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Outcomes of patients with hematologic malignancies requiring ICU care for critical illness are suboptimal and represent a major unmet need in this population. We present data from a dedicated haematology oncology setting including 63 patients with a median age of 60 years admitted to the ICU for critical illness with organ dysfunction. The most common underlying diagnosis was multiple myeloma (30%) followed by acute myeloid leukemia (25%). Chemotherapy had been initiated for 90.7% patients before ICU admission. The most common indication for ICU care was respiratory failure (36.5%) and shock (17.5%) patients. Evidence of sepsis was present in 44 (69%) patients. After shifting to ICU, 32 (50%) patients required inotropic support and 18 (28%) required invasive mechanical ventilation. After a median of 5 days of ICU stay, 43.1% patients had died, most commonly due to multiorgan dysfunction. Risk of mortality was higher with involvement of more than two major organs (p = .001), underlying AML (p = .001), need for mechanical ventilation (p = .001) and high inotrope usage (p = .004). Neutropenia was not associated with mortality. Our study indicates high rates of short term mortality and defines prognostic factors which can be used to prognosticate patients and establish goals of care. Supplementary Information: The online version contains supplementary material available at 10.1007/s12288-024-01757-3.
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AIM: The aim of the study was to compare the surface roughness and microhardness of bulk-fill composite and nanohybrid composite resin after exposure to three different beverages at different time intervals. METHODOLOGY: In this study, 60 composite discs each for bulk fill and nanohybrid, of dimensions 10 mm × 2 mm were made. Both composites were randomly divided into four subgroups, i.e., 15 samples each for artificial saliva, tea, coffee, and soft drinks which were further subdivided into five samples for three time intervals. Composite resin discs were immersed in beverages for 4 min in 24 h for 7, 15, and 30 days. All samples were evaluated for surface roughness and microhardness before and after immersion. RESULTS: Both the composites showed a significant increase in surface roughness in all the beverages with maximum change in surface roughness observed in nanohybrid composite resin immersed in soft drinks. Furthermore, the microhardness of both the composites was decreased significantly in all beverages with maximum change in microhardness observed in nanohybrid composite resin immersed in soft drinks. CONCLUSIONS: Bulk-fill composite resin has better resistance to surface roughness and higher microhardness as compared to nanohybrid. Furthermore, acidic beverages highly affect the physical properties of both composite resins for longer periods.
Résumé Objectif:Comparer la rugosité de surface et la microdureté du composite Bulk-Fill et de la résine composite nanohybride après exposition à trois boissons différentes à différents intervalles de temps.Matériels et Méthodes:Dans cette étude, 60 disques composites chacun pour remplissage en vrac et nanohybride, de dimensions 10 mm X 2 mm ont été fabriqués. Les deux composites ont été divisés au hasard en quatre sous-groupes, soit 15 échantillons chacun pour la salive artificielle, le thé, le café et les boissons gazeuses, qui ont ensuite été subdivisés en 5 échantillons pendant 3 intervalles de temps. Des disques de résine composite ont été immergés dans des boissons pendant 4 minutes en 24 heures pendant 7, 15 et 30 jours. Tous les échantillons ont été évalués pour la rugosité de surface et la microdureté avant et après immersion.Résultats:Les deux composites ont montré une augmentation significative de la rugosité de surface dans toutes les boissons, un changement maximal de rugosité de surface ayant été observé dans la résine composite nanohybride immergée dans une boisson gazeuse. De plus, la microdureté des deux composites a diminué de manière significative dans toutes les boissons, un changement maximal de microdureté ayant été observé dans la résine composite nanohybride immergée dans une boisson gazeuse.Conclusions:La résine composite de remplissage en vrac a une meilleure résistance à la rugosité de surface et une microdureté plus élevée que la nanohybride. De plus, les boissons acides affectent fortement les propriétés physiques des deux résines composites sur des périodes plus longues.
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Bebidas , Resinas Compostas , Dureza , Teste de Materiais , Nanocompostos , Propriedades de Superfície , Resinas Compostas/química , Humanos , Fatores de Tempo , Nanocompostos/química , Chá , Café/química , Técnicas In Vitro , Bebidas Gaseificadas , Saliva Artificial/químicaRESUMO
OBJECTIVES: This study investigates the effect of e-cigarette-related harm and addiction perceptions on e-cigarette initiation among US tobacco-naïve adolescents. STUDY DESIGN: This is a longitudinal study. METHODS: Using data from five waves (2013-2019) of the Population Assessment of Tobacco and Health Study, we created a longitudinal data set for 2775 youth aged 12-17 years who had no prior use of tobacco products at Wave 1. E-cigarette initiation was defined as transitioning from non-use at Wave 1 to ever use in subsequent waves. Kaplan-Meier survival and Cox proportional hazard regression models were used to assess the impact of harm and addiction perceptions on e-cigarette initiation. RESULTS: Our analytic sample comprised 63.1% of youth who had never used tobacco products at Wave 1 and consequently initiated e-cigarette use in subsequent waves. Over time, fewer individuals perceived e-cigarettes as harmless (14.1%-2.1%), whereas more perceived them as likely to cause addiction (53.7%-76.6%). Compared with perceiving e-cigarettes as a lot of harm, those perceiving some harm (adjusted hazard ratio [aHR] = 1.30, 95% confidence interval [CI]: 1.12-1.52), little harm (aHR = 1.42, 95% CI: 1.20-1.68), or no harm (aHR = 2.09, 95% CI: 1.64-2.65) were more likely to initiate e-cigarette use. Demographic factors for initiation included being Black or Hispanic ethnicity (vs White), younger age (12-14 vs15-17 years), and receiving over $20 per week (vs $0) in pocket money, with P-values <0.05. However, in adjusted results, addiction perceptions did not significantly impact e-cigarette initiation (P-values >0.05). CONCLUSIONS: Among youth without prior tobacco/nicotine use, perceiving e-cigarettes as having low harm significantly predicted initiation over time. Effective prevention strategies, including targeted risk communication interventions, are essential for discouraging e-cigarette use among youth.
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Sistemas Eletrônicos de Liberação de Nicotina , Produtos do Tabaco , Humanos , Adolescente , Fumar/epidemiologia , Estudos Longitudinais , Cognição , NicotianaRESUMO
INTRODUCTION: Although great strides have been made in maternal and newborn health in Nepal, the maternal mortality ratio (MMR) is still high at 186 per 100,000 births. Many maternal deaths are preventable if there is access to a skilled birth attendant (SBA). The Ministry of Health and Population of Nepal launched the in-service SBA training program in 2007 and has trained over 10,000 SBAs to date. Evidence shows that one episode of training is not enough to retain skills. Therefore, the Nick Simons Institute (NSI) in collaboration with National Health Training Center (NHTC) devised a Follow-Up and Enhancement Program (FEP) in 2011 where the knowledge, clinical skills, and working environment of SBA graduates were assessed directly at their worksites. FEP allows on-site coaching and feedback so that graduates may continue to improve upon any gaps in their knowledge, skills, and working environment. This study aims to assess the effectiveness of FEP. METHODS: We used a mixed-methods research design. A total of 73 SBAs who had a pre-FEP assessment in 2016 were followed up for a post-FEP assessment in 2017. We also collected data from 3 additional districts (115 SBAs) that had not previously had FEP, to compare SBAs in FEP versus non-FEP districts. Qualitative data was collected from 16 health facilities on the perceptions, motivation, and satisfaction of stakeholders. RESULTS: Of the total 188 SBAs that were sampled, a one-time FEP increased knowledge scores by 9%, clinical skills scores by 29%, and enabling environment scores by 7%. The number of deliveries conducted improved with a one-time FEP, although this increase was not statistically significant. We found a trickle-down effect of working in a facility that has had prior FEP, with SBAs that have never had FEP improving their clinical skills. FEP was found to be a highly accepted program and is beneficial to SBAs, trainers, and the Hospital Management Committee (HFOMC). However, a one-time FEP is not sufficient in retaining clinical skills and knowledge. CONCLUSION: FEP is a highly effective program by both quantitative and qualitative evaluation. Our study suggests that FEP should be frequent and continuous to retain the knowledge and clinical skills of SBAs, motivate them through on-site coaching, and improve their working environment through direct feedback to the Ministry of Health and Population.
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Academias e Institutos , Competência Clínica , Humanos , Recém-Nascido , Feminino , Nepal , Seguimentos , Confiabilidade dos DadosRESUMO
BACKGROUND: E-learning is the delivery of learning and training through digital resources. Although e-learning is based on formalized learning, it is provided through computers, tablets, and even cellular phones those are connected to the Internet. This makes it easy for users to learn anytime, anywhere, with few, if any restrictions. MATERIAL AND METHODS: A cross-sectional study was done, and data was obtained through an online survey method from September 14, 2020 to October 08, 2020. Questions were created in "Google Forms." The targeted population was all nursing students from all over Nepal. There were a total of 365 respondents. A pilot study was done on 10 students. After the pilot study, the same question was distributed to all the respondents. RESULTS: Almost half (40.8%) got disturbed in their online class because of electricity; around half of the respondents (41.9%) are disturbed in their online class because of Internet problems. Moreover, around half of the respondents (44.4%) use the data pack daily, and 38.6% use the data sometimes. CONCLUSION: The study concludes that most students suffered from Internet disturbance and electricity problems during online classes. Because of electricity and Internet problems, most students feel anxious during class, and most of the students are not able to attend classes. Most students are compelled to use data packs for online classes. However, the course may not be completed if the problems arising during online classes are not solved.
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INTRODUCTION: The mangled hand is a complex and uncommon injury of the upper extremity. It involves injury to multiple structures i.e., bone, soft tissue, and neurovascular bundles of the hand leading to loss of function and viability. These injuries are usually caused due to trauma from high-energy equipment. PRESENTATION OF CASE: A 32-year female presented with a crush injury to her right hand by a grass-cutting machine. The right hand was de-vascularised with injury to both radial and ulnar arteries. She had multiple lacerations, fractures of the distal radius and ulna, and multiple fractures of the metacarpals and phalanges. An initial revascularization procedure with a vein graft was done in the ulnar artery, joints were stabilized, and planned for reconstructive surgery at a later date. DISCUSSION: Initial evaluation includes a decision to salvage or amputate the limb. Early intervention to restore vascularity is key to salvaging a mangled hand. This should be followed by a multidisciplinary team approach. Preference is given to reconstruction procedures rather than amputation and prosthesis procedures. CONCLUSION: Early intervention, a multispecialty approach, and staged procedures are required for the successful management of a mangled hand. Eventually, physiotherapy has a key role in the restoration of function.
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Background and Aims: To overcome the procedure-related complications associated with landmark-guided percutaneous dilatational tracheostomy (PDT) ultrasound is emerging as a promising tool. Present study was designed to compare landmark-guided PDT and ultrasound-guided PDT in terms of efficiency, efficacy, and accuracy. Material and Methods: Hundred intensive care unit patients requiring prolonged mechanical ventilation were prospectively randomized into 2 groups of 50 patients each. In land mark guided (LMG) group, patients underwent landmark-guided PDT, whereas in ultrasound guided (USG) group, patients underwent ultrasound-guided PDT. Results: Both the groups were comparable in terms of demographic data, sequential organ failure assessment score, ventilator settings, and mean days on mechanical ventilation prior to PDT. The mean assessment time in the ultrasound-guided group (1.56 ± 1 min) was significantly more (P-value = 0.000) than in the landmark-guided group (0.84 ± 0.72 min). The mean total procedure time for the USG group (5.98 ± 10.23 min) was more than that for the LMG group (4.86 ± 8.03 min) (P-value 0.542). Deviation of puncture site from the midline was seen in two patients in group A as compared to none in the USG group (P-value = 0.153). The number of patients requiring more than one attempt for successful needle insertion was more (P-value = 0.148) in the LMG group (20%) as compared to USG group (8%). Incidence of complications, like bleeding and desaturation was more in the LMG group as compared to the USG group. Conclusion: Ultrasound-guided PDT is associated with reduction in periprocedural complications as compared to landmark technique, although it takes slightly longer time.
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South Asians are estimated to have a 40% increased risk for coronary artery disease as compared to populations from other regions. Nepal, as a South Asian country, should also analyze the burden of coronary artery disease and its risk factors to minimize cardiovascular morbidity and mortality. We reviewed the barriers to cardiovascular care and its services in low- and middle-income countries, including Nepal. The identified barriers included coronary artery disease risk factors, access, cost, adherence to cardiovascular care, awareness, knowledge gaps, and socioeconomic and health system challenges. The possible strategies to reduce coronary artery disease included national, regional, and local perspectives. It also highlighted the involvement of community workers and local leaders, education, patient-centered intervention, easy access to drugs and treatments, rehabilitation and public health measures, innovation within the health care system, and multi-sectoral involvement. This review provides insights into the current situation of coronary artery disease and its possible solutions.
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Doença da Artéria Coronariana , Humanos , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/terapia , Nepal/epidemiologia , Atenção à Saúde , Fatores de Risco , EscolaridadeRESUMO
BACKGROUND: Surgical management of unstable distal clavicle fractures (DCFs) remains controversial. Traditional open techniques result in acceptable union rates but are fraught with complications. In response to these limitations, arthroscopic techniques have been developed; however, clinical outcome data are limited. PURPOSE: The primary purpose was to systematically evaluate the clinical and radiographic outcomes of arthroscopic fixation of unstable DCFs. The secondary purpose was to characterize the overall complication rate, focusing on major complications and subsequent reoperations. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included a search of the PubMed, Web of Science, Cochrane Register of Controlled Trials, EMBASE, and Scopus databases. English-language studies between 2008 and 2019 that reported on outcomes of patients with DCFs who underwent operative fixation using an arthroscopic or arthroscopically assisted surgical technique were included. Data consisted of patient characteristics, fracture type, surgical technique, concomitant injuries, union rates, functional outcomes, and complications. RESULTS: A total of 15 studies consisting of 226 DCFs treated using an arthroscopically based technique were included in the systematic review. The majority of fractures were classified as Neer type II. Most (97%) of the fractures underwent arthroscopic fixation using a cortical button coracoclavicular stabilization surgical technique. Bony union was reported in 94.1% of the fractures. Good to excellent outcomes were recorded in most patients at the final follow-up. The Constant-Murley score was the most widely used functional outcome score; the pooled mean Constant score was 93.06 (95% CI, 91.48-94.64). Complications were reported in 14 of the 15 studies, and the overall complication rate was 27.4%. However, only 12% of these were considered major complications, and only 6% required a reoperation for hardware-related complications. CONCLUSION: Arthroscopic fixation of DCFs resulted in good functional outcomes with union rates comparable to those of traditional open techniques. While the overall complication profile was similar to that of other described techniques, there was a much lower incidence of major complications, including hardware-related complications and reoperations.
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Structural flexibility of the peptide linker connecting two domains is essential for the functioning of multi-domain complex. Nitric oxide synthase (NOS) isoforms contain the oxygenase and the reductase domains connected by calmodulin binding linker (CBL) region. Additionally, the endothelial NOS (eNOS) isoform contain an auto-inhibitory loop (AI) in the FMN reductase sub-domain which represses the inter-domain electron transfer process. Binding of Ca2+-Calmodulin complex on the CBL region relieves the AI loop repression and facilitates electron transfer from FMN in the reductase domain to the heme in the oxygenase domain. Few experimental studies have reported that in vitro mutation of Serine-615 (S615D) and Serine-633 (S633D) in the FMN reductase sub-domain to aspartic acid increased NO production and increased Ca2+ sensitivity. To understand the role of AI loop in eNOS repression and activation in serine mutants (S615D and S633D), we modelled the FMN reductase sub-domain of human eNOS protein with and without the CBL region. Molecular dynamics simulations performed indicated that the mutant protein AI loop structure was stabilized by salt bridge formed between D615 and R602. It was also found that mutation increased the flexibility of C-terminal residues of eNOS CBL region. The hinge-like movement of the AI loop allowed rotation of the FMN sub-domain clockwise which may favour electron-transfer in the mutant protein. This study provides insight on mutation (S615D and S633D) induced changes in AI loop and increased flexibility of CBL region which may lead to the protein activation and may also facilitate Calmodulin binding at physiological Ca2+ concentration. Graphical Abstract Mutation of amino acid residues contribute to structural changes at molecular level leading to alteration in protein dynamics and its function. Serine-615 and Serine-633 in the auto-inhibitory loop of human eNOS reductase model was mutated to aspartic acid in silico and molecular dynamics simulations of the protein showed that steric hindrance due to mutation altered the auto-inhibitory loop rearrangement and the FMN sub-domain movement favouring electron transfer.
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Mononucleotídeo de Flavina/química , Simulação de Dinâmica Molecular , Mutação/genética , Óxido Nítrico Sintase Tipo III/antagonistas & inibidores , Óxido Nítrico Sintase Tipo III/genética , Humanos , Proteínas Mutantes/química , Proteínas Mutantes/genética , Óxido Nítrico Sintase Tipo III/química , Domínios Proteicos , Estrutura Secundária de Proteína , SaisRESUMO
In athletes, foot injuries present with a variety of mechanisms, severity, and implications for return to play. Although potentially given less attention than knee and shoulder injuries by the team physician, foot injuries are common and thus require knowledgeable consideration. In this article, we review the anatomy, presentation, workup, and management of several of the most common athletic foot injuries, including turf toe, Lisfranc injuries, Jones fractures, and navicular stress fractures. The goal is to provide the team physician with the information necessary to evaluate and manage these injuries on the sideline and in the training room.
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Traumatismos em Atletas , Traumatismos do Pé , Fraturas Ósseas , Esportes , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Traumatismos do Pé/diagnóstico , Traumatismos do Pé/terapia , Humanos , Estações do AnoRESUMO
Conventional cotton scouring in the textile industry using alkali results in huge environmental impact which can be overcome by using enzymes. Pectinase along with cutinase gives enhanced bioscouring results. Cutin was extracted from tomato peels and was used as substrate in the microbial media. The strain isolated from tomato peel was identified as Acinetobacter baumannii AU10 by 16S rDNA sequencing. The cutinase production was optimized by Placket-Burman and Response Surface Methodology (RSM) and the maximum production of 82.75 U/mL obtained at sucrose 6.68% (w/v), gelatin 2.74 g/L at a temperature of 35.93 °C. Cutinase was purified by ammonium sulfate precipitation, hydrophobic interaction chromatography and ion exchange chromatography with a recovery of 25.6% and specific activity of 38030 U/mg. The confirmation test for the purity of cutinase was analyzed by RP-HPLC. The molecular mass of cutinase was determined as 28.9 kDa by SDS-PAGE technique. Scanning electron microscopic analysis showed a rough and open primary wall surface on the cutinase bioscoured fabric which confirmed its activity on cutin present in the cotton fabric. Additionally, the cutinase-bioscoured samples showed better absorbency than the untreated samples. Therefore, enzymatic scouring increases wetting capacity of scoured cotton and also helps to reduce environmental pollution.
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Acinetobacter baumannii , Proteínas de Bactérias , Hidrolases de Éster Carboxílico , Fibra de Algodão , Acinetobacter baumannii/enzimologia , Acinetobacter baumannii/genética , Proteínas de Bactérias/química , Proteínas de Bactérias/genética , Proteínas de Bactérias/isolamento & purificação , Hidrolases de Éster Carboxílico/química , Hidrolases de Éster Carboxílico/genética , Hidrolases de Éster Carboxílico/isolamento & purificaçãoRESUMO
BACKGROUND: The American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form is one of the most frequently used outcomes score for shoulder pathology. The patient report section of the ASES questionnaire (p-ASES) is easy to complete, can be quickly administered, and is applicable to a wide range of shoulder pathologies, yet a validated Spanish translation of this questionnaire does not currently exist for diverse Spanish-speaking populations. The purpose of this study was to translate and culturally adapt the patient report section of the ASES to Spanish and to assess its validity and reliability among a culturally diverse group of Spanish-speaking patients, typically seen in the United States. METHODS: The p-ASES Standardized Shoulder Assessment Form was translated into Spanish using a universal approach for translation and cultural adaptation of instruments. A total of 127 Spanish-speaking patients with shoulder pain were included in the study and asked to complete the Spanish translated p-ASES form, the Patient-Reported Outcomes Measurement Information System (PROMIS) v1.2 Physical Function SF 20a in Spanish and a demographics questionnaire. Construct validity was tested using correlational analysis between the Spanish translation of the p-ASES to the Spanish translation of the PROMIS v1.2 Physical Function Short Form 20a. Reliability was measured using both test-retest reliability and internal consistency (Cronbach α) in a subgroup of 27 patients who completed both surveys at a separate time point. RESULTS: The p-ASES demonstrated desirable convergent validity with the validated Spanish version of the PROMIS v1.2 Physical Function Short Form 20a with a strong correlation (r = 0.82, P < .04) for Spanish speakers. The Spanish translation of the p-ASES proved to be a reliable tool with a high degree of internal consistency across question items (α = 0.90). The Spanish p-ASES also demonstrated excellent test-retest reliability with a strong correlation (r = 0.87, P < .001) between time 1 and time 2. CONCLUSION: The Spanish p-ASES is both a valid and reliable tool for assessing shoulder function in Spanish-speaking patients from diverse cultural backgrounds and it demonstrates psychometric properties equivalent to those of the English-language version.
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Cotovelo , Ombro , Cirurgiões , Humanos , Idioma , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários , Estados UnidosRESUMO
We report on a comparison between the theoretically predicted and experimentally measured spectra of the first-forbidden nonunique ß-decay transition ^{137}Xe(7/2^{-})â^{137}Cs(7/2^{+}). The experimental data were acquired by the EXO-200 experiment during a deployment of an AmBe neutron source. The ultralow background environment of EXO-200, together with dedicated source deployment and analysis procedures, allowed for collection of a pure sample of the decays, with an estimated signal to background ratio of more than 99 to 1 in the energy range from 1075 to 4175 keV. In addition to providing a rare and accurate measurement of the first-forbidden nonunique ß-decay shape, this work constitutes a novel test of the calculated electron spectral shapes in the context of the reactor antineutrino anomaly and spectral bump.
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BACKGROUND AND AIM: Luteolin belongs to flavone group of flavonoids, present in many plants with potent antioxidant, anti-inflammatory and anti-proliferative effects. The objective of present study was to investigate protective effect of luteolin on injury induced inflammation via Monosodium urate (MSU) crystals induced and Acetaminophen (AMP) induced liver injury in rats. EXPERIMENTAL PROCEDURE: Protective effect of luteolin was observed by measurement of rat paw edema, lysosomal enzymes, antioxidants status and cytokine level. Measurement of uric acid level and neutrophil infiltration were done in AMP induced liver injury in rats. Luteolin was tested at 30 and 50â¯mg/kg doses and compare with colchicine. RESULTS AND CONCLUSION: Luteolin significantly decreases paw edema in dose dependent manner compare to control group in MSU crystal-induced rats. Luteolin (50â¯mg/kg) was showed significant decrease in serum level of oxidative and lysosomal enzymes, proinflammatory cytokines i.e. tumor necrosis factor (TNF)-α (39.28⯱â¯3.17), interleukin (IL)-1ß (12.07⯱â¯1.24), and IL-6 (24.72⯱â¯2.52) in MSU crystal-induced rats. In AMP induced liver injury, tissue uric acid level and myeloperoxidase were decreased significantly after treatment with luteolin as well as N-acetylcysteine. Serum level of liver enzymes was significantly reduced after treatment with luteolin. Histological observation of ankle joints and liver was support to protective effect of luteolin at both doses. In conclusion, luteolin showed anti-inflammatory effect through restoration of cytokine level, lysosomal enzymes level and antioxidants status. The reduction of liver tissue uric acid content may be one of the mechanisms for protective effect of luteolin. It can contribute to reduce injury induced inflammation.
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A search for neutrinoless double-ß decay (0νßß) in ^{136}Xe is performed with the full EXO-200 dataset using a deep neural network to discriminate between 0νßß and background events. Relative to previous analyses, the signal detection efficiency has been raised from 80.8% to 96.4±3.0%, and the energy resolution of the detector at the Q value of ^{136}Xe 0νßß has been improved from σ/E=1.23% to 1.15±0.02% with the upgraded detector. Accounting for the new data, the median 90% confidence level 0νßß half-life sensitivity for this analysis is 5.0×10^{25} yr with a total ^{136}Xe exposure of 234.1 kg yr. No statistically significant evidence for 0νßß is observed, leading to a lower limit on the 0νßß half-life of 3.5×10^{25} yr at the 90% confidence level.
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BACKGROUND: When treated conservatively, unstable distal clavicle fractures demonstrate a high symptomatic nonunion rate. While a variety of surgical techniques have been described, many of these techniques are associated with high failure rates and hardware-related complications. The surgical technique used in this study has shown promising biomechanical results; however, long-term clinical results have not yet been described. PURPOSE: To assess the clinical and radiological outcomes of a surgical technique for fixing displaced distal clavicle fractures using a combination of cortical button fixation and coracoclavicular (CC) ligament reconstruction. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We conducted a retrospective review of 22 consecutive patients with displaced, unstable Neer type II or V distal clavicle fractures who underwent this surgical technique from 2012 to 2019. Primary outcome variables were radiographic union, patient satisfaction, and postoperative shoulder function. Preoperative and postoperative University of California, Los Angeles (UCLA), and American Shoulder and Elbow Surgeons (ASES) scores were compared. Secondary outcome variables included intraoperative complications, postoperative complications, time to radiographic union, and preoperative and postoperative CC distance. Quality of life was assessed using preoperative and postoperative 36-Item Short Form Health Survey (SF-36) scores. RESULTS: Nearly all (21/22) patients were available for a final review; 1 patient was lost to follow-up at 2 weeks. All 21 patients achieved radiographic union by 4 months (mean, 60.38 days; range, 41-84 days; 95% CI, 53.80-66.96 days). All patients were satisfied with the surgical procedure and their functional outcome. The mean UCLA score improved from 5.36 (95% CI, 4.14-6.60) preoperatively to 32.52 (95% CI, 30.56-34.48) postoperatively (mean difference, 27.14; P < .001). The mean ASES score improved from 16.23 (95% CI, 9.79-22.67) preoperatively to 88.11 (95% CI, 81.82-94.40) postoperatively (mean difference, 71.91; P < .001). Statistically significant improvements in SF-36 scores were seen in the physical functioning, role limitations due to physical health, pain, social functioning, and emotional well-being categories. There were 3 postoperative complications, including 1 patient with a minor complication secondary to hardware irritation, 1 patient with adhesive capsulitis, and 1 patient with wound dehiscence requiring wound closure. CONCLUSION: We describe a surgical technique for fixing displaced distal clavicle fractures using a combination of cortical button fixation and CC ligament reconstruction that resulted in a 100% union rate and excellent clinical outcomes with acceptable complications.
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INTRODUCTION: Head and neck involvement with histoplasmosis usually occurs as a part of the disseminated illness. There are no pathognomic features of the upper aerodigestive tract involvement and the lesion may mimic a host of other conditions. The current report presents our experience with head and neck histoplasmosis in a non-endemic tertiary care center. MATERIALS AND METHODS: We present a case of disseminated histoplasmosis with oral symptoms and lesions as the chief complaints. A 10â¯years' retrospective institutional database search was undertaken to identify the patients with histoplasmosis affecting head and neck region treated at our institution. The demographic and treatment details of the patients were reviewed. RESULTS: In addition to the index patient, four more patients (two with gingivobuccal and one each with nasal and laryngeal histoplasmosis) were found. Out of the five patients, only one patient was found to have underlying immunosuppression. All of the patients were diagnosed with biopsy showing typical appearance of the intracellular organism. All the patients were satisfactorily treated with systemic antifungal treatment. CONCLUSION: Upper aerodigestive tract involvement with histoplasmosis can present as an intriguing clinical puzzle. A high index of suspicion is needed and biopsy is the gold standard for the diagnosis. Intravenous Liposomal Amphotericin B and oral Itraconazole are standard treatment agents of choice and are highly efficacious in achieving cure.
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Anfotericina B/uso terapêutico , Histoplasmose/tratamento farmacológico , Histoplasmose/patologia , Itraconazol/uso terapêutico , Imageamento por Ressonância Magnética/métodos , Língua/patologia , Idoso , Antifúngicos/uso terapêutico , Biópsia por Agulha , Quimioterapia Combinada , Feminino , Seguimentos , Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico por imagem , Humanos , Imuno-Histoquímica , Medição de Risco , Resultado do TratamentoRESUMO
BACKGROUND: Leaving against medical advice (LAMA) is a common health concern seen worldwide. It has variable incidence and reasons depending upon disease, geographical region and type of health care system. MATERIALS AND METHODS: We approached anesthesiologists and intensivists for their opinion through ISA and ISCCM contact database using Monkey Survey of 22 questions covering geographical area, type of healthcare system, incidence, reasons, type of disease, expected outcome of LAMA patients etc. RESULTS: We received only 1154 responses. Only 584 answered all questions. Out of 1154, only 313 respondents were from government medical colleges or hospitals while remaining responses were from private and corporate sector. Most hospitals had >100 beds. ICUs were semi-closed and supervised by critical-care physicians. LAMA incidence was maximum from ICU (45%) followed by ward (32%) and emergency (25%). Most patients of LAMA had ICU stay for >1 week (60%). Eighty percent of the respondents opined that financial constraints are the most common reason of LAMA. Unsatisfactory care was rarely considered as a factor for LAMA. Approximately 40% patients had advanced malignancy or disease. Nearly 2/3rd strongly believed that insurance cover may reduce the LAMA rate. CONCLUSION: Most patients get LAMA from the ICU after a stay of week. Financial constraints, terminal medical illness, malignancy and sepsis are major causes of LAMA. Remedial methods suggested to decrease the incidence include a good national health policy by the state; improved communication between the patient, caregivers and heathcare team; practice of palliative and end-of-life care support; and lastly, awareness among the people about advance directives. HOW TO CITE THIS ARTICLE: Paul G, Gautam PL et al. Patients Leaving Against Medical Advice-A National Survey. Indian J Crit Care Med 2019;23(3):143-148.