Tea polyphenol nanoparticles enable targeted siRNA delivery and multi-bioactive therapy for abdominal aortic aneurysms.

Abdominal aortic aneurysm (AAA) is a life-threatening vascular disease, while there is a lack of pharmaceutical interventions to halt AAA progression presently. To address the multifaceted pathology of AAA, this work develops a novel multifunctional gene delivery system to simultaneously deliver two siRNAs targeting MMP-2 and MMP-9. The system (TPNs-siRNA), formed through the oxidative polymerization and self-assembly of epigallocatechin gallate (EGCG), efficiently encapsulates siRNAs during self-assembly. TPNs-siRNA safeguards siRNAs from biological degradation, facilitates intracellular siRNA transfection, promotes lysosomal escape, and releases siRNAs to silence MMP-2 and MMP-9. Additionally, TPNs, serving as a multi-bioactive material, mitigates oxidative stress and inflammation, fosters M1-to-M2 repolarization of macrophages, and inhibits cell calcification and apoptosis. In experiments with AAA mice, TPNs-siRNA accumulated and persisted in aneurysmal tissue after intravenous delivery, demonstrating that TPNs-siRNA can be significantly distributed in macrophages and VSMCs relevant to AAA pathogenesis. Leveraging the carrier's intrinsic multi-bioactive properties, the targeted siRNA delivery by TPNs exhibits a synergistic effect for enhanced AAA therapy. Furthermore, TPNs-siRNA is gradually metabolized and excreted from the body, resulting in excellent biocompatibility. Consequently, TPNs emerges as a promising multi-bioactive nanotherapy and a targeted delivery nanocarrier for effective AAA therapy.

Evaluation Health Risks and Sorption of Hexavalent Chromium (Cr(VI) by Biochar and Iron Doped Zinc Oxide Modified Biochar (Fe-ZnO@BC) Using Trifolium: A Green Synthesis Technique.

Contamination of aquatic and terrestrial environment with hexavalent chromium Cr(VI) is one of the major hazards worldwide due its carcinogenicity, persistency and immobility. Different research techniques have been adopted for Cr(VI) remediation present in terrestrial and aquatic media, while adsorption being the most advance, low cost, environmentally friendly and common method. The present study discussed the mechanisms of Parthenium hysterophorus derived biochar, iron-doped zinc oxide nanoparticles (nFe-ZnO) and Fe-ZnO modified biochar (Fe-ZnO@BC) involved in Cr(VI) mobility and bioavailability. Pot experiments were conducted to study the effect of Parthenium hysterophorus derived biochar, nFe-ZnO and Fe-ZnO@BC application rates (2%, 2 mg/kg, 10 mg/kg, respectively). The results indicated that the addition of soil amendments reduced Cr(VI) mobility. The findings revealed that the reduction in chromium mobility was observed by P. hysterophorus BC, and Fe-ZnO@BC but nFe-ZnO application significantly (p = 0.05) reduced Cr(VI) and CrT uptake as compared to the control treatments. The results of SEM coupled with EDS showed a high micropores and channel, smooth surface which helped in adsorption, and may enhance soil conditions. The concentration index (CI) by different amendments in trifolium plant was followed the descending order as: nFe-ZnO > Fe-ZnO@BC > P. hysterophorus BC after 30, 60 and 90 days of harvesting, respectively. In addition, human health risk index was found less than one (H1 < 1.0) in amended soils as compared to control treatments.

Comparative efficacy of Parthenium hysterophorus (L.) derived biochar and iron doped zinc oxide nanoparticle on heavy metals (HMs) mobility and its uptake by Triticum aestivum (L.) in chromite mining contaminated soils.

In this study we investigated the efficacy of a novel material parthenium weed (Parthenium hysterophorus L.) biochar (PBC), iron doped zinc oxide nanoparticles (nFe-ZnO), and biochar modified with nFe-ZnO (Fe-ZnO@BC) to adsorb heavy metals (HMs) and reduce their uptake by wheat (Triticum aestivum L.) in a highly chromite mining contaminated soil. The co-application of the applied soil conditioners exhibited a positive effect on the immobilization and restricted the HMs uptake below their threshold levels in shoot content of wheat. The maximum adsorption capacity was because of large surface area, cation exchange capacity, surface precipitation, and complexation of the soil conditioners. The scanning electron microscopy (SEM) coupled with energy dispersive spectroscopy (EDS) showed porous smooth structure of parthenium weed derived biochar that helped in HMs adsorption, increase the efficiency of soil fertilizers and nutrients retention which help in the enhancement soil condition. Under different application rates the highest translocation factor (TFHMs) was obtained at 2 g nFe-ZnO rate followed the descending order: Mn > Cr > Cu > Ni > Pb. The overall TFHMs was found <1.0 indicating that low content of HMs accumulation in roots from soil slight transferred to shoot, thus satisfying the remediation requirements.

Wheat is considered as an important staple food which is grown in a chromite mining contaminated soil containing toxic HMs releasing from weathering of mafic and ultramafic rocks in the study area. The present research work is significantly beneficial in identifying the efficiency of treatment technologies to immobilize toxic HMs in soil. Parthenium weed derived biochar and biochar modified with nFe-ZnO (Fe-ZnO@BC) reduce the HMs uptake by wheat plant.

Hydrochemical evaluation of groundwater for drinking and irrigation purposes using multivariate indices along Indus Suture Zone, North Pakistan.

The present study is aimed to investigate the hydrochemical characteristics, spatial distribution and suitability of groundwater for drinking and irrigation purposes along the Indus Suture Zone (ISZ), north Pakistan. Physicochemical parameters and hazardous trace elements (HTEs) like Cd, Co, Cu and Mn were determined following standard methods. The mean and median concentrations were found below the World Health Organization (WHO) drinking water guidelines values. Hydrochemical results indicate that groundwater sources were mainly attributed to rock-water interaction category. Piper diagram shows that most of the groundwater samples fall in Ca-HCO3─ class presenting weak-alkaline proportion type. The drinking water quality index (DWQI) ranking was categorized as good to excellent, indicating the overall quality of the groundwater may pose no health hazard concern. Based on irrigation WQI (SAR, Na%, MAR, KR), the groundwater was found fit for irrigation except SAR whereas 36% of the groundwater samples fall within the poor class. The total HI values through dermal contact exceeded the safe non-carcinogenic threshold of HI = 1. Therefore, there is required an effective groundwater monitoring and management facility in the study area to safeguard residents from various illnesses associated with varying HTEs concentrations in drinking water. The major response actions needed for groundwater bodies restoration are including the installation of a continuous groundwater monitoring network and control of agricultural fertilizers that seems to be the most effective and tangible for immediate action.

The surgical management for isolated scaphotrapeziotrapezoid (STT) osteoarthritis : a systematic review of the literature.

We performed a systematic review to find out the safety and efficacy of various procedures for isolated scaphotrapeziotrapezoid osteoarthritis. Eleven articles were included. The most common procedure was arthroplasty with pyrocarbon implant (28%), followed by resection of distal pole of scaphoid with proximal trapezium and trapezoid resection (18%). The other procedures included trapeziectomy with ligament reconstruction and tendon interposition (LRTI) (14%), arthroscopic resection of distal scaphoid (11%), trapezium and trapezoid resection with LRTI (10%) and arthrodesis (10%). Complications were noted in 18 (15%) patients. The most common complication (7.5%) was asymptomatic dorsal intercalated segmental instability (DISI) followed by dislocation of the pyrocarbon implant (3%). Fusion resulted in decreased range of motion and grip strength. The distal scaphoid resection was related to high rate of DISI. Although the pyrocarbon implant has a higher dislocation rate which requires revision surgery, this complication is avoidable with good surgical technique. Arthroplasty with pyrocarbon implant may be the first choice in younger patients.

Activable Photodynamic DNA Probe with an "AND" Logic Gate for Precision Skin Cancer Therapy.

Photodynamic therapy (PDT) has emerged as a promising approach for squamous cell carcinoma treatment but hindered by tumor hypoxia, acquired resistance, phototoxicity, and so on. To address these issues, we developed a smart strategy utilizing activable photosensitizers delivered by an aptamer-functionalized DNA probe (ADP). The ADP incorporated an AS1411 aptamer for tumor targeting and a linear antisense oligonucleotide (ASO) for recognition of Survivin mRNA. In the absence of the target, PDT remained quenched, thereby avoiding phototoxicity during circulation and nonselective distribution. With the aid of the aptamer, ADP achieved selective targeting of tumors. Upon internalization, ADP targeted recognized Survivin mRNA, triggering PDT activation, and releasing ASO to down-regulate Survivin expression and reverse tumor resistance. Consequently, the activable photosensitizers exhibited an "AND" logic gate, combining tumor-targeting delivery and tumor-related gene activation, thus enhancing its specificity. Additionally, the incorporation of hemin into the ADP provided catalase activity, converting tumor-abundant H2O2 into O2, thereby ameliorating tumor hypoxia. The resulting functionalized G-quadruplex/hemin-DNA probe complex demonstrated targeted delivery and activation, minimized side effects, and enhanced PDT efficacy in both xenograft tumor-bearing mice and patient-derived xenograft models. This study offers a unique and promising platform for efficient and safe PDT, thus holding great potential for future clinical translation and improved cancer therapy.

Polydatin Inhibits Hepatocellular Carcinoma Cell Proliferation and Sensitizes Doxorubicin and Cisplatin through Targeting Cell Mitotic Machinery.

Polydatin (PD) is a natural compound with anticancer activities, but the underlying mechanisms remain largely unclear. To understand how PD inhibited hepatocellular carcinoma (HCC), we studied PD treatments in HCC HepG2 and SK-HEP1 cells, and normal liver HL-7702 cells. PD selectively blocked the proliferation of HCC cells but showed low toxicity in normal cells, while the effects of doxorubicin (DOX) and cisplatin (DDP) on HCC and normal liver cells were opposite. In the cotreatment studies, PD synergistically improved the inhibitory activities of DOX and DDP in HCC cells but alleviated their toxicity in HL-7702 cells. Furthermore, RNA-seq studies of PD-treated HepG2 cells revealed multiple altered signaling pathways. We identified 1679 Differentially Expressed Genes (DEGs) with over a 2.0-fold change in response to PD treatment. Integrative analyses using the DEGs in PD-treated HepG2 cells and DEGs in a TCGA dataset of HCC patients revealed five PD-repressed DEGs regulating mitotic spindle midzone formation. The expression of these genes showed significantly positive correlation with poor clinical outcomes of HCC patients, suggesting that mitotic machinery was likely a primary target of PD. Our findings improve the understanding of PD's anticancer mechanisms and provide insights into developing effective clinical approaches in HCC therapies.

Kyphoplasty for lytic tumour lesions of the spine: prospective follow-up of 11 cases from procedure to death.

BACKGROUND: The life span of cancer patients has improved due to advancements in cancer management. With long survival periods, more patients show metastatic disease. Osteolytic tumours of spine are generated by metastatic deposits or primary tumours of the spine. A prospective study was performed to evaluate the efficacy and safety of percutaneous kyphoplasty in patients with osteolytic tumours of the thoracic and lumbar spine. MATERIALS AND METHODS: Eleven patients (age range 52-77/average 65 years; 7 female, 4 male) with osteolytic tumours of the spine were treated with kyphoplasty. The main Tokuhashi score was registered preoperatively. Outcome was assessed prospectively by visual analogue scale (VAS) for pain, ECOG performance status, walking distance, standing and sitting time. RESULTS: Preoperative VAS (average 7.5; range 2.6-10) dropped to 3.0, 5 days postoperatively and remained below 5 for follow-up. Main Tokuhashi score was 6.3, ranging from 3 to 9. Survival time ranged from 2 to 293 (average 74.4) weeks. Average walking distance, standing and sitting time and ECOG performance score showed improvement. All patients returned home and no patient required re-operation or readmission due to local disease progression or recurrence. CONCLUSION: Kyphoplasty is a suitable palliative treatment option for patients with advanced metastatic disease of the spine even with low Tokuhashi scores allowing rapid pain relief and mobilisation to increase the quality of life.

Operative technique of two parallel compression screws and autologous bone graft for ankle arthrodesis after failed total ankle replacement.

BACKGROUND: The management of failed total ankle replacement (TAR) depends on the primary indication, presence of infection, condition of adjacent joints, and available bone stock. In addition, the patient's expectations, age, and general health should also be taken into account. METHODS: This article describes a technique of arthrodesis in failed TAR with two parallel screws inserted in opposite directions and autologous cancellous bone graft. Four patients were managed using this technique. The subtalar joint and both malleoli were preserved. RESULTS: The average time for radiological union was 14.8 weeks. There were no hardware-related complications or infections. One patient developed subsequent subtalar arthritis and is waiting for subtalar joint fusion. CONCLUSION: The results from this small series of patients suggest that arthrodesis following failed total ankle replacement with two parallel screws and bone graft may be an effective technique.

Current Advances of Nanomedicines Delivering Arsenic Trioxide for Enhanced Tumor Therapy.

Arsenic trioxide (ATO) is one of the first-line chemotherapeutic drugs for acute promyelocytic leukemia. Its anti-cancer activities against various human neoplastic diseases have been extensively studied. However, the clinical use of ATO for solid tumors is limited, and these limitations are because of severe systemic toxicity, low bioavailability, and quick renal elimination before it reaches the target site. Although without much success, several efforts have been made to boost ATO bioavailability toward solid tumors without raising its dose. It has been found that nanomedicines have various advantages for drug delivery, including increased bioavailability, effectiveness, dose-response, targeting capabilities, and safety as compared to traditional drugs. Therefore, nanotechnology to deliver ATO to solid tumors is the main topic of this review, which outlines the previous and present medical applications of ATO. We also summarised ATO anti-cancer mechanisms, limitations, and outcomes of combinatorial treatment with chemo agents. As a result, we strongly recommend conducting pre-clinical and clinical studies of ATO, especially nano-system-based ones that might lead to a novel combination therapy for cancer treatment with high efficacy, bioavailability, and low toxicity for cancer patients.

Combinatorial effect of thymoquinone with chemo agents for tumor therapy.

BACKGROUND: Most chemotherapeutics used in cancer therapies exhibit considerable side effects to the patients. Thus, developing new chemo agents to treat cancer patients with minimal toxic and side effects is urgently needed. Recently, the combination of different chemotherapeutics has become a promising strategy to treat malignancies. Thymoquinone (TQ) is a primary bioactive compound derived from the folk medicinal plant Nigella sativa, which has been found an antitumor, chemopreventive and chemopotentiating agent against human neoplastic diseases. PURPOSE: We briefly summarize the current research of the biomolecular mechanisms of TQ and evaluate the existing literature on TQ adjuvant therapies against various cancers. METHOD: The data in this review were gathered by several search engines including, Google Scholar, PubMed and ScienceDirect. We highlighted and classified the outcomes of both in vitro and in vivo experiments of TQ adjuvant therapies against human cancers and their chemopreventive activities on vital organs. RESULTS: Several studies have shown that TQ synergistically potentiated the antitumor activity of numerous chemo agents against human neoplastic disease, including lung, breast, liver, colorectal, skin, prostate, stomach, bone and blood cancers. TQ also acted as a chemopreventive agent and reduced the toxicity of many chemo agents to vital organs, such as the heart, liver, kidneys and lungs. CONCLUSION: In summary, we highly recommend an advanced evaluation of TQ adjuvant therapies at the level of preclinical and clinical trials, which could lead to a novel combinatorial therapy for cancer treatment with low or tolerable adverse effects on patients.

L5-S1 disc replacement after two previous fusion surgeries for scoliosis.

Following scoliosis surgery, lumbar motion segment degeneration below the level of fusion is not uncommon. Especially long fusions extending to the mid and lower lumbar spine increase the likelihood of degeneration of the remaining motion segments. The management for these patients is controversial and depends on the clinical presentation and level of degeneration. The increasing confidence in motion-preserving technology leads to a dilemma on whether to fuse the remaining lumbar levels or risk utilising disc arthroplasty to preserve the remaining motion segments and facilitate coronal balance in patients with previous long fusion for scoliosis. We present an interesting case of a 44-year-old lady, who underwent two-stage corrective surgery for progressive idiopathic scoliosis at the age of 22 years. In the first stage, she had T11-L3 anterior fusion, whilst in the second stage posterior fusion was done from T5 to L3. At 22 years after the initial surgery, she presented with worsening low back pain and bilateral L4 radicular symptoms. MRI scan confirmed severe disc degeneration at L3-4 and L5-S1 levels with preserved L4-5 disc. She initially underwent L3-L4 decompression and posterolateral fusion at that level, which relieved her radicular symptoms. However, she had persistent pain at the lumbosacral junction with Modic I changes. The options of an anterior L5-S1 fusion or disc replacement were considered and discussed with the patient. The disc replacement option was decided upon with the patient, as anterior fusion was judged to increase the risk of coronal imbalance. At the 1-year follow-up, she reported significant improvement in the back pain. The radiographs at 1 year showed satisfactory position and function of the artificial disc replacement. The disc was flexed laterally, accommodating the coronal balance of the spine. We conclude that L5-S1 motion segment can be preserved with artificial disc replacement in patients with previous long fusion for scoliosis surgery. The real difficulty arises when choosing between disc replacement and extension of fusion. In our patient, the disc replacement has worked well so far. However, the disc is clearly at a mechanical disadvantage, and loss of function in the mid- or long term would not be surprising.

The success of tibiotalocalcaneal arthrodesis with intramedullary nailing--a systematic review of the literature.

Tibiotalocalcaneal arthrodesis with an intramedullary nail may find indications for a variety of conditions of the hindfoot. We performed a systematic review of the literature primarily to find out the union rates and complications of tibiotalocalcaneal arthrodesis with an intramedullary nail. We included 33 studies for this review. These studies included 631 patients who had 659 procedures. Eighteen cases were excluded and 641 joints (613 patients) were available for the final analysis. We analysed the indications, union rates, complications and re-operation rates. The union rate was 86.7% with an average union time of 4.5 months. The complication rate was 55.7%. Metalwork related complications made a significant proportion of all the complications. The re-operation rate was 22%. Revision arthrodesis was done in 3% and amputation in 1.5% the cases. The review indicates that tibiotalocalcaneal arthrodesis with an intramedullary nail has a relatively good union rate but a high rate of complications. Majority of the complications are related to the metalwork. The suggested strategies to minimise these complications are discussed.

Treatment Of Vertical Fracture Of Distal Radius Using Interfragmentary Screws Through Direct Lateral Approach To Distal Radius.

BACKGROUND: Distal radius fractures are very common injuries. Majority of these fractures are transverse or oblique in nature. Isolated vertical fractures of the distal radius in the sagittal plane are rare injuries. The management of these vertical fractures is therefore different from the usual transverse or oblique fractures of the distal radius. We report on a 53-year-old right-handed gentleman who fell from his bicycle and sustained a vertical fracture of the distal radius. His distal radius fracture was fixed surgically using two interfragmentary screws. A direct lateral approach of the distal radius was used to expose the distal radius. The rationale for using direct lateral approach and interfragmentary screws for this type of fracture is discussed.

Transcriptome analysis of signaling pathways targeted by Ellagic acid in hepatocellular carcinoma cells.

BACKGROUND: Ellagic acid (EA) possesses prominent inhibitory activities against various cancers, including hepatocellular carcinoma (HCC). Our recent study demonstrated EA's activities in reducing HCC cell proliferation and tumor formation. However, the mechanisms of EA to exert its anticancer activities and its primary targets in cancer cells have not been systematically explored. METHODS: Cell proliferation assay and flow cytometric analysis were used to examine the effects of EA treatment on viability and apoptosis, respectively, of HepG2 cells. RNA-seq studies and associated pathway analyses by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were employed to determine EA's primary targets. Differentially expressed genes (DEG) in EA-treated HepG2 cells were verified by RT-qPCR and Western blot. Integrative analyses of the RNA-seq dataset with a TCGA dataset derived from HCC patients were conducted to verify EA-targeted genes and signaling pathways. Interaction network analysis of the DEGs, shRNA-mediated knockdown, cell viability assay, and colony formation assay were used to validate EA's primary targets. RESULTS: EA reduced cell viability, caused DNA damage, and induced cell cycle arrest at G1 phase of HepG2 cells. We identified 5765 DEGs encoding proteins with over 2.0-fold changes in EA-treated HepG2 cells by DESeq2. These DEGs showed significant enrichment in the pathways regulating DNA replication and cell cycle progression. As primary targets, p21 was significantly upregulated, while MCM2-7 were uniformly downregulated in response to EA treatment. Consistently, p21 knockdown desensitized liver cells to EA in cell viability and colony formation assays. CONCLUSION: EA induced G1 phase arrest and promoted apoptosis of HCC cells through activating the p21 gene and downregulating the MCM2-7 genes, respectively. GENERAL SIGNIFICANCE: The discoveries in this study provide helpful insights into developing novel strategies in the therapeutic treatment of HCC patients.

The use of complementary and alternative medicine by patients attending a general otolaryngology clinic: can we afford to ignore it?

BACKGROUND: There is growing interest in use of complementary and alternative medicine (CAM) among the general population. Little information is available, however, on CAM use in adults attending an otolaryngology outpatient clinic in the UK. OBJECTIVE: The purpose of this article is to study the prevalence and pattern of CAM use among adult patients attending the ear, nose, and throat (ENT) clinic in a UK teaching hospital. STUDY DESIGN: A cross-sectional study was used. SUBJECTS AND METHODS: All patients on their primary visit to an ENT clinic were asked to complete an anonymous questionnaire for a 14-week period from October 2005 to January 2006. RESULTS: Based on 1366 completed questionnaires, 53% (728/1366) were female and 47% (638/1366) were male. Twenty-nine percent (395/1366) were older than 60 years, and 56% (763/1366) were married. Twenty percent (275/1366) had a university education. Sixty-one percent (833/1366) had used CAM, almost 36% in the preceding 12 months. The popular remedies were cod liver oil (368/833), garlic (197/833), cranberry (181/833), aloe vera (176/833), primrose oil (174/833), and Echinacea (163/833). Nonherbal therapies included massage (230/833), acupuncture (186/833), aromatherapy (135/833), chiropractic (121/833), reflexology (119/833), and homeopathy (110/833). Seventeen percent (143/833) used CAM for their current illness. Only 8% (64/833) found CAM ineffective; yet, 57% (473/833) would recommend CAM to others. Fifty-one percent (421/833) failed to inform their primary physician of their CAM use. CONCLUSION: Despite concerns over CAM efficacy, safety, and cost effectiveness, use of CAM is popular among patients attending an ENT clinic. Their use is not generally related to their presenting illness. Otolaryngologists should be aware of current trends in CAM use when managing patients, including possible interactions with other medication.

Transanal small bowel evisceration following digital reduction of a chronically prolapsing rectum.

Evisceration of the small bowel through a rectal perforation is rare. This is the case of a 66 year-old female presenting to the Accident and Emergency Department with transanal evisceration of her small bowel resulting from attempted digital reduction and subsequent tear of her chronically prolapsing rectum. Reduction of the prolapsed small bowel and primary repair of the rectal tear were carried out at laparotomy. The management of this case is discussed.

Osteochondral fracture of the lateral femoral condyle involving the entire weight bearing articular surface fixed with biodegradable screws.

Osteochondral fracture of lateral femoral condyle can result from support and other twisting injuries of the knee. Arthroscopy is a better diagnostic and therapeutic tool as standard radiographs can mislead regarding the size and location of the fragment. If fragment is large and displaced, arthrotomy may become necessary. We present a case of large osteochondral fracture of lateral femoral condyle involving the entire articular surface in a 12 year old male. This was treated with open reduction and internal fixation using biodegradable screws. MRI at six weeks after surgery showed satisfactory results. After the surgery full weight bearing was allowed at three months.

Common trend of antibiotics usage in a tertiary care hospital of Peshawar, Pakistan.

BACKGROUND: Antibiotics are used to eradicate the pre- and postoperative infections in surgical procedures and in all others medical cases. However, inappropriate and indiscriminate use of antimicrobial agents can potentially have a number of problems. The emergence of antimicrobial resistant bacteria, an increased number of patients experiencing adverse drug events, and increased drug-related cost have been documented. The objective of the study was to determine the trend of use of antibiotics and hospitalisation of patients in various units of a tertiary care hospital, to investigate practice variation of antimicrobial agents within the hospital, and to identify and document any opportunity for its improvement. METHODS: A questionnaire containing relevant information about the study was prepared. Patients' age, sex, diagnosis, duration of hospital stay and type of antibiotic used were recorded and analysed, with particular reference to antibiotic group and disease pattern, in 3 different treatment areas of Hayatabad Medical Complex (HMC), Peshawar, Pakistan, from July 2006 to June 2007. RESULTS: During the period under report, a total of 519 patients were studied for their disease and the type of antibiotics used. The leading type of antibiotics reported were 3rd generation antibiotic used on 147 (28.33%) patients in the 3 units collectively, 1st generation 127 (24.47%), and penicillin 99 (19.08%), while macrolides were the least used. CONCLUSION: The available resources are needed to be effectively utilised, to minimise the hospital stay due to rational use of antibiotics, and to minimise burden of antibiotics on poor patients.

Outcome of surgery in neck of femur fracture patients with poor pre-fracture mobility.

BACKGROUND: Hip fractures are common with a UK incidence of over 70,000 cases and total healthcare costs of over £2 billion per year. Mortality rates of 10% at 30 days and up to 30% at 1-year have been reported. We wanted to assess the outcome of hip fracture surgery in patients with reduced pre-fracture mobility as this has not been exclusively studied previously. METHODS: We retrospectively reviewed 168 hip fracture patients with reduced pre-fracture mobility (wheelchair bound, bed bound, walking with 2 aids or a frame) who underwent hip fracture surgery at our institution between 2008 and 2013 using case notes, discharge letters, outpatient clinic letters and laboratory test results. Measured outcomes included 30-day renal, cardiac and respiratory morbidity as well as 30-day and 1-year mortality. RESULTS: Our study comprised 27% males and 73% females with a mean age of 82 years. The 30-day chest infection, acute renal failure and acute coronary syndrome rates were 26%, 7.7% and 4% respectively. In those patients who were either wheelchair or bed bound, 30-day and 1-year mortality rates were 11.8% and 52% respectively whereas in those who could mobilise with the help of 2 aids or frame, 30-day and 1-year mortality rates were 4.34% and 39.70% respectively. CONCLUSION: Our study highlighted increased 30-day and 1-year morbidity and mortality rates following hip fracture surgery with notable high rates of respiratory and renal complications in patients with reduced pre-fracture mobility. We would recommend pre- and postoperative optimisation with orthogeriatric review, chest physiotherapy and intravenous fluid hydration to reduce complication rates and improve morbidity and mortality.