Botox in below knee amputation for the management of post-operative contracture: a systematic review.

During the 1970s, scientists first used botulinum toxin to treat strabismus. While testing on monkeys, they noticed that the toxin could also reduce wrinkles in the glabella area. This led to its widespread use in both medical and cosmetic fields. The objective of the study was to evaluate the potential use of Botox in managing post-operative contracture after below-knee amputation. We conducted a systematic review In Pubmed, Cochrane Library, Embase, and Google Scholar using the MESH terms Botox, botulinum toxin, post-operative contracture, amputation, and below knee amputation. Our goal was to evaluate the potential use of Botox to manage post-operative contracture in patients who have undergone below-knee amputation. Our findings show evidence in the literature that Botox can effectively manage stump hyperhidrosis, phantom pain, and jumping stump, but no clinical trial has been found that discusses the use of Botox for post-operative contracture. Botox has been used in different ways to manage spasticity. Further studies and clinical trials are needed to support the use of Botox to manage this complication.

Prevalence and correlates of generalized anxiety disorder and perceived stress among Sudanese medical students.

BACKGROUND: Generalized Anxiety Disorder (GAD) causes significant disturbance in an individual's well-being and activity. Whereby, interfering with the dynamic progress in life. Also, anxiety is a product of stress and a major predictor of academic performance. This study aimed to assess the prevalence of Generalized Anxiety Disorder (GAD), measure levels of anxiety and perceived stress, evaluate the academic profile, identify lifestyle characteristics, and explore the relationship between these factors. METHODS: In this cross-sectional study, 340 Sudanese medical students filled out online questionnaires, composed of the sociodemographic and lifestyle characteristics, academic profile, Generalized Anxiety Disorder-2 scale (GAD-2), and Perceived Stress Scale-10 (PSS-10). Descriptive and inferential statistics were applied using Statistical Package for Social Science (SPSS) Version 20.0 for data analysis. RESULTS: Of 340 medical students, 3.8% of them were diagnosed with GAD, while 29.1% scored ≥ 3 in GAD-2, indicating a possible diagnosis. The study found that 9.7% of the participants used addictive substances, with 42% of them having high GAD-2 scores. Moreover, high anxiety levels were associated with high-stress scores (p-value = 0.000). Also, high GAD-2 scores were significantly associated with students who spent less than 10,000 SDG (18 USD) weekly, spent more time on entertainment using smart devices (p-value = 0.004), and had an unhealthy diet (p-value = 0.004). Low anxiety levels were associated with better sleep quality (p-value = 0.00), satisfaction with religious practices (p-value = 0.00), and increased leisure/hobby time (p-value = 0.018). High-stress levels were observed in females (p-value = 0.035), those with lower academic performance satisfaction levels, and increased hours of smart device usage for entertainment (p-value = 0.001). Reduced stress levels were associated with being ≥ 23 years old, increased leisure/hobby time (p-value = 0.002), satisfaction with religious practices [F(3, 166.6) = 10.8, p-value = 0.00)], and having a healthy diet (p-value = 0.006). CONCLUSION: The low prevalence of GAD corresponded with previous literature, but 29.1% of medical students had a high probability of having GAD. The study emphasizes on providing accessible mental health services for medical students and interventions addressing modifiable risk factors.

A Comparative Study on the Quality of MRI Reporting in Primary Rectal Cancer.

Background Rectal cancer is a widespread health concern in the UK, and MRI is vital for accurate diagnosis and effective treatment. To enhance the quality of MRI reports for rectal cancer, structured reporting can be utilized. Despite the existence of global guidelines and templates, there is a lack of use for standardized templates. Thus, this study seeks to assess and compare the quality of MRI reports in free text style for rectal cancer at a single hospital with international recommendations. Methodology We conducted a retrospective cohort study on adult patients diagnosed with primary rectal cancer and underwent an MRI of the rectum/pelvis. The study aimed to identify and compare the difference in reporting quality between in-house GI radiologists and out-of-hours outsourced reporting agencies. The quality of reporting was identified based on at least fifteen selected features recommended by the European Society of Gastrointestinal and Abdominal Radiology and the Society of Abdominal Radiology. The study was performed in a General and Colorectal Surgery Department in the North East of England. Results The study retrospectively analysed 94 reports of primary rectal cancer patients over three years. The quality of reporting was compared between in-house GI radiologists and out-of-hours outsourced reporting agencies. The results showed that in-house radiologists had better reporting quality than outsourced agencies in terms of TNM stage (TNM is a notation system that describes the stage of cancer), predicted extramural venous invasion (EMVI), mesorectal fascia involvement (MRF), T stage, and shape. No statistical significance was found for metastasis, node status, further MRF description, peritoneal reflection, or MRI signal. Conclusion The study found that local GI radiologists had better quality reporting than outsourced agencies for rectal cancer MRI reports, but still missed important features. A unified structured reporting template is recommended to improve the quality of MRI reporting for rectal cancer.

Experience of the Sudanese doctors in surgery of conjoined twins.

Surgical separation of conjoined twins remains one of the most unique and rewarding experiences in the field of pediatric surgery, bearing in mind that this decision is their best chance of survival. These are the first reported cases of successfully separating omphalopagus conjoined twins by the liver in Sudan. After an emergency cesarean section, 62-day-old term-conjoined twins were referred to our pediatric surgery center. Examination revealed well-appearing twins fused from the xiphoid to the umbilicus; imaging confirmed a fused liver with a separate portal and caval structures, necessitating surgical separation and closure, which was done successfully on subsequent hours with well tolerance and recovery discharged on day 21. The second case involved 21-day-old term-conjoined female twins who were fused from the xiphoid to the umbilicus and shared the same cord, as well as complete fusion of the liver with separate other vital organs. They were successfully separated and recovered well.

Effective Reconstruction of Expectation Values from Ab Initio Quantum Embedding.

Quantum embedding is an appealing route to fragment a large interacting quantum system into several smaller auxiliary "cluster" problems to exploit the locality of the correlated physics. In this work, we critically review approaches to recombine these fragmented solutions in order to compute nonlocal expectation values, including the total energy. Starting from the democratic partitioning of expectation values used in density matrix embedding theory, we motivate and develop a number of alternative approaches, numerically demonstrating their efficiency and improved accuracy as a function of increasing cluster size for both energetics and nonlocal two-body observables in molecular and solid state systems. These approaches consider the N-representability of the resulting expectation values via an implicit global wave function across the clusters, as well as the importance of including contributions to expectation values spanning multiple fragments simultaneously, thereby alleviating the fundamental locality approximation of the embedding. We clearly demonstrate the value of these introduced functionals for reliable extraction of observables and robust and systematic convergence as the cluster size increases, allowing for significantly smaller clusters to be used for a desired accuracy compared to traditional approaches in ab initio wave function quantum embedding.

The Necessity of Routine Pre-operative Group and Save Testing for Emergency Appendectomies.

Background Pre-surgical group and save (G&S) tests are routine but can result in unnecessary expense and theatre delays. The objective of this study was to assess the necessity of G&S testing prior to appendectomy and evaluate the cost implications. Methods This retrospective study analysed the records of 200 patients with appendicitis who underwent emergency appendectomies at a busy general surgery department between March 2021 to August 2022. The study adhered to local clinical governance unit protocol and the Strengthening the Reporting of Cohort Studies in Surgery (STROCCS) guidelines. Patients who had elective appendectomies or other emergency procedures were excluded. Data was collected on age, gender, number of samples and requirement for perioperative transfusion. Comparisons were drawn between patients who underwent laparoscopic, open or converted emergency appendectomies. Results Of the sample population, (median age 32, 55.5% male), 93.5% had valid preoperative G&S tests. None required perioperative blood transfusions. 26% of the patients only required one sample for a valid G&S due to having previous sample in the lab; 55% required two samples; 7% needed a third sample because one initial sample was rejected; and 5.5% required four samples because the initial two samples were rejected. The total cost of these samples was estimated to be £3,500.14. Conclusion Emergency appendectomy poses minimal risk of resulting in the need for blood transfusions. Reevaluating the need for routine preoperative G&S testing and adopting a risk-benefit analysis approach could have a financial benefit for the NHS.

Prevalence and outcomes of hyponatremia among COVID-19 patients: A systematic review and meta-analysis.

Objectives: On March 2020, the WHO declared coronavirus disease 2019 (COVID-19) pandemic. COVID-19 is associated with various clinical syndromes, with electrolytes imbalances involved. This review aims to quantify the prevalence and outcomes of hyponatremia among COVID-19 patients, as well as to review the underlying pathophysiological mechanisms of hyponatremia among these patients. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines, we conducted a systematic literature search using the electronic databases of Google Scholar, MEDLINE (PubMed), WHO Virtual Health Library, and ScienceDirect, without limitations regarding gender, geographical area, race or publication date, up until December 13, 2021. Primary outcomes measured were mortality, intensive care unit (ICU) admission, assisted ventilation need, and length of hospital stay (LOS). Secondary outcome was the mechanism underlying hyponatremia among COVID-19 patients. Results: From a total of 52 included studies, 23 underwent quantitative analysis. For the primary outcomes; proportions, odds ratios (OR), and standardized mean difference (SMD) were calculated using random effects model. The prevalence of hyponatremia was found to be 25.8%. Hyponatremia was found to be significantly associated with increased odds for mortality (OR = 1.97[95% CI, 1.50-2.59]), ICU admission (OR = 1.91 [95% CI, 1.56-2.35]), assisted ventilation need (OR = 2.04 [95% CI, 1.73-2.38]), and with increased LOS (SMD of 5.74 h [95% CI, 0.092-0.385]). Regarding the mechanisms underlying hyponatremia, syndrome of inappropriate anti-diuretic hormone secretion (SIADH) was most commonly reported, followed by adrenal insufficiency, and finally hypovolemic hyponatremia due to gastrointestinal losses. Conclusion: Hyponatremia among COVID-19 patients is generally associated with poor outcomes, with SIADH being the most common underlying mechanism.

Usefulness of MRI findings in differentiating between septic arthritis and transient synovitis of hip joint in children: A systematic review and meta-analysis.

Purpose: Septic arthritis (SA) of the hip joint is a serious infection which can lead to more irreversible complications. Differentiating Septic arthritis from Transient synovitis (which is the most common cause of painful hip in children) is difficult and very important to prevent serious complications which can occur with Septic arthritis. The aim of this study was to find out the MRI findings which can differentiate between these two conditions. Methods: Systematic literature search was conducted according to the PRISMA guidelines on MEDLINE(PubMed), Google Scholar, ScienceDirect, and world Health Organization Virtual Health Library, up to April 2022. Studies that compared MRI findings between Septic Arthritis and Transient Synovitis of hip joint in children were included. The pooled sensitivity and specificity estimates of these findings were calculated using MetaDTA version 2.0. Results: Six studies were included in qualitative analysis and five were included in quantitative analysis. Pooled sensitivity and specificity of synovial enhancement were 94.2 % (95 % CI, 45.2-99.7 %) and 60.6 % (95% CI, 6-97.4 %) respectively. Soft tissue changes had pooled sensitivity and specificity of 75 % (95% CI, 57.5-86.9 %) and 69.9 % (95 % CI, 46.5-86.2 %) respectively. Pooled sensitivity and specificity of femoral head changes were 41.5 % (95 % CI, 15.9-72.7 %) and 87.3 % (95 % CI, 75.5-93.8 %) respectively. Bone marrow changes had pooled sensitivity and specificity of 70 % (95 % CI, 26.8-93.7 %) and 99.9 % (95 % CI, 28.7-100 %) respectively. Conclusion: MRI findings especially bone marrow changes were found to be useful in differentiating septic arthritis from transient synovitis among children presented with painful hip after exclusion of other causes.

Outcomes of neonatal hypothermia among very low birth weight infants: a Meta-analysis.

BACKGROUND: Neonatal admission hypothermia (HT) is a frequently encountered problem in neonatal intensive care units (NICUs) and it has been linked to a higher risk of mortality and morbidity. However, there is a disparity in data in the existing literature regarding the prevalence and outcomes associated with HT in very low birth weight (VLBW) infants. This review aimed to provide further summary and analyses of the association between HT and adverse clinical outcomes in VLBW infants. METHODS: In July 2020, we conducted this review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic database search was conducted in MEDLINE (PubMed), Google Scholar, ScienceDirect, World Health Organization Virtual Health Library, Cochrane Library databases, and System for Information on Grey Literature in Europe (SIGLE). We included studies that assessed the prevalence of HT and/or the association between HT and any adverse outcomes in VLBW infants. We calculated the pooled prevalence and Odds Ratio (OR) estimates with the corresponding 95% Confidence Interval (CI) using the Comprehensive meta-analysis software version 3.3 (Biostat, Engle-wood, NJ, USA; http://www.Meta-Analysis.com ). RESULTS: Eighteen studies that fulfilled the eligibility criteria were meta-analyzed. The pooled prevalence of HT among VLBW infants was 48.3% (95% CI, 42.0-54.7%). HT in VLBW infants was significantly associated with mortality (OR = 1.89; 1.72-2.09), intra-ventricular hemorrhage (OR = 1.86; 1.09-3.14), bronchopulmonary dysplasia (OR = 1.28; 1.16-1.40), neonatal sepsis (OR = 1.47; 1.09-2.49), and retinopathy of prematurity (OR = 1.45; 1.28-1.72). CONCLUSION: Neonatal HT rate is high in VLBW infants and it is a risk factor for mortality and morbidity in VLBW infants. This review provides a comprehensive view of the prevalence and outcomes of HT in VLBW infants.

Shear Strength of Externally U-Bonded Carbon Fiber-Reinforced Polymer High-Strength Reinforced Concrete.

In this paper, we investigate the contribution of Fiber-Reinforced Polymer (FRP) to the load-carrying capacity of shear-strengthened Reinforced Concrete (RC) beams. Specifically, the investigation is focused on the FRP's contribution in the presence and absence of shear stirrups. To this end, two sets of full-scale RC beam specimens were tested to failure in a simply supported setup. Set 1 consisted of specimens without shear stirrups whereas Set 2 included steel stirrups spaced at 170 mm. One and two layers of FRP discrete strips were bonded to the beams in a U-jacketing configuration. To investigate the contribution of FRP and its interaction with the stirrups, two different locations were considered when bonding the FRP strips: between the stirrups (referred to as Off-beams) and at the same level of the stirrups (referred to as On). Results of the experimental program showed that strengthening the beams with two layers of FRP does not necessarily translate to improved capacity. Furthermore, the location of FRP strips with respect to the location of shear stirrups has an influence on the beam's overall behavior, especially its displacement ductility. This is an important parameter to consider to avoid premature failure of RC members. Test results were then used to assess the performance and accuracy of the predictions of ACI PRC-440.2-17 and fib-TG9.3. Both design codes were found to be conservative with an average prediction-to-test ratio of 0.7.