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1.
J Pak Med Assoc ; 71(8): 2093-2096, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34418039

RESUMO

Diabetes mellitus has reached pandemic proportions throughout the globe. Though hyperglycaemia is the hall mark feature of diabetes, there are several variations in its etiology, clinical presentation, and associated complications. Some of these variations have been distinctly described in specific regions and ethnicities across India and other regions in the world. In this commentary we describe these endemic syndromes associated with diabetes to improve their awareness, recognition and management. A focused attention on these relatively neglected clinical challenges would encourage future discussion and research to address these conditions.


Assuntos
Diabetes Mellitus , Hiperglicemia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Humanos , Índia/epidemiologia , Síndrome
2.
Int J Biol Macromol ; 189: 443-454, 2021 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-34425122

RESUMO

In this contribution, we report the fabrication of multifunctional nanoparticles with gold shell over an iron oxide nanoparticles (INPs) core. The fabricated system combines the magnetic property of INPs and the surface plasmon resonance of gold. The developed nanoparticles are coated with thiolated pectin (TPGINs), which provides stability to the nanoparticles dispersion and allows the loading of hydrophobic anticancer drugs. Curcumin (Cur) is used as the model drug and an encapsulation efficiency of approximately 80% in TPGINs is observed. Cytotoxicity study with HeLa cells shows that Cur-loaded TPGINs have better viability percent (~30%) than Cur alone (~40%) at a dose of 30 µg of TPGINs. Further, annexin V-PI assay demonstrated the enhanced anticancer activity of Cur-loaded TPGINs via induction of apoptosis. The use of TPGINs leads to a significant enhancement in generating reactive oxygen species (ROS) in HeLa cells through improved radiosensitization by gamma irradiation (0.5 Gy). TPGINs are further evaluated for imparting contrast in magnetic resonance imaging (MRI) with the r2 relaxivity in the range of 11.06-13.94 s-1 µg-1 mL when measured at 7 Tesla. These experimental results indicate the potential of TPGINs for drug delivery and MR imaging.

3.
Nanomedicine (Lond) ; 16(22): 1963-1982, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34431318

RESUMO

Aim: To differentiate mesenchymal stem cells into functional dopaminergic neurons using an electrospun polycaprolactone (PCL) and graphene (G) nanocomposite. Methods: A one-step approach was used to electrospin the PCL nanocomposite, with varying G concentrations, followed by evaluating their biocompatibility and neuronal differentiation. Results: PCL with exiguous graphene demonstrated an ideal nanotopography with an unprecedented combination of guidance stimuli and substrate cues, aiding the enhanced differentiation of mesenchymal stem cells into dopaminergic neurons. These newly differentiated neurons were seen to exhibit unique neuronal arborization, enhanced intracellular Ca2+ influx and dopamine secretion. Conclusion: Having cost-effective fabrication and room-temperature storage, the PCL-G nanocomposites could pave the way for enhanced neuronal differentiation, thereby opening a new horizon for an array of applications in neural regenerative medicine.


Assuntos
Grafite , Células-Tronco Mesenquimais , Nanocompostos , Nanofibras , Diferenciação Celular , Humanos , Poliésteres , Engenharia Tecidual , Tecidos Suporte
4.
J Assoc Physicians India ; 69(2): 30-34, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33527808

RESUMO

Background: Diabetic foot ulcer (DFU) is one of the most dreaded complications of Type 2 Diabetes Mellitus (T2DM). Preventive podiatry is most efficient way of minimising DFU. The main aim of the study was to assess the knowledge and foot care practices among patients living with T2DM concerning the DFU. Materials and Methods: We conducted a cross-sectional study in a rural-area of Haryana, India between January to March 2019 amongst 416 people living with T2DM after using multistage random sampling. A pre-tested, structured survey instrument prepared from the recommendation of the American College of Foot and Ankle Surgeons and the Diabetes UK was used after Hindi translation as per standard protocol. The knowledge and practices were classified as good, satisfactory and poor if the total score was between 8-11, 6-7 and <6. Results: 14.2% had a previous history of DFU. The prevalence of good, satisfactory and poor knowledge was 63.5%, 12.5% and 24.0%. Further, 46.7%, 32.7% and 20.6% respondents depicted good, satisfactory and poor practices regarding foot care. On multivariate binary logistic regression analysis, younger age group, higher education, Per capita family income in INR, Blood glucose levels, HbA1c Levels, physical activity and previous history of DFU emerged as significant predictors of good foot-care knowledge and practices. Conclusion: There is an evident gap between foot-care knowledge and practices that should be addressed through comprehensive behaviour change strategies. Comprehensive risk-assessments for diabetes associated complications needs to be piloted at community level to assess the feasibility.


Assuntos
Diabetes Mellitus Tipo 2 , Pé Diabético , Podiatria , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Pé Diabético/epidemiologia , Pé Diabético/prevenção & controle , Humanos , Índia/epidemiologia
5.
J Pak Med Assoc ; 70(10): 1860-1861, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33159771

RESUMO

This opinion piece discusses the concept of social insulin resistance, and helps create a comprehensive biopsychosocial model of insulin resistance. Social insulin resistance is defined as a negative attitude, present in some social groups, directed towards avoidance or rejection of insulin therapy. The various aspects of social insulin resistance are described in detail. This important construct has both clinical and public health relevance, and will help plan strategies to improve the acceptance and usage of insulin in diabetes care.


Assuntos
Diabetes Mellitus Tipo 2 , Resistência à Insulina , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos , Hipoglicemiantes , Insulina
6.
Med Eng Phys ; 79: 52-59, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32145999

RESUMO

INTRODUCTION: Evidence now exists advocating the use of computer navigation in total knee arthroplasty (TKA). Despite the introduction of new navigation systems into clinical practice no evidence currently exists showing independent verification of their accuracy. The aim of this study was to validate the in vivo accuracy of the Exactech Guided Personalised Surgery (GPS) computer navigation system using a validated computed tomography (CT) measurement of alignment. METHOD: Consecutive patients who underwent TKA using the GPS Navigation System at our institution were prospectively recruited. Intraoperative parameters of 3D alignment as measured by the GPS navigation system were recorded and compared against the postoperative measurements of alignment measured using the Perth CT Protocol to assess the accuracy of the GPS navigation system. RESULTS: 29 consecutive patients (13 male, 16 female) who underwent TKA were prospectively recruited. Overall, for all measures of 3D alignment the mean difference between intraoperatively recorded and postoperative CT-measured alignment was 1.55° ± 0.22° (95% confidence interval). Individual measurement differences in the femoral prosthesis were: coronal alignment 1.64° ± 0.52°; flexion 2.07° ± 0.55°; rotation 1.38° ± 0.33° Differences in the tibial prosthesis were: coronal alignment 2.03° ± 0.53°; slope 1.14° ± 0.39° The whole limb coronal alignment difference was 2.34° ± 0.83° CONCLUSION: The Exactech GPS Navigation system is very accurate with a high concordance between intraoperative and postoperative measures of alignment and prosthesis positioning. We therefore confidently validate the system and support its continued use in clinical practice. Other navigation systems should undergo a similar validation process.


Assuntos
Artroplastia do Joelho , Tomografia Computadorizada por Raios X , Adulto , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Cirurgia Assistida por Computador
7.
Indian J Orthop ; 53(6): 751-757, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31673177

RESUMO

Background: Trauma causes a major burden on the health system and economy of the country. A better understanding of the epidemiology of trauma can be of great help in planning preventive and curative strategies. Materials and Methods: A total of 4834 patients of trauma presenting during 1 year were included in this observational study. Demographic profile and other related criteria were noted, and data were statistically analyzed. Results: Male to female ratio was 5:1; most affected age group was 25-44 years in males and 45-64 years in females; 23.2% were illiterate; and professionals and students were most commonly affected. Road traffic accident (RTA), fall, and assault were the three most common causes; two wheelers were the most common accident causing vehicle. Nearly 17.7% were below poverty line and 67.6% reached hospital within 12 h. Medicolegal cases were 29.7%; only 29.3% reached hospital by ambulance and 3.72% were hemodynamically unstable. Only 3.6% received prehospital care and 16.23% were under alcohol influence. About 23.18% of RTA victims were pedestrians; city roads were the most common accident site. Head injury (25.85%) was the most common associated injury. Fractures were most common in hand (9.72%). The injury severity score (ISS) and New ISS were worse in the patients who were not using seat belt/helmet or were under influence of alcohol. The rate of death and associated injuries was also higher in this group. Conclusion: Trauma is a major preventable cause of mortality and morbidity mainly affecting the productive age group of the society.

8.
J Family Med Prim Care ; 8(1): 120-124, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30911491

RESUMO

Background: Prevention of intimate partner violence is an important public health goal owing to its negative psychological and physical health consequence. Objectives: Estimate the prevalence of reciprocate and nonreciprocate violence, severity of injuries, and related risk factors. Materials and Methods: The present study was a community-based cross-sectional study using multistage random sampling in which a total of 880 currently married women in the age group 15-49 years were interviewed using modified conflict tactics scale. Logistic regression was used to identify factors associated with both the types of domestic violence. Results: Total prevalence for spousal violence was 33.2% (283), out of which 14.84% (42) were reciprocally violent. Alcoholic husband [Adjusted Odds Ratio (AOR): 3.262, P = 0.001], late year of marriage (>2 years) [AOR: 0.359, P = 0.001], low education of the participants [AOR: 1.443, P = 0.033], and low socioeconomic class [AOR: 0.562, P = 0.004] are the risk factors for nonreciprocate domestic violence. Alcoholic husband [AOR: 4.372, P = 0.001] and nuclear family [AOR: 3.115, P = 0.001] were found as significant risk factors for reciprocate domestic violence. Women indulging in reciprocate violence were associated with more severe injuries than nonreciprocate violence. Conclusion: This study depicts that every third female has experienced spousal violence and also highlights the existence of reciprocate violence in India. Alcoholism, low education of husbands, and living in nuclear family are the important determinants for reciprocate violence. Also, reciprocate violence is associated with severe injuries.

9.
J Prosthodont ; 28(2): e843-e848, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28834052

RESUMO

PURPOSE: To estimate the incidence of obstructive sleep apnea (OSA) in elderly edentulous patients (aged 60-65 years) and investigate a correlation of serum serotonin levels with the apnea-hypopnea index (AHI), respiratory effort-related arousal (RERA), and respiratory disturbance index (RDI). MATERIALS AND METHODS: 381 elderly completely edentulous patients (307 male, 74 female) aged 60 to 65 years with a history of edentulism of 12 to 15 months, seeking oral rehabilitation at the prosthodontic clinic at Saraswati Dental College & Hospital, Lucknow, India, between January 2014 and January 2016 were enrolled for the present study. After application of the inclusion and exclusion criteria of this study, 183 patients (162 male, 21 female) who were found susceptible, were subjected to the BERLIN questionnaire and Epworth Sleepiness Scale (ESS) to assess sleep disordered breathing (SDB) and then put through all-night polysomnography (PSG). On the basis of AHI, RERA, and RDI scores, 156 patients (143 male, 13 female) who tested positive for OSA were classified according to its intensity. All 156 patients underwent body-mass index (BMI) estimation, cephalometry, and intraoral examination for skeletal and soft tissue profile record. Serum serotonin was estimated from whole blood samples for the 156 OSA and the 27 normal patients. The 156 (147 nonobese, 9 obese) OSA-positive patients were provided with complete dentures and were trained to use the same as a modified mandibular advancement device (MAD) during sleep at night. These patients were kept on a quarterly follow-up for 9 months. Data collected was subjected to statistical analysis, and inferences drawn. RESULTS: The incidence of OSA in elderly edentulous subjects was found to be 32.03% in males and 8.91% in females. A mere 9 out of 156 (5.76%) elderly edentulous OSA patients were found to be obese (Class I) on the basis of BMI estimation. Cephalometry of the patients showed that they had a skeletal class I maxillomandibular relationship. AHI scores of nonobese patients revealed that most of the patients had moderate OSA, followed by mild OSA and severe OSA. Serum serotonin levels ranged from 53 to 83 ng/dL. AHI score of the 9 obese patients were in the moderate to severe range, and their serum serotonin levels were 60 to 70 ng/dL. A correlation between severity of OSA and serum serotonin level was validated in this study. CONCLUSION: OSA was found to be prevalent in edentulous subjects due to pharyngeal collapse and decreased neuromuscular control. An inverse relationship of serum serotonin levels and AHI scores was established.


Assuntos
Boca Edêntula/complicações , Serotonina/sangue , Apneia Obstrutiva do Sono/epidemiologia , Idoso , Índice de Massa Corporal , Cefalometria , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Polissonografia , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/sangue , Apneia Obstrutiva do Sono/etiologia
10.
Indian J Psychol Med ; 40(6): 534-539, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30533949

RESUMO

Background: No nation is untouched by domestic violence, and it is well-known that domestic violence has serious impact on women's health and well-being. The present study aimed to assess the prevalence and characteristics of domestic violence and injuries owing to domestic violence among currently married women. Materials and Methods: This was a community-based, cross-sectional study conducted in the rural and urban areas of Haryana. In total, 880 currently married females of the reproductive age group were interviewed using the Women's Questionnaire (used in National Family Health Survey-3) which is according to the Modified Conflict Tactics Scale. Results: Totally, 37% of the females had ever experienced domestic violence and 28.9% currently experienced domestic violence. All types of violence (except sexual violence) were significantly more common in the rural area than the urban area. Injuries owing to domestic violence were reported by more than half (55.4%) of the women. Among spousal violence, emotional violence was the most common type of violence followed by physical violence. Only 0.1% and 4.5% of females had ever initiated physical and emotional violence respectively, against their husbands, and in rest of the cases, it was the husband who initiated violence. Conclusion: Awareness regarding domestic violence needs to be made, and law enforcement regarding it needs to be made stringent. Rehabilitation of victims of domestic/spousal violence should also be considered on priority.

11.
J Conserv Dent ; 21(2): 230-232, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29674831

RESUMO

A metallic obstruction in the canal orifice of a maxillary right canine could not be bypassed during endodontic treatment. Aids such as ultrasonics and retrieval kits were not available for the removal of the obstruction. Therefore, a novel approach using a disposable syringe needle was employed. A 22-gauge needle was inserted into the orifice and turned in an arc with a gentle apical pressure and alternate rocking motion around the obstruction. This procedure was repeated few times to cut dentin and successfully dislodge and remove the obstruction using the sharp beveled tip of the needle. This case report demonstrates that, in the absence of other aids, the use of a disposable syringe needle is a simple, economical, and yet an effective technique for conservative removal of dentin and to dislodge and remove an obstruction from the root canal. However, its effectiveness depends on case selection and straight-line accessibility to the obstruction.

12.
SICOT J ; 4: 3, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29469803

RESUMO

Fracture of the femoral head (OTA 31-C1.3) following anterior obturator dislocations are a challenging problem as the fractures are often communited, impacted and with loose osteochondral fragments, making surgical fixation difficult. This can result in residual articular defects if the fragments cannot be internally fixed and need be excised, predisposing to secondary osteoarthritis. Treatment options for these defects are limited, have variable results and with limited literature to guide us on outcomes due to the rarity of these injuries. Here, we describe the first use of the technique of partial femoral head resurfacing in two patients with such fractures and report on their long term outcomes.

13.
Indian J Crit Care Med ; 22(1): 5-9, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29422725

RESUMO

Objective: Chikungunya is generally a mild disease, rarely requiring Intensive Care Unit (ICU) admission. However, certain populations may develop organ dysfunction necessitating ICU admission. The purpose of the study was to assess the clinical profile and course of chikungunya patients admitted to the ICU, and to ascertain factors linked with poor outcome. Methods: All patients with chikungunya admitted to ICU were included in the study. Admission Acute Physiology and Chronic Health Evaluation (APACHE) II score and sequential organ failure assessment (SOFA) score were calculated. Primary outcome measured was 28-day mortality and secondary outcomes measured were length of hospital and ICU stay and the need for vasopressor support, renal replacement therapy (RRT), and mechanical ventilation (MV). Logistic regression analysis was performed to identify factors predicting mortality. Results: The most common complaints were fever (96.67%) and altered sensorium (56.67%). Mean admission APACHE II and SOFA scores were 17.28 ± 7.9 and 7.15 ± 4.2, respectively. Fifty-one patients had underlying comorbidities. Vasopressors were required by 46.76%; RRT by 26.67%, and MV by 58.33%, respectively. The 28-day mortality was 36.67%. High APACHE II score (odds ratio: 1.535; 95% confidence interval: 1.053-2.237; P = 0.026) and need for dialysis (odds ratio: 833.221; 95% confidence interval: 1.853-374,664.825; P = 0.031) could independently predict mortality. Conclusions: Patients with chikungunya fever may require ICU admission for organ failure. They are generally elderly patients with underlying comorbidities. Despite aggressive resuscitation and organ support, these patients are at high risk of death. Admission APACHE II score and need for dialysis may predict patients at higher risk of death.

14.
ANZ J Surg ; 88(4): 284-289, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29124832

RESUMO

Continued advancements in orthopaedics have led to the development of many new implants; many of these are being utilized in clinical practice with little or no evidence base for their safety or effectiveness. Highly publicized failures in orthopaedic technology have led to an increased awareness of this issue in both medical and non-medical circles. In most cases, the significant harm caused to the public could have been avoided by the appropriately staged implementation of new implants. This review comments on the current literature regarding the optimal practice for the introduction of new orthopaedic technology. The authors' experience with the failed ESKA Adapter Short-stem/Modular Hip is described; the methodology used for its evaluation is used as a basis to discuss what was successful about the process and also give warning on what could be improved upon. The ideal practice requires new orthopaedic implants to be evaluated by high-volume surgeons in specialist orthopaedic hospitals. These studies should include biomechanical studies, radiostereophotometric analysis, implant retrieval and outcome assessment. Results and complications should be reported early to the appropriate joint registry and regulatory body. Once a suitable evidence base has developed, the implant can be distributed into wider clinical practice or withdrawn. These recommendations aim to protect the patient and public from harm while allowing surgical innovation to still continue.


Assuntos
Prótese de Quadril/efeitos adversos , Segurança do Paciente , Desenho de Prótese , Falha de Prótese , Austrália , Fenômenos Biomecânicos , Análise de Falha de Equipamento , Medicina Baseada em Evidências , Humanos , Osseointegração , Guias de Prática Clínica como Assunto , Reoperação , Propriedades de Superfície
15.
Mater Sci Eng C Mater Biol Appl ; 80: 243-251, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-28866162

RESUMO

In this study, we have synthesized magnetic nanocomposites of magnetite nanoparticles coated with 6-aminohexanoic acid and pectin (MAP). The size of the aqueous dispersion of the nanocomposites was 147nm with a Polydispersity index (PDI) of 0.32, and the nanocomposites were stable in NaCl up to a concentration of 0.45% (w/v) after which they aggregated. The dispersion of the nanocomposites was stable in Dulbecco's Modified Eagle's medium (DMEM) in the presence of 5 and 10% fetal bovine serum (FBS). Curcumin was used as a model drug to evaluate the potential of the nanocomposites for drug delivery applications. The release behavior of curcumin from the nanocomposites showed a biphasic pattern with initial burst release followed by a slow release, and the size of the aqueous dispersion of curcumin loaded nanocomposites was 159nm with a PDI of 0.34.


Assuntos
Nanopartículas de Magnetita , Ácido Aminocaproico , Animais , Sistemas de Liberação de Medicamentos , Nanocompostos , Nanopartículas , Pectinas
16.
Mater Sci Eng C Mater Biol Appl ; 80: 274-281, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-28866165

RESUMO

In this paper we report synthesis of aqueous based gold coated iron oxide nanoparticles to integrate the localized surface plasma resonance (SPR) properties of gold and magnetic properties of iron oxide in a single system. Iron oxide-gold core shell nanoparticles were stabilized by attachment of thiolated sodium alginate to the surface of nanoparticles. Transmission electron microscope (TEM) micrograph presents an average elementary particle size of 8.1±2.1nm. High resolution TEM (HR-TEM) and X-ray photon spectroscopy further confirms the presence of gold shell around iron oxide core. Gold coating is responsible for reducing saturation magnetization (Ms) value from ~41emu/g to ~24emu/g - in thiolated sodium alginate stabilized gold coated iron oxide core-shell nanoparticles. The drug (curcumin) loading efficiency for the prepared nanocomposites was estimated to be around 7.2wt% (72µgdrug/mg nanoparticles) with encapsulation efficiency of 72.8%. Gold-coated iron oxide core-shell nanoparticles could be of immense importance in the field of targeted drug delivery along with capability to be used as contrast agent for MRI & CT.


Assuntos
Nanopartículas Metálicas , Alginatos , Compostos Férricos , Ácido Glucurônico , Ouro , Ácidos Hexurônicos
17.
Skeletal Radiol ; 46(2): 177-183, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27826701

RESUMO

OBJECTIVE: The aim was to develop a CT-based protocol to accurately measure post-operative acetabular cup inclination and anteversion establishing which bony reference points facilitate the most accurate estimation of these variables. MATERIALS AND METHODS: An all-polyethylene acetabular liner was implanted into a cadaveric acetabulum. A conventional pelvic CT scan was performed and reformatted images created in both functional and anterior pelvic planes. CT images were transferred to a Freedom-Plus Graphics software package enabling an identical, virtual 3D model of the cadaveric pelvis to be created and definitive acetabular cup orientation established. Using coronal and axial slices of the CT scans, acetabular cup inclination and anteversion were measured on five occasions by ten radiographers using differing predetermined bony landmarks as reference points. The intra- and inter-observer variation in measurement of acetabular cup orientation using varying bony reference points was assessed in comparison to the elucidated definitive cup position. RESULTS AND CONCLUSION: Virtually derived definitive acetabular cup orientation was measured showing cup inclination and anteversion as 41.0 and 22.5° respectively. Mean CT-based measurement of cup inclination and anteversion by ten radiographers were 43.1 and 20.8° respectively. No statistically significant difference was found in intra- and inter-observer recorded results. No statistically significant differences were found when using different bony landmarks. CT assessment of acetabular component inclination and anteversion is accurate, reliable and reproducible when measured using differing bony landmarks as reference points. We recommend measuring acetabular inclination and anteversion from the inferior acetabular wall/teardrop and posterior ischium respectively.


Assuntos
Acetábulo/diagnóstico por imagem , Artroplastia de Quadril , Prótese de Quadril , Tomografia Computadorizada por Raios X/métodos , Acetábulo/cirurgia , Pontos de Referência Anatômicos , Cadáver , Humanos , Imageamento Tridimensional , Polietileno , Desenho de Prótese , Ajuste de Prótese , Interpretação de Imagem Radiográfica Assistida por Computador
18.
Ann Vasc Surg ; 33: 210-9, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26965805

RESUMO

BACKGROUND: Fracture and dislocation of the proximal humerus is common. It is associated with a number of vascular, neurologic, and orthopedic complications; these include brachial plexopathy and avascular necrosis (AVN) of the humeral head. These complications are rare but can potentially cause severe disability to patients; however, they remain poorly described in the literature. To describe vascular, orthopedic, and neurologic outcomes after axillary artery repair, in patients with proximal humeral fractures or dislocations. METHODS: We conducted a retrospective review of patients admitted to 2 tertiary trauma centers in Victoria, Australia, with fracture or dislocation of the proximal humerus and associated axillary artery injury. Patients were selected according to guidelines for trauma call or alert and the presence of high-risk mechanism of injury. Data on vascular, orthopedic, and neurologic complications were collected. RESULTS: Twenty-one patients were identified. Injury to the first part of the axillary artery was noted in 11 patients (52%). Brachial plexus exploration was performed in 17 patients (81%). Four patients (19%) underwent nerve repair. Long-term neurologic recovery was universally poor. Major orthopedic complications included AVN of the humeral head, delayed union, and the need for prosthesis or arthrodesis. Eleven patients (52%) received upper limb fasciotomy. Five patients (24%) underwent delayed secondary upper limb amputation. CONCLUSIONS: There was an unusually high rate of injuries to the first part of the axillary artery. Close clinical observation is recommended for such patients. AVN of the humeral head and brachial plexopathy remain significant and debilitating complications.


Assuntos
Artéria Axilar/lesões , Neuropatias do Plexo Braquial/etiologia , Plexo Braquial/fisiopatologia , Luxação do Ombro/complicações , Fraturas do Ombro/complicações , Lesões do Sistema Vascular/etiologia , Adolescente , Adulto , Idoso , Amputação , Angiografia Digital , Artéria Axilar/diagnóstico por imagem , Neuropatias do Plexo Braquial/diagnóstico , Neuropatias do Plexo Braquial/fisiopatologia , Neuropatias do Plexo Braquial/terapia , Angiografia por Tomografia Computadorizada , Fasciotomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Procedimentos Ortopédicos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/fisiopatologia , Luxação do Ombro/terapia , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/fisiopatologia , Fraturas do Ombro/terapia , Centros de Atenção Terciária , Fatores de Tempo , Centros de Traumatologia , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/terapia , Vitória , Adulto Jovem
19.
Injury ; 47(1): 192-6, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26391591

RESUMO

INTRODUCTION: Trampoline-related injuries in adults are uncommon. Participation in trampolining is increasing following its admission as a sport in the Olympics and the opening of local recreational trampoline centres. The aim of this study was to assess the number and outcomes of adult trampoline-related orthopaedic injuries presenting to four trauma hospitals in Victoria. METHODS: A cohort study was performed for the period 2007-2013. Adult patients registered by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) who had sustained a trampolining related injury were included in this study. Descriptive analyses were used to describe the patient population, the injuries sustained and their in-hospital and 6-month outcomes. RESULTS: There was an increase in trampolining injuries from 2007 (n=3) to 2012 (n=14) and 2013 (n=18). Overall, fifty patients with a median age of 25 (range 16-66) were identified. Thirty-five patients (70%) had lower limb injuries, 20 patients (40%) had spinal injuries and one patient had an upper limb injury. Thirty-nine patients (78%) required surgery. Fractures of the tibia (n=13), ankle fractures (n=12) and cervical spine injuries (n=7) were the most common injuries; all of which required surgery. Complications included death, spinal cord injuries, compartment syndrome and open fractures. At 6 months post injury, more than half (52%) of the patients had not achieved a good recovery, 32% had some form of persistent disability, 14% did not get back to work and overall physical health for the cohort was well below population norms for the SF-12. CONCLUSION: Adult trampoline-related injuries have increased in the last few years in this cohort identified through VOTOR. Lower limb and spinal injuries are most prevalent. Public awareness and education are important to reduce the risk for people participating in this activity.


Assuntos
Prevenção de Acidentes/métodos , Acidentes por Quedas/estatística & dados numéricos , Acidentes Domésticos/estatística & dados numéricos , Fraturas Ósseas/epidemiologia , Hospitalização/estatística & dados numéricos , Lesões do Pescoço/epidemiologia , Traumatismos da Coluna Vertebral/epidemiologia , Equipamentos Esportivos/efeitos adversos , Centros de Traumatologia , Acidentes por Quedas/prevenção & controle , Acidentes Domésticos/prevenção & controle , Adulto , Idoso , Estudos de Coortes , Avaliação da Deficiência , Feminino , Fraturas Ósseas/etiologia , Fraturas Ósseas/prevenção & controle , Educação em Saúde , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/etiologia , Lesões do Pescoço/prevenção & controle , Jogos e Brinquedos , Recreação , Retorno ao Trabalho , Fatores de Risco , Traumatismos da Coluna Vertebral/etiologia , Traumatismos da Coluna Vertebral/prevenção & controle , Centros de Traumatologia/estatística & dados numéricos , Vitória/epidemiologia
20.
J Prosthet Dent ; 115(2): 177-82, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26443067

RESUMO

STATEMENT OF PROBLEM: The gingival sulcus should remain open long enough for the impression material to flow into it and completely fill the space provided by the gingival displacement. Impressions with less sulcal width have a higher incidence of voids, tearing of impression materials, and reduction in marginal accuracy. PURPOSE: The purpose of this clinical study was to investigate the closure, gingival displacement, and gingival inflammation of the gingival crevice after the use of medicated gingival displacement cord and cordless systems. MATERIAL AND METHODS: Gingival sulcus closure was studied in 40 participants. They were divided into 4 groups: 2 cord (Ultrapack, SilTrax AS) and 2 cordless (Expasyl, Traxodent Hemodent paste) methods. The labial surfaces of the maxillary right and left central incisors were evaluated. Gingival sulcus was photographed every 20 seconds from 0 to 180 seconds after the removal of the cord or cordless system. The bleeding index (BI) and gingival index (GI) were measured at day 0, day 1, and day 7. The width of the sulcal orifice was measured at the mid-buccal (MB) and transitional line angle (TLA) on a digital image, using computer software (Photoshop version 7.0; Adobe). Data were analyzed with ANOVA, Tukey honest significant difference (HSD), Kruskal-Wallis, and Mann-Whitney U tests (α=.05). RESULTS: All groups showed a sulcal width greater than 0.22 mm up to 60 seconds after the removal of the displacement materials at the MB and up to 40 seconds at the TLA. Among all groups, Expasyl showed the fastest closure. Gingival displacement in the MB area for the cord group was greater than for the cordless groups. GI and BI indices were larger for the cord group than for the cordless group at days 0 and 1. CONCLUSIONS: At up to 60 seconds, the cord and cordless techniques were equally effective. The cord group showed a greater amount of displacement than the cordless group. However, the cordless materials showed reduced frequency of changes to the gingival index.


Assuntos
Técnica de Moldagem Odontológica , Gengiva/patologia , Técnicas de Retração Gengival , Materiais para Moldagem Odontológica/química , Técnica de Moldagem Odontológica/instrumentação , Elasticidade , Gengiva/anatomia & histologia , Gengivite , Humanos , Inflamação , Transdutores de Pressão
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