Isolated intrathoracic injury with air bag use

The restrained (air bag and seatbelt) driver of a vehicle involved in a high-speed motor-vehicle accident sustained a tear of the thoracic aorta with no signs of external injury. Air bag deployment may mask significant internal injury, and a high index of suspicion is warranted in such situations.     

2nd World Water Forum

The world is facing a water crisis. About one billion people lack access to safe water and three billion to appropriate sanitation. There will probably be two billion extra people on the planet by 2025; so while today's shortages are for fresh water and sanitation, tomorrow's are predicted to be for growing crops. Already, 10% of world food production is drawing down underground water faster than the recharge rates. Water also threatens to cause conflicts between regions--a state of affairs that is expected to worsen as this century progresses. To raise public awareness of these issues and pressurize politicians to act, the World Water Commission (WWC) held a Forum in March 2000 in The Hague. The Forum collected together a huge range of people from governments, non-government organizations (NGOs), workers for the environment and development, private sector water providers, trades unions and scientific institutes. They all discussed a document (World Water Vision: A Water Secure World, referred to as the Vision) drawn up by the WWC as a basis for action. The Forum culminated in a meeting of ministers from over 140 governments.     

Headless compression screw fixation prevents symptomatic metalwork in arthroscopic ankle arthrodesis

BackgroundArthroscopic ankle arthrodesis (AAA) is a recognised salvage procedure for end-stage arthritis. Its reported disadvantages include a high rate of re-operation for symptomatic prominence of metalwork. We propose that the use of a headless screw would reduce this re-operation rate.MethodsWe reviewed 32 AAAs, using the Acutrak?6/7 mm headless screw fixation system, to determine peri-operative parameters and complication rates.ResultsAt an average of 22 months follow-up, 28 (88%) had united radiologically. There were 2 stable fibrous non-unions not requiring further intervention. Of the other 2, one was successfully revised using an open technique, and the other patient died of unrelated causes.There were no other complications in this series, with no cases of metalwork removal for prominence or pain.ConclusionsUsing a headless screw fixation for arthroscopic ankle arthrodesis prevents symptomatic metalwork prominence and the requirement for removal.     

COVID-19 associated coagulopathy in critically ill patients: A hypercoagulable state demonstrated by parameters of haemostasis and clot waveform analysis

Journal of Thrombosis and Thrombolysis - Patients with COVID-19 are known to be at risk of developing both venous, arterial and microvascular thrombosis, due to an excessive immuno-thrombogenic...     

Stroke as a Neurological Complication of COVID-19: A Systematic Review and Meta-Analysis of Incidence,Outcomes and Predictors

IntroductionCOVID-19 is a multi-system infection which predominantly affects the respiratory system, but also causes systemic inflammation, endothelialitis and thrombosis. The consequences of this include renal dysfunction, hepatitis and stroke. In this systematic review, we aimed to evaluate the epidemiology, clinical course, and outcomes of patients who suffer from stroke as a complication of COVID-19.MethodsWe conducted a systematic review of all studies published between November 1, 2019 and July 8, 2020 which reported on patients who suffered from stroke as a complication of COVID-19.Results326 studies were screened, and 30 studies reporting findings from 55,176 patients including 899 with stroke were included. The average age of patients who suffered from stroke as a complication of COVID-19 was 65.5 (Range: 40.4–76.4 years). The average incidence of stroke as a complication of COVID-19 was 1.74% (95% CI: 1.09% to 2.51%). The average mortality of stroke in COVID-19 patients was 31.76% (95% CI: 17.77% to 47.31%). These patients also had deranged clinical parameters including deranged coagulation profiles, liver function tests, and full blood counts.ConclusionAlthough stroke is an uncommon complication of COVID-19, when present, it often results in significant morbidity and mortality. In COVID-19 patients, stroke was associated with older age, comorbidities, and severe illness.     

A novel 506kb deletion causing εγδβ thalassemia

We describe a novel deletion causing εγδβ thalassemia in a Pakistani family. The Pakistani deletion is 506kb in length, and the second largest εγδβ thalassemia deletion reported to date. It removes the entire β globin gene (HBB) cluster, extending from 431kb upstream to 75kb downstream of the ε globin gene (HBE). The breakpoint junction occurred within a 160bp palindrome embedded in LINE/LTR repeats, and contained a short (9bp) region of direct homology which may have contributed to the recombination event. Characterization of the deletion breakpoints has been particularly challenging due to the complexity of DNA deletion, insertion and inversion, involving a multitude of methodologies, mirroring the changing DNA analysis technologies.