An Observational Cohort Study of the Adoption of Elastic Stable Intramedullary Nailing for the Treatment of Pediatric Femur Fractures in Kumasi,Ghana

Background

In high- and middle-income countries, elastic stable intramedullary nailing (ESIN) is the commonest treatment of femur fractures in children 5–11 years of age. At Komfo Anokye Teaching hospital (KATH) in Kumasi, Ghana, prior to this study all pediatric femur fractures were treated with skin traction to union. This study was designed to report the early results and costs of the adoption of ESIN at KATH to provide data to other low- and middle-income sites considering adoption of this surgical technique.

Methods

An observational cohort study that included 84 pediatric patients ages 3–14 years presenting with closed femur fractures and treated with either skin traction or ESIN. Multivariate logistic regression was used to compare the rate of treatment success between treatment groups.

Results

Treatment success (coronal and sagittal angulation less than 10 ° and shortening less than 15 mm at osseous union) was achieved in 92 % of the ESIN group versus 67 % of the skin traction group (odds ratio for ESIN group 9.28 (1.6–54.7); p = 0.0138). Average length of stay was significantly lower in the ESIN group (p = 0.001), but charges to patients were higher in the ESIN group (p < 0.001) because of the high cost of implants.

Conclusions

The initial experience of operative treatment of femoral shaft fractures in children using ESIN was positive, with improved rates of treatment success and no surgical complications. Because of the high cost of implants, direct costs of treatment remained higher with ESIN despite reductions in length of hospital stay.     

Essential role for Galpha13 in endothelial cells during embryonic development

Toward identifying the roles of protease-activated receptor-1 (PAR1) and other G protein-coupled receptors important for vascular development, we investigated the role of Galpha13 in endothelial cells in the mouse embryo. LacZ inserted into Galpha13 exon 1 was highly expressed in endothelial cells at midgestation. Endothelial-specific Galpha13 knockout embryos died at embryonic days 9.5-11.5 and resembled the PAR1 knockout. Restoration of Galpha13 expression in endothelial cells by use of a Tie2 promoter-driven Galpha13 transgene rescued development of endothelial-specific Galpha13 knockout embryos as well the embryonic day 9.5 vascular phenotype in Galpha13 conventional knockouts; transgene-positive Galpha13-/- embryos developed for several days beyond their transgene-negative Galpha13-/- littermates and then manifested a previously uncharacterized phenotype that included intracranial bleeding and exencephaly. Taken together, our results suggest a critical role for Galpha13 in endothelial cells during vascular development, place Galpha13 as a candidate mediator of PAR1 signaling in this process, and reveal roles for Galpha13 in other cell types in the mammalian embryo.     

Time intervals in the treatment of fractured femurs as indicators of the quality of trauma systems

Objective

To investigate the use of time intervals in the treatment of fractured femurs as indicators of the quality of trauma systems.

Methods

Time intervals from injury to admission, admission to surgery and surgery to discharge for patients with isolated femur fractures in four low- and middle-income countries were compared with the corresponding values from one German hospital, an Israeli hospital and the National Trauma Data Bank of the United States of America by means of Student’s t-tests. The correlations between the time intervals recorded in a country and that country’s expenditure on health and gross domestic product (GDP) were also evaluated using Pearson’s product moment correlation coefficient.

Findings

Relative to patients from high-income countries, those from low- and middle-income countries were significantly more likely to be male and to have been treated by open femoral nailing, and their intervals from injury to admission, admission to surgery and surgery to discharge were significantly longer. Strong negative correlations were detected between the interval from injury to admission and government expenditure on health, and between the interval from admission to surgery and the per capita values for total expenditure on health, government expenditure on health and GDP. Strong positive correlations were detected between the interval from surgery to discharge and general government expenditure on health.

Conclusion

The time intervals for the treatment of femur fractures are relatively long in low- and middle-income countries, can easily be measured, and are highly correlated with accessible and quantifiable country data on health and economics.     

Müllerian inhibiting substance blocks autophosphorylation of the EGF receptor by inhibiting tyrosine kinase

The fetal regressor Müllerian inhibiting substance (MIS), in concentrations as low as picomolar, inhibited the growth of A-431 cells and the autophosphorylation of its epidermal growth factor (EGF) receptor. The inhibition of membrane phosphorylation was due neither to the reduction of the total number of EGF receptor binding sites, nor to stimulation of intrinsic phosphates, but rather to inhibition of tyrosine kinase activity. MIS control of EGF receptor autophosphorylation by tyrosine kinase may be one mechanism by which Müllerian duct regression in the embryo and the inhibition of A-431 proliferation is initiated. In addition, MIS as an inhibitor of phosphorylation may furnish a tool to probe the role of membrane phosphorylation in growth control.     

Health literacy among cancer survivors: Results from the 2016 behavioral risk factor surveillance system survey

Health literacy is a set of knowledge and skills that enables individuals to obtain, communicate, process and understand information, and services to make appropriate health decisions and to successfully navigate the health care system. Health literacy is important to quality of cancer survivorship care and patient self-management of their disease.We examined health literacy among cancer survivors, using data from the 2016 Behavioral Risk Factor Surveillance System. We compared health literacy across various demographic and socioeconomic groups and estimated the adjusted odds in favor of low health literacy for these characteristics.We found that about 16% of the cancer survivors had low health literacy. The prevalence was higher among Hispanic and Black individuals, and among those with poor health status, low income and educational attainment.A sizeable percentage of cancer survivors have low health literacy which is likely to complicate their ability to self-manage their disease and navigate the health care system for optimal care. In order to ensure the quality and appropriateness of cancer survivorship care, effective interventions are needed to address low health literacy in these populations.     

A Survey of Deep Venous Thrombosis Management by Consultant Vascular Surgeons in the United Kingdom and Ireland

OBJECTIVES: The aim of this study was to detail the current consensus amongst vascular surgeons in Great Britain and Ireland regarding their investigation and management of patients with suspected or proven deep vein thrombosis (DVT). METHODS: The database of the Vascular Surgical Society of Great Britain and Ireland (VSS) was utilised to send coded postal questionnaires to all consultant surgeon members. RESULTS: Replies were received from 281 (65%) consultants. Duplex ultrasound is used alone to confirm DVT by 69% of respondents. A thrombophilia screen is always performed by 14% of consultants, for patients with proven DVT, and is more commonly requested by consultants based in a teaching hospital. The majority (57%) of consultants treat DVT with unfractionated heparin (UFH) and warfarin, whereas only 38% utilise low molecular weight heparins (LMWH) and warfarin. A management policy for DVT is reported to be in place by 59%, and a set policy for the specific management of calf vein DVT by just 20%. CONCLUSION: New diagnostic modalities and treatments have been developed for DVT that are more convenient and cost-effective. Although clinical guidelines for the management of patients with DVT are beginning to emerge, there is still a wide discrepancy in many areas of DVT management, and practice at variance with the current evidence base, amongst vascular surgeons in the United Kingdom and Ireland.