Pulmonary artery pressure in cystic fibrosis adults: Characteristics,clinical correlates and long-term follow-up

BackgroundWe examined pulmonary artery pressure (PAP) characteristics of CF adults, studied clinical correlates and long-term survival.MethodsComprehensive clinical data were collected and Doppler echocardiography was used to estimate PAP in 109 stable CF adults and 50 healthy controls.ResultsCF patients had lower day and night-time oxygen status, elevated CRP and BNP, and elevated PAP (27.7(13.2, 62.8) mmHg patients v 17.9(11.3, 30.9) mmHg controls, p < 0.001). Even patients with mild pulmonary disease had raised PAP. PAP measurements strongly correlated with arterial partial pressure of oxygen (PaO₂, r = − 0.673, p < 0.001), and FEV₁ percentage predicted (FEV₁%, r = − 0.642, p < 0.001) which were both independent predictors of PAP. At 10 year follow up PAP measurements were related to survival but FEV₁% and PaO₂ were both stronger predictors of death.ConclusionsPAP is raised in CF adults and correlates with pulmonary disease severity. Unlike PaO₂ and FEV₁%, it does not appear to be an independent prognostic marker.     

The role of psychological flexibility in appearance anxiety in people who have experienced a visible burn injury

BackgroundIndividuals with visible differences can experience appearance anxiety that is distressing and disruptive to daily functioning. Understanding psychological factors that maintain appearance anxiety related to scarring is important in developing theoretical understanding of adjustment to injury, and in identifying targets for psychological therapies. This study aimed to investigate whether psychological flexibility, a key element underpinning acceptance and commitment therapy (ACT), was associated with appearance anxiety. It was hypothesised that reduced psychological flexibility (lower acceptance, cognitive defusion, mindfulness, and committed action) would be related to increased appearance anxiety. The role of psychological flexibility in the maintenance of appearance anxiety was investigated using a cross-sectional quantitative questionnaire study.MethodSeventy-eight burns patients (47 female, 31 male; M age = 45.2 years) completed the Derriford Appearance Scale (DAS-24), the Acceptance and Action Questionnaire (AAQ-II), the Cognitive Fusion Questionnaire (CFQ), the Five Facet Mindfulness Questionnaire (FFMQ), and the Committed Action Questionnaire (CAQ-8).ResultsAs hypothesised, increased appearance anxiety was related to reduced acceptance (r_s(76) = 0.80, p < 0.001, one-tailed) and cognitive defusion (r_s(76) = 0.76, p < 0.001). Reduced levels of mindfully describing (r(72) = −0.39, p < 0.001), acting with awareness (r(72) = −0.57, p < 0.001), non-judging (r(72) = −0.61, p < 0.001) and non-reactivity (r(72) = −0.28, p < 0.01) as well as reduced committed action (r(72) = −0.57, p < 0.001) were also related to increased appearance anxiety.ConclusionsIndividuals experiencing appearance anxiety associated with a burn injury may struggle with accepting difficult emotions, stepping back from distressing thoughts, being mindful and engaging in valued action. These findings suggest that ACT may be useful in treating appearance related anxiety and concerns associated with conditions causing a visible difference.     

Factors affecting acid base status during hepatectomy in cirrhotic patients

ObjectiveTo study acid base changes during hepatectomy in cirrhotic patients and their relations to intraoperative variables and different preoperative scoring systems used to asses hepatic patients.MethodsAfter obtaining approval of the Ethics and Research Committee of the National Liver Institute – Menoufia University and written informed patient consent, 80 patients scheduled for hepatectomy for hepatocellular carcinoma were included in the study. Anesthesia was induced with propofol, fentanyl, and rocuronium then maintained with desflurane and 50% O₂ in air. Samples for arterial blood gases and serum lactate were withdrawn from a left radial artery catheter just before the start of resection of liver parenchyma and immediately after its completion. Intraoperative events were recorded including use of Pringle maneuver and fluids and blood products infusions.ResultsNo differences were found in study parameters between Child class A and B patients except for the preresection lactate (p = 0.02). Patients with MELD score <11 had higher preresection HCO₃ (p = 0.004), higher BE (p = 0.002), and lower lactate (p = 0.001) than patients with MELD score ?11. These findings were true also for patients with MELD-Na score <11 as they had higher preresection HCO₃ (p = 0.001), higher BE (p = 0.001), and lower lactate (p < 0.001) than patients with MELD-Na score ?11. All patients had significant decrease in pH (p < 0.001), HCO₃ (p < 0.001), and BE (p < 0.001) and significant increase in lactate (p < 0.001). These changes were augmented by intraoperative RBCs and FFP transfusion, using Pringle maneuver, but type of hepatectomy had significant effect only on HCO₃ and BE. Again these changes in pH, HCO₃, BE, and lactate were more obvious in patients with preoperative MELD score ?11, and this was also true in patients with preoperative MELD-Na score ?11 only with HCO₃, BE, and lactate, but not with pH.ConclusionChanges occurred in acid base status during hepatectomy in cirrhotic patients are affected by the preoperative condition of the patient (MELD and MELD-Na scores) as well as by intraoperative transfusion of blood products, use of Pringle maneuver and to a lesser extent by major versus minor hepatectomy.     

Muscle volume is related to trabecular and cortical bone architecture in typically developing children

IntroductionMuscle is strongly related to cortical bone architecture in children; however, the relationship between muscle volume and trabecular bone architecture is poorly studied. The aim of this study was to determine if muscle volume is related to trabecular bone architecture in children and if the relationship is different than the relationship between muscle volume and cortical bone architecture.Materials and methodsForty typically developing children (20 boys and 20 girls; 6 to 12 y) were included in the study. Measures of trabecular bone architecture [i.e., apparent trabecular bone volume to total volume (appBV/TV), trabecular number (appTb.N), trabecular thickness (appTb.Th) and trabecular separation (appTb.Sp)] in the distal femur, cortical bone architecture [cortical volume, total volume, section modulus (Z) and polar moment of inertia (J)] in the midfemur, muscle volume in the midthigh and femur length were assessed using magnetic resonance imaging. Total physical activity and moderate-to-vigorous physical activity were assessed using an accelerometer-based activity monitor worn around the waist for four days. Calcium intake was assessed using diet records. Relationships among the measures were tested using multiple linear regression analysis.ResultsMuscle volume was moderately-to-strongly related to measures of trabecular bone architecture [appBV/TV (r = 0.81), appTb.N (r = 0.53), appTb.Th (r = 0.67), appTb.Sp (r = − 0.71); all p < 0.001] but more strongly related to measures of cortical bone architecture [cortical volume (r = 0.96), total volume (r = 0.94), Z (r = 0.94) and J (r = 0.92; all p < 0.001)]. Similar relationships were observed between femur length and measures of trabecular (p < 0.01) and cortical (p < 0.001) bone architecture. Sex, physical activity and calcium intake were not related to any measure of bone architecture (p > 0.05). Because muscle volume and femur length were strongly related (r = 0.91, p < 0.001), muscle volume was scaled for femur length (muscle volume/femur length^2.77). When muscle volume/femur length^2.77 was included in a regression model with femur length, sex, physical activity and calcium intake, muscle volume/femur length^2.77 was a significant predictor of appBV/TV, appTb.Th and appTb.Sp (partial r = 0.44 to 0.49, p < 0.05) and all measures of cortical bone architecture (partial r = 0.47 to 0.54; p < 0.01).ConclusionsThe findings suggest that muscle volume in the midthigh is related to trabecular bone architecture in the distal femur of typically developing children. The relationship is weaker than the relationship between muscle volume in the midthigh and cortical bone architecture in the midfemur, but the discrepancy is driven, in large part, by the greater dependence of cortical bone architecture measures on femur length.     

Assessment of foot posture: Correlation between different clinical techniques

BackgroundClinical evaluation of foot posture is necessary for assessing and treating patients with lower extremity dysfunction. Although several studies have explored the reliability and validity of different clinical techniques for the measurement of foot posture, there is limited research in studies investigating whether two or more such techniques correlate with each other.ObjectivesTo explore the correlations between the valgus and arch index measurements with the measurements of the navicular drop and drift in bipedal and single-leg stance.MethodsClinical measurements of the valgus index, the arch index, the navicular drop and drift were performed on the left foot of 26 healthy subjects in bipedal and in single-leg stance with 30° knee flexion.ResultsThe valgus index yielded moderate to strong correlations with the measurement of navicular drop (bipedal: r = 0.657, p < 0.001; single-leg stance: r = 0.613, p = 0.001) and small correlations with navicular drift (bipedal: r = 0.481, p = 0.13; single-leg stance: r = 0.335, p = 0.094). The arch index demonstrated small correlations with the navicular drop and drift in both bipedal and single-leg stance (r = 0.317-0.428, p = 0.115–0.029).ConclusionsAlthough strong associations were obtained between the valgus index and the navicular drop, all other correlations demonstrated low degrees of association. Further research should explore the association of these clinical measurements in patients with foot/lower limb impairments.     

Influence of cerclages on primary stability of tumor megaprostheses subjected to distal femur defects

BackroundPurpose of this experimental study was to investigate the influence of cerclages on the primary stability of the MUTARS^® system using distally fractured synthetic femora.Methods4 MUTARS^® prostheses were implanted in synthetic femora respectively. Groups consisted of 4 intact bones, 4 fractured with cerclages and 4 fractured bones without cerclages. Spatial micromovements were measured with a high-precision rotational setup.FindingsThe order from the weakest to the strongest torque transmission of the intact bones was rm₁-rm₄-rm₂-rm₃ (p = 0.011) and of the fractured bones with cerclages rm₄-rm₁-rm₃-rm₂ (p = 0.013). The MUTARS^® stems broke out of the fractured femoral shaft by removing cerclages (p < 0.001) and by the influence of bone defect A (p < 0.001). Overall micromovements of the intact bones were lower than those of the fractured bones without cerclages (p < 0.001) and overall micromovements of the fractured bones with cerclages were lower than those of bones without cerclages (p < 0.001).InterpretationDue to high press-fit at the proximal and distal isthmus region fissural fractures of the femur may occur. This should always be taken into account. It is advisable to secure them and provide a prophylaxis for these fissural fractures by means of cerclages.     

The effect of aging on the hardness of foot sole skin: A preliminary study

BackgroundFoot problems are common in older people and altered biomechanical parameters under the foot sole has been proposed as a key risk factor for foot lesions. Therefore the aim of this study was to investigate the age-related differences in the hardness of foot sole skin.MethodsTwenty-six healthy volunteers without foot problems, aged from 26 to 65 years, were examined using shore meter. The hardness of the foot sole under the big toe (area 8), 1st metatarsal head (area 5), 3rd metatarsal head (area 6), 5th metatarsal head (area 7), mid foot (area 3, 4) and hind foot (area 1, 2) were measured. The correlation between age and hardness of foot sole was examined and comparisons were made between two age groups.ResultsFrom the result we observe statistical significant (p < 0.05; p < 0.01; p < 0.005) differences in hardness between age groups in hind foot, metatarsal heads (1st, 3rd & 5th) and big toe. Strong positive correlations between age and hardness of the foot sole were found at the big toe (r = 0.57; p < 0.005), 1st metatarsal head (r = 0.567; p < 0.00001), 3rd metatarsal head (r = 0.565; p < 0.00001), 5th metatarsal head (r = 0.55; p < 0.00001), and heel (r = 0.59; p < 0.0001).ConclusionThe loss of compliance in the foot sole may be one of the factors responsible for the higher incidence of foot problems in aged people. Routine foot examination and appropriate therapeutic intervention including the use of foot orthoses and optimal hardness of foot wear insole may help to prevent the serious foot injuries.     

Location of atypical femoral fracture can be determined by tensile stress distribution influenced by femoral bowing and neck-shaft angle: a CT-based nonlinear finite element analysis model for the assessment of femoral shaft loading stress

IntroductionLoading stress due to individual variations in femoral morphology is thought to be strongly associated with the pathogenesis of atypical femoral fracture (AFF). In Japan, studies on AFF regarding pathogenesis in the mid-shaft are well-documented and a key factor in the injury is thought to be femoral shaft bowing deformity. Thus, we developed a CT-based finite element analysis (CT/FEA) model to assess distribution of loading stress in the femoral shaft.Patients and MethodsA multicenter prospective study was performed at 12 hospitals in Japan from August 2015 to February 2017. We assembled three study groups—the mid-shaft AFF group (n = 12), the subtrochanteric AFF group (n = 10), and the control group (n = 11)—and analyzed femoral morphology and loading stress in the femoral shaft by nonlinear CT/FEA.ResultsFemoral bowing in the mid-shaft AFF group was significantly greater (lateral bowing, p < 0.0001; anterior bowing, p < 0.01). Femoral neck-shaft angle in the subtrochanteric AFF group was significantly smaller (p < 0.001). On CT/FEA, both the mid-shaft and subtrochanteric AFF group showed maximum tensile stress located adjacent to the fracture site. Quantitatively, there was a correlation between femoral bowing and the ratio of tensile stress, which was calculated between the mid-shaft and subtrochanteric region (lateral bowing, r = 0.6373, p < 0.0001; anterior bowing, r = −0.5825, p < 0.001).ConclusionsCT/FEA demonstrated that tensile stress by loading stress can cause AFF. The location of AFF injury could be determined by individual stress distribution influenced by femoral bowing and neck-shaft angle.     

Lengthening scarf osteotomy for recurrent hallux valgus

BackgroundWe describe using the scarf osteotomy to correct a recurrent hallux valgus deformity and lengthen the shortened first metatarsal in symptomatic iatrogenic first brachymetatarsia.MethodsThirty-six lengthening scarf osteotomies were undertaken in 31 patients. Clinical and radiographic measures were taken pre and postoperatively.ResultsMean age at presentation was 53.4 years, and mean followup 3.9 years. The mean lengthening achieved was 4.9 mm. All osteotomies united with no complications. The mean IMA reduction was 4.0° (p < 0.001) and HVA 13.0° (p < 0.001). The mean AOFAS score increase was 33.8 (p < 0.001). There was a positive trend but no correlation (r = 0.28) between amount of metatarsal lengthening and AOFAS score change.ConclusionsWe describe the largest lengthening scarf osteotomy series for recurrent hallux valgus with iatrogenic first brachymetatarsia. The results suggest the procedure is successful, with a low complication rate. We anticipate that restoring first metatarsal length and alignment may reduce biomechanical transfer metatarsalgia over time.     

Análise bibliométrica no campo da anestesiologia no período de 2009‐2018

ObjectiveThe limited number of bibliometric studies in the literature have generally focused on the top‐cited studies in the field of anesthesia, however, there is a lack of studies that made a holistic bibliometric evaluation of these works. The purpose of this study is to make a contemporary summary of the articles published in the field of anesthesia within the last 10 years through detailed bibliometric methods.MethodsThe articles published between the years 2009 and 2018 were downloaded from the Web of Science (WoS) database and analyzed using bibliometric methods. The literature review was conducted using the keyword “Anesthesiology” in the “Research Area” category via the advanced search option available in WoS. The relation between the number of publications of the countries and the Gross Domestic Products and Human Development Index values were analyzed using Spearman's correlation coefficient. The number of articles between the years 2019 and 2021 was estimated through linear regression analysis.ResultsA review of the literature indicated 41,003 articles in the Web of Science database. Estimations included 4,910 (3,971‐5,849) articles for the year 2019. There was a high‐level, positive significant correlation between the number of publications and Gross Domestic Product (r = 0.776, p < 0.001).ConclusionThe findings show that countries with high income are effective in the field of anesthesia, which indicates a strong association between research productivity and economic development. Undeveloped and developing countries should be encouraged to conduct research in the field of anesthesia.     

Comparative study between Air-Q and Intubating Laryngeal Mask Airway when used as conduit for fiber-optic

This study compared Air-Q and Intubating LMA when used as a conduit for endotracheal intubation.MethodsOne hundred patients scheduled for surgical operations under general anesthesia were randomly allocated into two equal groups (n = 50). Group I: Air-Q and group II: Intubating Laryngeal Mask Airway (ILMA) in both groups intubation was done by Fiberoptic bronchoscope (FOB) through study device. After induction of anesthesia, patients were ventilated with Air-Q or ILMA. Then, endotracheal tube (ETT) was inserted through study device. Recorded measurements were as follows: number of attempts and duration of insertion of device, peak airway pressure and fiberoptic grading of laryngeal view. Also, we recorded number of attempts and duration of insertion of ETT and the incidence of blood stain on device and sore throat grading.ResultsDuration of insertion of Air-Q was 13.300 ± 3.471 s, whilst that of ILMA was 19.640 ± 4.737 s (p < 0.001). In group I, peak airway pressure was 26.400 ± 2.176 cmH₂O, whilst, in group II, it was 25.260 ± 1.468 cmH₂O (p < 0.01). Full view of vocal cords amounted to 78% and 26% of Groups I and II patients, respectively (p < 0.001). Time of insertion of ETT was 33.5 ± 6.795 s in group I, whilst in group II, it was 39.5 ± 6.566 s (p < 0.001). Blood stain was found on supraglottic device in 46% and 22% of cases in Groups I and II, respectively (p < 0.01).ConclusionAir-Q proved to be an excellent conduit for endotracheal intubation compared to the ILMA.     

Molecular analysis of changes in Pseudomonas aeruginosa load during treatment of a pulmonary exacerbation in cystic fibrosis

BackgroundIntravenous antibiotics for pulmonary exacerbations (PEs) of cystic fibrosis (CF) usually target Pseudomonas aeruginosa. Insights into the CF lung microbiome have questioned this approach. We used RT-qPCR to determine whether intravenous antibiotics reduced P. aeruginosa numbers and whether this correlated with improved lung function. We also investigated antibiotic effects on other common respiratory pathogens in CF.MethodsSputa were collected from patients when stable and again during a PE. Sputa were expectorated into a RNA preservation buffer for RNA extraction and preparation of cDNA. qPCR was used to enumerate viable P. aeruginosa as well as Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Burkholderia cepacia complex and Aspergillus fumigatus.ResultsFifteen CF patients were followed through 21 PEs. A complete set of serial sputum samples was unavailable for two patients (three separate PEs). P. aeruginosa numbers did not increase immediately prior to a PE, but numbers during intravenous antibiotic treatment were reduced ≥ 4-log in 6/18 and ≥ 1-log in 4/18 PEs. In 7/18 PEs, P. aeruginosa numbers changed very little with intravenous antibiotics and one patient demonstrated a ≥ 2-log increase in P. aeruginosa load. H. influenzae and S. pneumoniae were detected in ten and five PEs respectively, but with antibiotic treatment these bacteria rapidly became undetectable in 6/10 and 4/5 PEs, respectively. There was a negative correlation between P. aeruginosa numbers and FEV₁ during stable phase (r_s = 0.75, p < 0.05), and reductions in P. aeruginosa load with intravenous antibiotic treatment correlated with improved FEV₁ (r_s = 0.52, p < 0.05).ConclusionsExacerbations are not due to increased P. aeruginosa numbers in CF adults. However, lung function improvements correlate with reduced P. aeruginosa burden suggesting that current antibiotic treatment strategies remain appropriate in most patients. Improved understanding of PE characterised by unchanged P. aeruginosa numbers and minimal lung function improvement following treatment may allow better targeted therapies.     

Age but not gender modulates the relationship between PTH and vitamin D

ContextIt is unclear whether the relationship between 25-OHD and PTH is modulated by age or gender.ObjectiveTo assess the 25-OHD–PTH relationship in 340 adolescents (10–17 years) and 443 elderly (65–85 years) of the same ethnic group, and living in the same sunny country.AssessmentsCalcium intake was estimated. Serum calcium, phosphorus, 25-OHD and PTH were measured. Body fat was determined by DXA.Results25-OHD levels were lower in the elderly in the overall group (p < 0.001) and within genders. 25-OHD levels were lower in females in the overall group and within age subgroups (p < 0.05). PTH levels were higher in the elderly in the overall population and in both genders (p < 0.001). There were no gender differences in PTH levels within age subgroups. For the same 25-OHD level, PTH levels were comparable across genders but were 1.5–2 folds higher in the elderly compared to adolescents (p < 0.001). PTH correlated positively with age (p < 0.001), body fat (p = 0.02), and negatively with calcium intake (p < 0.001), and 25-OHD (p < 0.001). The magnitude of the correlation with 25-OHD decreased after adjustment for age but not for gender. In multivariate analyses, age, 25-OHD and fat mass were independent predictors for PTH. In the elderly, after adjustment for serum creatinine, only 25-OHD and creatinine were independent predictors of PTH.ConclusionThe negative relationship between 25-OHD and PTH is modulated by age but not gender. Desirable 25-OHD levels derived from examining the 25-OHD–PTH relationship should therefore take into account the age of the population of interest.     

Intentional injury against children in Sub-Saharan Africa: A tertiary trauma centre experience

BackgroundIntentional injuries are the result of violence. This is an important public health issue, particularly in children, and is an unaddressed problem in sub-Saharan Africa. This study sought to describe the characteristics of intentional injury, particularly physical abuse, in children presenting to our tertiary trauma centre in Lilongwe, Malawi and how they compare to children with unintentional injuries.MethodsA retrospective analysis of children (<18 years old) with traumatic injuries presenting to Kamuzu Central Hospital (KCH) in Lilongwe, Malawi from 2009 to 2013 was performed. Children with intentional and unintentional injuries were compared with bivariate analysis and multivariate logistic regression modelling.Results67,672 patients with traumatic injuries presented to KCH of which 24,365 were children. 1976 (8.1%) patients presented with intentional injury. Intentional injury patients had a higher mean age (11.1 ± 5.0 vs. 7.1 ± 4.6, p < 0.001), a greater male preponderance (72.5 vs. 63.6%, p < 0.001), were more often injured at night (38.3 vs. 20.7%, p < 0.001), and alcohol was more often involved (7.8 vs. 1.0%, p < 0.001). Multivariate logistic regression modelling showed that increasing age, male gender, and nighttime or urban setting for injury were associated with increased odds of intentional injury. Soft tissue injuries were more common in intentional injury patients (80.5 vs. 45.4%, p < 0.001) and fist punches were the most common weapon (25.6%). Most patients were discharged in both groups (89.2 vs 80.9%, p < 0.001) and overall mortality was lower for intentional injury patients (0.9 vs. 1.2%, p = 0.001). Head injury was the most common cause of death (43.8 vs. 32.2%, p < 0.001) in both groups.ConclusionsSub-Saharan African tertiary hospitals are uniquely positioned to play a pivotal role in the identification, clinical management, and alleviation of intentional injuries to children by facilitating access to social services and through prevention efforts.     

The Evaluation of Consistency Between Body Composition Assessments in Pediatric Population Using Pencil Beam and Fan Beam Dual-Energy X-Ray Absorptiometers

The replacement of the old dual-energy X-ray absorptiometry system with a novel one should be preceded by a cross-calibration procedure. Therefore, the study was aimed at investigating the consistency of bone and body composition measures performed in pediatric population using pencil beam (DPX-L; GE Healthcare, GE Healthcare, Madison, WI) and fan beam (Prodigy; GE Healthcare, GE Healthcare, Madison, WI) densitometers. The study group consisted of 212 healthy children aged 4–18 yr. Total body (TB) and lumbar spine (S) (L2–L4) measurements were performed using DPX-L and Prodigy during the same visit. Bland-Altman analysis, linear regressions, and paired t-test were performed to evaluate the consistency of measurements and to establish a cross-calibration equation. The average Prodigy values for TB and lumbar spine bone mineral density (BMD) and content (BMC) were 2.7%, 2.4% and 1.6%, 1.6% higher than those of DPX-L, respectively (p < 0.0001). Prodigy-assessed bone area (BA) was lower by 1.4% for TBBA (p < 0.0001) and 1.1% for SBA (p < 0.001). Lean body mass (LBM) from Prodigy was higher by 6.9% (p < 0.0001), whereas fat mass (FM) was lower by 8.4% compared with those from DPX-L (p < 0.0001). Bland-Altman analyses revealed the effect of magnitude that was nonlinear (2nd degree polynomial) for TBBMD (r = 0.32, p = 0.001), TBBMC (r = 0.51, p < 0.0001), TBBA (r = 0.34, p < 0.0001), and LBM (r = 0.56, p < 0.0001), but not for FM (r = 0.14, not significant [n.s.]). In contrast, in lumbar spine, the magnitude dependence was linear and significant for SBMC (r = 0.46, p < 0.0001) and SBA (r = 0.34, p < 0.0001) but not for SBMD (r = 0.12, n.s.). Both skeletal and body composition variables assessed by DPX-L and Prodigy devices were highly correlated, showing R² values ranging from 0.976 for FM to 0.994 for SBMC. The results of this study document a necessity for implementation of calculated cross-calibration equations to transform DPX-L–based local pediatric references into a novel Prodigy system.     

Increased morbidity associated with weekend paediatric road traffic injuries: 10-year analysis of trauma registry data

BackgroundRoad traffic injuries (RTIs) are a significant cause of paediatric morbidity and mortality worldwide, with a disproportionate number of these injuries occurring in low- and middle-income countries (LMICs). Adult data from LMICs suggest that weekends are particularly high-risk for RTIs, but whether children are at increased risk of RTI on weekends has not previously been investigated in any setting. This study sought to assess patterns in paediatric RTI presentations using hospital-based trauma surveillance data in Cape Town, South Africa.MethodsData was analysed from Childsafe South Africa's prospectively collected trauma registry for injured children below 13 years of age presenting to a tertiary paediatric referral Trauma Department between 2004 and 2013.ResultsDuring the 10-year study period, a total of 71,180 patients presented with traumatic injuries, of which 8,815 (12.4%) resulted from RTIs. RTI patients had a mean age of 5.2 ± 3.6 years, and were predominantly males and pedestrians. RTIs were more common on weekends than weekdays (2.98 vs. 2.19 patients/day, p < 0.001), representing a greater proportion of daily all-cause trauma (15.5% vs. 11.2%, p < 0.001). Moreover, weekend RTI patients sustained more severe injuries than on weekdays, and compared to weekend all-cause trauma patients (injury score 1.66 vs. 1.46 and 1.43, both p < 0.001). RTI patients were more likely to require admission to both the trauma ward (1.14 vs. 0.79 patients/day, p < 0.001) and the PICU (0.10 vs. 0.07 patients/day, p < 0.05) on weekends than on weekdays. Weekend RTI patients most frequently required admission to the trauma ward (p < 0.001) and the PICU (p < 0.05) during the last annual quarter.ConclusionsIn a LMIC-setting, paediatric RTI patients are more frequently brought to medical attention, sustain more severe injuries and more frequently require hospital admission during the weekend. Weekends during the last annual quarter were particularly high-risk for paediatric RTIs. These findings highlight the importance of trauma surveillance data to inform targeted community prevention strategies for improving child road safety.     

Prevalence and risk factors for recovery of filamentous fungi in individuals with cystic fibrosis

BackgroundFilamentous fungi are frequently recovered from respiratory cultures of individuals with CF.MethodsA CF cohort database was utilized to determine filamentous fungal prevalence and risk factors.ResultsThe prevalence of filamentous fungal isolation increased from 2.0% in 1997 to 28.7% in 2007. The odds of isolating filamentous fungi during a quarter was greater in CF adults [p < 0.001], during chronic oral antibiotic use [p = 0.002] and increased with each 10% drop in FEV₁ percent predicted [p = 0.005], while inhaled corticosteroids surprisingly decreased the likelihood [p = 0.012]. The direction of these effects persisted after excluding individuals with ABPA. A sub-analysis determined older age [p = 0.019] and use of inhaled antibiotics [p = 0.011] were independent risk factors for onset of fungal colonization.ConclusionsThis study suggests that isolation of filamentous fungi in CF at JHH has increased and risk factors include older age, decreased lung function, and chronic oral antibiotics.     

Ablative fractional resurfacing for burn scar management affects the number and type of elective surgical reconstructive procedures,hospital admission patterns as well as length of stay

BackgroundReconstructive surgery remains the main approach to address burn scar contractures. Ablative fractional resurfacing is an increasingly popular tool for severe burn scar management, but its effect on overall burns reconstructive case-mix, operating time and patterns of hospital admission have not been reported.MethodsRetrospective analysis of hospital administrative data from September 2013 to June 2017 was performed evaluating these effects of ablative fractional CO₂ laser (CO₂-AFL).ResultsThe total number of acute burn patients treated at CRGH increased substantially over this timeframe, resulting in 412 elective procedures including 82 before and 330 after introducing CO₂-AFL. The proportion of traditional non-laser reconstructive procedures dropped considerably to 23.9% in about 2.5 years following CO₂-AFL introduction. This change in approach had a profound effect on LOS with average LOS being 1.96 days for non-laser and 0.36 days for CO₂-AFL-procedures (p < 0.001). Anaesthetic times also decreased significantly, with median durations at 90 min pre-laser and 64 min post-laser introduction (p < 0.001), and median anaesthetic times at 87 min (non-AFL) and 57 min (AFL procedures) (p < 0.001).ConclusionAFL profoundly affects elective reconstructive burn case mix with a replacement of conventional reconstructive operations in favour of AFL-procedures. This results in reductions of average LOS and anaesthetic times. Consequently, increased use of AFL in burn scar management could potentially reduce overall costs associated with burn scar reconstruction.     

Hallux rigidus: A cross-sectional study to evaluate clinical parameters

BackgroundHallux rigidus (HR) is a common condition with history and physical examination used to help evaluate pathology, grade clinical changes and to inform treatment.MethodA cross-sectional study was undertaken to evaluate the demographics of and clinical parameters encountered in HR. In 110 subjects (180 feet) aged 18–70 years (mean 52 years) a standardized history and physical examination was undertaken. Clinical parameters associated with HR were evaluated. The Foot Health Status Questionnaire (FHSQ) was used to measure health-related quality-of-life dimensions.ResultsSeventy (64%) subjects had bilateral HR and 73 (66%) were female. Mean HR onset was 44 (14–68 years) years and median HR duration 6 years (1–33 years). A history of 1st MTPJ trauma presented in 22% of subjects; 74% of whom had unilateral HR. Eighty-four (47%) feet had pes planus based on a positive Foot Posture Index. A correlation between pes planus and 1st MTPJ pain was found (r = 0.84, p = 0.05). In 74% of feet, hallux abductus interphalangeus angle (HAI°) was greater than normal (≤10°). A correlation between HAI and reduced 1st MTPJ ROM was found (r = 0.92, p = 0.05). Second toe length was the same as the hallux in 111 feet (62%). A correlation between valgus hallucal rotation and 1st MTP joint pain in HR was found (r = .78, p = .05). A positive relationship was found between 2nd toe length and 1st MTPJ pain (p = 0.001 < 0.05). A correlation between hallucal interphalangeal joint (IPJ) hyperextension and 1st MTPJ pain was found (r = 0.78, p = 0.01). A positive relationship was found between lesser MTPJ pain and supination at propulsion (p < 0.001). There was no evidence of Achilles tendon contracture. The FHSQ results concur with clinical findings.ConclusionsHR was associated with female gender, bilateral involvement, older age groups, increased HAI°, 2nd toe length similar to hallux, hallucal IPJ hyperextension, lesser MTP joint pain, flat foot and certain gait alterations. HR was not associated with Achilles tendon tightness or footwear. The content validity of clinical parameters of HR needs to be established by formal research prior to their inclusion in a classification of HR.     

Knee loading protects against osteonecrosis of the femoral head by enhancing vessel remodeling and bone healing

Osteonecrosis of the femoral head is a serious orthopedic problem. Moderate loads with knee loading promote bone formation, but their effects on osteonecrosis have not been investigated. Using a rat model, we examined a hypothesis that knee loading enhances vessel remodeling and bone healing through the modulation of the fate of bone marrow-derived cells. In this study, osteonecrosis was induced by transecting the ligamentum teres followed by a tight ligature around the femoral neck. For knee loading, 5 N loads were laterally applied to the knee at 15 Hz for 5 min/day for 5 weeks. Changes in bone mineral density (BMD) and bone mineral content (BMC) of the femur were measured by pDEXA, and ink infusion was performed to evaluate vessel remodeling. Femoral heads were harvested for histomorphometry, and bone marrow-derived cells were isolated to examine osteoclast development and osteoblast differentiation. The results showed that osteonecrosis significantly induced bone loss, and knee loading stimulated both vessel remodeling and bone healing. The osteonecrosis group exhibited the lowest trabecular BV/TV (p < 0.001) in the femoral head, and lowest femoral BMD and BMC (both p < 0.01). However, knee loading increased trabecular BV/TV (p < 0.05) as well as BMD (p < 0.05) and BMC (p < 0.01). Osteonecrosis decreased the vessel volume (p < 0.001), vessel number (p < 0.001) and VEGF expression (p < 0.01), and knee loading increased them (p < 0.001, p < 0.001 and p < 0.01). Osteonecrosis activated osteoclast development, and knee loading reduced its formation, migration, adhesion and the level of “pit” formation (p < 0.001, p < 0.01, p < 0.001 and p < 0.001). Furthermore, knee loading significantly increased osteoblast differentiation and CFU-F (both p < 0.001). A significantly positive correlation was observed between vessel remodeling and bone healing (both p < 0.01). These results indicate that knee loading could be effective in repair osteonecrosis of the femoral head in a rat model. This effect might be attributed to promoting vessel remodeling, suppressing osteoclast development, and increasing osteoblast and fibroblast differentiation. In summary, the current study suggests that knee loading might potentially be employed as a non-invasive therapy for osteonecrosis of the femoral head.