OTTR procedure and to compare the clinical results of OTTR procedure with those of anatomical single-bundle revision reconstruction (SBR). HYPOTHESIS: The results of OTTR procedure are equivalent to that of SBR. METHODS: Seventy-six revision ACL reconstruction knees from April 2002 to December 2012 were involved in our study. We focused on 21 knees which underwent surgery with SBR and 22 knees with OTTR using hamstring tendon. The clinical results were evaluated by means of the Lysholm score and the knee stability was assessed by the Lachman test, pivot-shift test and side-to-side difference by KT-2000 pre-operatively and after 1 year post-operatively. AP translation and rotational laxity using a navigation system were evaluated before and after revision ACL reconstruction under anesthesia in 8 cases of OTTR and in 6 cases of SBR. RESULTS: There was no statistically significant difference between the OTTR and SBR regarding Lysholm score, Lachman test, pivot-shift test, ATT by KT-2000, and AP translation and rotational laxity with a navigation system. CONCLUSIONS: The clinical results of OTTR are almost equivalent to those of SBR. For the cases in which it is impossible to create the femoral tunnel in an anatomical position, OTTR is a valuable revision ACL reconstruction method. LEVEL OF EVIDENCE: Case-control study. Level III.

A new technique to avoid articular cartilage injury in anterior cruciate ligament reconstruction through far antero-medial portal.

Far antero-medial (FAM) portal technique is usually used in our department in anterior cruciate ligament (ACL) reconstruction when drilling the femoral tunnel. Although the FAM portal technique carries potential risks, such as cartilage injury of the lateral femoral condyle, peroneal nerve injury and blow out of the lateral femoral condyle's posterior wall, these problems were resolved in a cadaveric study, in which 110°-120°knee flexion was recommended when drilling the femoral tunnel. However, there is a potential risk of injuring the cartilage of the medial femoral condyle especially when drilling the postero-lateral bundle. A new method is proposed to ensure that the femoral tunnel drilling does not damage the cartilage of the medial femoral condyle.

Proprioceptive function after isolated single-bundle posterior cruciate ligament reconstruction with remnant preservation for chronic posterior cruciate ligament injuries.

INTRODUCTION: Posterior cruciate ligament (PCL) reconstruction using the remnant preserving technique may contribute to improved postoperative posterior stability, graft healing, and proprioception recovery. Although there have been several reports on remnant preserving PCL reconstruction, no study has yet evaluated the proprioceptive functions before and after PCL reconstruction with remnant preservation. The purpose of this study is to retrospectively evaluate the clinical outcomes and proprioceptive function after isolated single-bundle PCL reconstruction with remnant preservation for chronic PCL injuries. HYPOTHESIS: Isolated single-bundle PCL reconstruction with remnant preservation surgery for chronic PCL injuries provides satisfactory clinical outcomes and good recovery of the proprioceptive function. METHODS: Nineteen patients who had undergone isolated single-bundle PCL reconstruction with remnant preservation for chronic PCL injuries were followed up for more than 2 years. The posterior laxity was measured by the gravity sag view, stress radiography and the KT-2000 knee arthrometer. The proprioceptive function was defined as the threshold to detect passive motion (TTDPM). RESULTS: The average Lysholm score significantly improved from 63.7±13.2 preoperatively to 94.4±4.6 at final follow-up. The postoperative posterior laxity significantly improved. Regarding TTDPM, there were no significant differences between the preoperative score and the score at every given time point, regardless of the starting angles and the moving directions of the knees. CONCLUSIONS: The proprioceptive function, defined as TTDPM, is maintained after single-bundle PCL reconstruction with remnant preservation, and the postoperative clinical scores and posterior laxity significantly improve. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Quality characteristics and acceptability of 'amala' (yam-based thick paste) as influenced by particle size categorization of yam (Dioscorea rotundata) flour.

The study was essentially an investigation on the influence of size-categorized yam (Dioscorea rotundata) flour on the quality characteristics and acceptability of amala (yam-based thick paste). Yam flour was separated into three major particle size categories (i.e. 75-150 µm, 150-300 µm and whole meal [<300 µm]), while the physicochemical properties of each category were evaluated and flour samples finally used to prepare amala. Both the protein and ash contents of the yam flours were found to decrease with the decrease in the particle size giving 2.87% and 2.27% in 75-150 µm flour category, respectively. The loose bulk density and packed bulk density of the whole meal (<300 µm) were higher than that of others giving 0.50 g/cm(3) and 0.78 g/cm(3), respectively, while 150-300 µm flour category gave the highest value (2.88 g/g) in water absorption capacity. The colour characteristics of the flour samples showed that the whole meal (<300 µm) had the highest lightness index, L*-value (76.4). The 75-150 µm flour category had the highest chroma, C-value (19.2), while that of 150-300 µm had the lowest value (18.7) with no significant difference at p < 0.05. The pasting characteristics of the flour samples showed that 75-150 µm flour category exhibited highest peak viscosity (257.1 RVU), while the whole meal (<300 µm) exhibited highest breakdown viscosity (40.9 RVU), final viscosity (364.0 RVU) and setback viscosity (99.7 RVU). The amala prepared from 150-300 µm flour category gave the highest softness index (19.6 mm) while that obtained from 75-150 µm flour category gave the lowest value (16.6 mm). The sensory quality rating of amala prepared from the flour samples showed that amala from 150-300 µm flour category was rated the highest in terms of colour, texture (ease of mouldability), aroma and overall acceptability. Both positive and negative correlations were found between some properties of size-categorized yam flours and sensory quality characteristics of amala.

Human immunodeficiency virus and invasive external otitis--a case report.

Acute invasive external otitis is an uncommon life-threatening infection of the external auditory canal (EAC), most often affecting the elderly diabetic patients. Although few reports have been made in HIV-positive/Aids patients among the caucasians. We present here a 25 year old nursing mother with a month history of fever, persistent otalgia with acutely inflammed EAC, gross facial cellulitis, mastoid abscess and facial paresis, following a minor left ear trauma with a matchstick. This unusual course of ear infection in an otherwise healthy young adult prompts a search for an immunodepressing factor which was confirmed to be Human Immunodeficiency Virus (HIV). This article highlights the clinical peculiarities and the management of invasive external otitis in an HIV-positive patient.

Cervical vertigo and cervical spondylosis--a need for adequate evaluation.

BACKGROUND: Cervical spine spondylotic changes are known to cause vertigo. The mechanism by which cervical vertigo is induced is very debatable. This study was to highlight the prevalence of vertigo and other vestibulocochlear organ affectation in patients with cervical spondylosis and to serve as a template for further research in this area. METHODOLOGY: A six-year retrospective review of vertiginous patients with radiological evidence of cervical spondylosis seen at the Otorhinolaryngology Clinic of University College Hospital (UCH), Ibadan. RESULTS: Forty-three patients, 23 males (53.5%) and 20 females (46.5%) had vertigo as a symptom and radiological evaluation for cervical spondylosis. The radiological findings were normal in 11 patients (26%) and abnormal in 32 patients (74%). Of the twenty-five patients who had pure tone audiometry, 40% were normal and 60% abnormal. Out of 20 affected ears, seven patients (47%) had right, 3 patients (20%) left and 5 patients (33%) both ear involved respectively. High frequency range was affected in 8 (40%), low in 2 (10%) and all in 10 (50%) ears respectively. Decibel hearing level (dBHL) loss ranged from 30-90 dBHL with a mean binaural of 43 (+/- 8.5) dBHL. CONCLUSION: We advocate early multidisciplinary approach in the management of all established cases of cervical vertigo.