Assessing the complications and effectiveness of open carpal tunnel release in a tertiary care centre in a developing country

INTRODUCTION

Open surgical release for carpal tunnel syndrome is not devoid of complications and its quantitative assessment with the Boston questionnaire in a developing country had not been conducted, where, lack of facilities and surgical technique can influence the outcome.

PRESENTATION OF CASE

This was a prospective study in which all cases of carpal tunnel syndrome undergoing open release between June 2007 and June 2012 and who returned for follow up were included. Each patient was requested to fill out the Boston questionnaire twice both pre and post op at 3 months. All complications were recorded as well as bio-data of patients and co morbidities. Follow up was at 2 weeks and at 3 months. Those reporting complications at 3 months were further followed up until 6 months. 373 patients were included in the study. Twenty four patients developed complications. Of these, 12 experienced pain resulting from reflex sympathetic dystrophy. Three patients developed wound dehiscence, 2 cases acquired infections, 4 patients developed immediate post-operative haemorrhage and in 3 patients there was late recurrence of median nerve compression. The symptom severity score pre-operatively was 3.30 (±0.60) and it improved to 1.65 (±0.75) post-operatively indicating a significant change (p < 0.0001). The preoperative functional status score was 2.58 (±0.75) and post-op it became 1.60 (±0.80) again implying a good improvement with an effect size of 1.3.

DISCUSSION

All of the complications produced were well managed. The complication incidence was low. The open release procedure produced good improvement in hand function and in decreasing the symptom severity.

CONCLUSION

Conducting open release for carpal tunnel syndrome in a tertiary referral centre in a developing country offers a good outcome.     

Frequency and Predictors of Non-compliance to Dietary Recommendations Among Hypertensive Patients

Compliance to dietary recommendations among hypertensive people is a major health care issue. Non-compliance can nullify the effects of even the most scientific and optimum treatment plan. The main aim of this study was to determine the frequency and predictors of non-adherence in our region. We also investigated the possible factors based on patient opinions that could increase compliance. A sample of 400 adult patients, diagnosed with hypertension for at least 3 years, who visited Civil Hospital during the time period April–June 2013 were included in this cross sectional study. Patient data and opinions were collected by two trained interviewers using a pre-coded questionnaire. Compliance was assessed based on patients self report. More than three quarters (n = 310, 77.5 %) of the hypertensive patients were non-compliant. More than one social gathering in a week, peer-influence, no friends to follow the recommended diet plan and lack of believe regarding diet as an effective measure to control blood pressure were found to be the significant predictors of non-compliance (P values <0.0001). Counseling was thought to be the most effective way by the patients to increase adherence. Non-compliance to dietary recommendations is a major problem prevalent especially in Pakistan. There is an urgent need for doctors and nurses to counsel their patients effectively to prevent future morbidities and mortalities because of non-compliance.     

Contribution of endothelin and its receptors to the regulation of vascular tone during exercise is different in the systemic, coronary and pulmonary circulation

OBJECTIVES: Exercise-induced vasodilation is thought to be mediated through various vasodilator substances, but blunting the influence of vasoconstrictors such as ET may also play a role. However, the role of ET and its receptors in the regulation of systemic, pulmonary and coronary vascular resistance is incompletely understood. The aim of this study was to identify the contribution of ET-1 through the ET(A) and ET(B) receptors to the regulation of tone in the systemic, coronary and pulmonary beds at rest and during exercise. METHODS: Ten chronically instrumented swine were studied while running on a treadmill before and after ET(A) blockade (EMD122946) or ET(AB) blockade (tezosentan). RESULTS: At rest, EMD122946 resulted in vasodilation in the coronary and systemic circulation, evidenced by a decrease in coronary and systemic vascular resistance and an increase in coronary and mixed venous O(2)-saturation. These effects waned during exercise. The effect of tezosentan on the systemic vasculature was similar to that of EMD122946, whereas it was smaller in the coronary circulation. EMD122946 had no effect on the pulmonary vasculature, whereas tezosentan decreased pulmonary resistance but only during exercise. CONCLUSIONS: ET exerts a constrictor influence on the coronary and systemic circulation through the ET(A)-receptor, which decreases during exercise thereby contributing to metabolic vasodilation. ET exerts a tonic vasodilator influence on coronary resistance vessels through the ET(B)-receptor. Finally, ET exerts an ET(B)-mediated constrictor influence in the pulmonary vasculature during exercise.     

Synthesis of Ni–Ag–ZnO solid solution nanoparticles for photoreduction and antimicrobial applications

ZnO is one of the most promising and efficient semiconductor materials for various light-harvesting applications. Herein, we reported the tuning of optical properties of ZnO nanoparticles (NPs) by co-incorporation of Ni and Ag ions in the ZnO lattice. A sonochemical approach was used to synthesize pure ZnO NPs, Ni–ZnO, Ag–ZnO and Ag/Ni–ZnO with different concentrations of Ni and Ag (0.5%, 2%, 4%, 8%, and 15%) and Ni doped Ag–ZnO solid solutions with 0.25%, 0.5%, and 5% Ni ions. The as-synthesized Ni–Ag–ZnO solid solution NPs were characterized by powdered X-ray diffraction (pXRD), FT-IR spectroscopy, scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), UV-vis (UV) spectroscopy, and photoluminescence (PL) spectroscopy. Ni–Ag co-incorporation into a ZnO lattice reduces charge recombination by inducing charge trap states between the valence and conduction bands of ZnO and interfacial transfer of electrons. The Ni doped Ag–ZnO solid solution NPs have shown superior 4-nitrophenol reduction compared to pure ZnO NPs which do not show this reaction. Furthermore, a methylene blue (MB) clock reaction was also performed. Antibacterial activity against E. coli and S. aureus has inhibited the growth pattern of both strains depending on the concentration of catalysts.

The synergic effect of Ni and Ag in Ni–Ag–ZnO solid solutions has tuned the optoelectronic properties of ZnO for photoreduction reactions.     

Tribological Behavior of Aluminum Hybrid Nanocomposites Reinforced with Alumina and Graphene Oxide

Due to rapid technological advancements, the demand for lightweight materials with improved tribo-mechanical properties is continuously growing. The development of composite materials is one of the routes taken by researchers to meet these target properties. Aluminum (Al) is one of the most suitable materials used for developing composites for a wide range of applications because of its light weight, high conductivity, and high specific strength. In this study, aluminum hybrid nanocomposites with alumina (10 Vol% Al₂O₃) and varying loadings of graphene oxide (0.25, 0.5 and 1 wt% GO) were fabricated using the spark plasma sintering technique. The tribological properties of the developed hybrid composites were evaluated by conducting ball-on-disk wear tests at a normal load of 3N, with a sliding speed of 0.1 m/s, and for a sliding distance of 100 m. A 440C hardened stainless steel ball with a diameter of 6.3 mm and a hardness of 62 RC was used as a counterface. Scanning electron microscopy (SEM), elemental X-ray dispersive analysis (EDS), and optical profilometry were used to ascertain the involved wear mechanisms. The results revealed that Al-10 Vol%Vol% Al₂O₃-0.25 wt% GO hybrid nanocomposite showed an increase of 48% in the hardness, a reduction of 55% in the specific wear rate, and a reduction of 5% in COF compared with pure aluminum.     

Objective screening for olfactory and gustatory dysfunction during the COVID‐19 pandemic: A prospective study in healthcare workers using self‐administered testing

BackgroundSmell and taste loss are highly prevalent symptoms in coronavirus disease 2019 (COVID‐19), although few studies have employed objective measures to quantify these symptoms, especially dysgeusia. Reports of unrecognized anosmia in COVID‐19 patients suggests that self‐reported measures are insufficient for capturing patients with chemosensory dysfunction.ObjectivesThe purpose of this study was to quantify the impact of recent COVID‐19 infection on chemosensory function and demonstrate the use of at‐home objective smell and taste testing in an at‐risk population of healthcare workers.MethodsTwo hundred and fifty healthcare workers were screened for possible loss of smell and taste using online surveys. Self‐administered smell and taste tests were mailed to respondents meeting criteria for elevated risk of infection, and one‐month follow‐up surveys were completed.ResultsAmong subjects with prior SARS‐CoV‐2 infection, 73% reported symptoms of olfactory and/or gustatory dysfunction. Self‐reported smell and taste loss were both strong predictors of COVID‐19 positivity. Subjects with evidence of recent SARS‐CoV‐2 infection (<45 days) had significantly lower olfactory scores but equivalent gustatory scores compared to other subjects. There was a time‐dependent increase in smell scores but not in taste scores among subjects with prior infection and chemosensory symptoms. The overall infection rate was 4.4%, with 2.5% reported by PCR swab.ConclusionHealthcare workers with recent SARS‐CoV‐2 infection had reduced olfaction and normal gustation on self‐administered objective testing compared to those without infection. Rates of infection and chemosensory symptoms in our cohort of healthcare workers reflect those of the general public.