Water contamination: A culprit of serum heavy metals concentration, oxidative stress and health risk among residents of a Nigerian crude oil-producing community.

Niger Delta has become popular for crude oil extraction for the past few decades. This uncoordinated activity has made it a hotspot for xenobiotics exposure and water bodies remain the environmental matrix significantly affected. One of the most deleterious components of crude oil is heavy metals (HMs). This study investigates HMs concentration in water and serum of humans residing in an oil-host community with the consideration of systemic effects, pollution status, carcinogenic and non-carcinogenic health risks and comparison made with residents from a non-oil-producing community. Heavy metal analysis, serum electrolytes, Urea, Creatinine, and liver enzymes were assessed using standard procedures; malondialdehyde, catalase, SOD, glutathione reductase, GPx and total antioxidant capacity (TAC) by spectrophotometry and TNF-α and 8-OHdG assessed via ELISA method. We found altered serum electrolytes; increased serum Pb and Cd levels; increased AST, ALT, ALP and lipid peroxidation; and decreased enzymes antioxidants including TAC among Ugbegugun community residents compared with control. We observed an association between environmental crude oil contamination, ecological and health risks in the community. We concluded that protracted exposure to HMs induces multi-systemic toxicities characterized by DNA damage, depletion of the antioxidant system, and increased free radical generation culminating lipo-peroxidation with significant ecological, carcinogenic, and non-carcinogenic risks characterize crude oil water contamination.

An assessment of the impact of behavioural cognitions on function in patients partaking in a trial of early home-based progressive resistance training after total hip replacement surgery.

BACKGROUND: Control cognitions have been directly related to positive engagement with rehabilitation regimes. The impact of such cognitions on recovery following surgery is not well understood. PURPOSE: To assess whether perceived control cognitions predict function 9-12 months following total hip replacement (THR). METHODS: Prospective cohort study performed as part of a randomised controlled trial. Behavioural cognitions (BC) (recovery locus of control (RLOC); perceived external behavioural control (PEBC))) and subjective functional outcome measures (Oxford hip score (OHS) and a reduced version of the Western Ontario and McMasters University Osteoarthritis Function scale (rWOMAC PF)) were administered pre-operatively and up to 12 months post-operatively to 50 patients randomised to home-based progressive resistance training (N = 26) or standard rehabilitation (N = 24), post-THR. Regression analysis investigated variance in functional scores. RESULTS: Group randomisation had no effect on BC. RLOC and OHS (6 months) correlated significantly with 12-month OHS, with 6-month OHS predicting 62.3% of the variance in 12-month OHS. 12-month rWOMAC PF was determined by each of its three previous assessments (pre-operative 8.8%, 6 weeks 17.8% and 6 months 67.3%). Variance in functional gain at 12 months (OHS and rWOMAC PF) was explained by pre-operative OHS and rWOMAC PF (63.7% and 63.8%, respectively). CONCLUSIONS: BC had no impact on functional outcome in this population. Subjectively assessed function at 12 months, as well as the levels of functional gain over time, was best explained by the patients' earlier functional status. Implications for Rehabilitation It is important to assess psychological factors such as poor pre-operative mental health and pain catastrophising in patients undergoing joint replacement surgery as these factors have an adverse effect on subjective patient outcomes. Pre-operative behavioural cognitions appear to have no impact on subjective functional outcome at 12 months post-THR. The pre-existing functional status of the patient appears to be most predictive of subjective function at 12 months post-THR, implying that perhaps earlier surgery may be optimal before the onset of a decline in function.

Does wrist immobilization following open carpal tunnel release improve functional outcome? A literature review.

Carpal Tunnel Syndrome (CTS) is a compressive neuropathy of the median nerve in the carpal tunnel. It is the most common peripheral entrapment neuropathy. The surgical management includes dividing the flexor retinaculum to decompress the median nerve. Post-operative mobilization of the wrist is controversial. Some surgeons splint the wrist for 2-4 weeks whilst others encourage early mobilization. The literature has been inconclusive as to which method is most beneficial. The purpose of this study is to review the literature regarding the effectiveness of wrist immobilization following open carpal tunnel decompression. We reviewed all published clinical trials claiming to evaluate the mobility status following open carpal tunnel release. Studies not in the English language as well as those with small number of patients (n < 30) were excluded. There were five studies that fulfilled the eligibility criteria and were included in this review. We conclude that there is no beneficial effect from post-operative immobilization after open carpal tunnel decompression when compared to early mobilization.

Outcome of gastroplasty and gastric bypass in a single centre in the UK.

BACKGROUND: Morbid obesity is defined as BMI>40 kg/m2. It affects 124,000 men and 412,000 women in England and Wales (NICE, July 2002). According to NICE guidelines, Bariatric surgery is indicated if the treatments for obesity such as exercise, diet and drugs fail. Procedures include laparoscopic gastric banding (LGB), vertical banded gastroplasty (VBG), and Gastric Bypass (GB). AIMS: The aim of this audit was to determine if NICE guidelines on the use of Bariatric surgery in the Manor Hospital, Walsall was being adhered to. Secondary aims were also to establish if Bariatric surgery is achieving its goal in the long-term and if weight reduction is being maintained in this group of patients. METHODS: A retrospective cohort study was carried out on patients who underwent Bariatric surgery between 1990 and 2004. Retrieved records were scrutinised and the following parameters were collated: pre-operative morbidities, intra and post-operative complication rates and weight reduction on follow-up. RESULTS: 129 patients were operated on in the 14 year period. For VBG, 40 out of 105 patients had weight gain by the 5th follow-up visit. This compared with 5 out of 18 patients after the same timescale for the GB group and 1 out of 6 in the LGB group. The most common post-operative complication was stenosis (28% of VBG group). CONCLUSION: Bariatric surgery is relatively safe as an intervention for morbid obesity. Weight loss however is not maintained in the long term. VBG and LGB are short term interventions. Further research is required to look into the merits of gastric bypass surgery.

Coracoid impingement syndrome: a literature review.

Coracoid impingement syndrome is a less common cause of shoulder pain. Symptoms are presumed to occur when the subscapularis tendon impinges between the coracoid and lesser tuberosity of the humerus. Coracoid impingement should be included in the differential diagnosis when evaluating a patient with activity-related anterior shoulder pain. It is not thought to be as common as subacromial impingement, and the possibility of the coexistence of the two conditions must be taken into consideration before treatment of either as an isolated process. If nonoperative treatment fails to relieve symptoms, surgical decompression can be offered as an option.

The prediction of outcome in somatised patients undergoing elective lumbar surgery.

We compared a group of 46 somatised patients with a control group of 41 non-somatised patients who had undergone elective surgery to the lumbar spine in an attempt to identify pre-operative factors which could predict the outcome. In a prospective single-centre study, the Distress and Risk Assessment method consisting of a modified somatic perception questionnaire and modified Zung depression index was used pre-operatively to identify somatised patients. The type and number of consultations were correlated with functional indicators of outcome, such as the Oswestry disability index and a visual analogue score for pain in the leg after follow-up for six and 12 months. Similar improvements in the Oswestry disability index were found in the somatised and non-somatised groups. Somatised patients who had a good outcome on the Oswestry disability index had an increased number of orthopaedic consultations (50 of 83 patients (60%) vs 29 of 73 patients (39.7%); p = 0.16) and waited less time for their surgery (5.5 months) (sd 5.26) vs 10.1 months (sd 6.29); p = 0.026). No other identifiable factors were found. A shorter wait for surgery appeared to predict a good outcome. Early review by a spinal surgeon and a reduced waiting time to surgery appear to be of particular benefit to somatised patients.

Pigmented villonodular synovitis of the talonavicular joint: a case report and review of the literature.

Pigmented villonodular synovitis (PVNS) is a locally aggressive synovial proliferative disorder of unknown aetiology affecting the linings of joints, tendon sheaths, and bursae. A 22-year-old female patient presented with a 3-year history of an increasingly painful swelling on the dorsum of her right foot. Examination revealed a 4 cm x 2 cm swelling that was fluctuant, tender on palpation, unattached to overlying skin and partially mobile. A firm, pedunculated intra-articular lesion from the talonavicular joint was removed at surgery. Histology revealed a nodular lesion of stromal cells and numerous giant cells with villous architecture as well as abundant haemosiderin deposition with foamy macrophages (in keeping with PVNS). The patient is currently under review by the orthopaedic oncology team. Talonavicular joint PVNS is rare. MRI scanning is the optimum investigation. Complete excision is necessary to minimise high risk of recurrence.

The effects of sex, parity and maternal age on birth weights in a specialist hospital setting in Nigeria.

This study looked at the combined effects of maternal age, fetal sex and parity in a specialist hospital setting and compared it with already published figures obtained from public health-care data in Nigeria. The results show a relationship exists with bivariate analysis between these variables and birth weight, but with multivariate analysis the relationship proves to be spurious. Socio-economic status and maternal health were felt to be the most important considerations within the specialist hospital setting, as patients who attend are more likely to be of high socio-economic status and therefore on a higher income and better educated. This has a beneficial impact on maternal health and a positive outcome on birth weight.