975 RELATIONSHIP BETWEEN HAND GRIP STRENGTH (HGS) AND 10 YEAR PROBABILITY OF MAJOR OSTEOPOROTIC FRACTURES IN OLDER

Introduction

HGS has been shown to be associated with adverse outcomes in a wide range of conditions. It has also been found to be associated with bone mineral density and is inversely associated with risk of osteoporotic fractures. The aim of this study was to determine the association between HGS and 10 year probability of sustaining a major osteoporotic fractures in older inpatient and to evaluate the effect of gender on this association.

Method

This was a cross-sectional, observational analysis of older patients admitted into hospital between September and November 2021. HGS was measured in these patients using the JAMAR hydraulic hand held dynamometer. The Southampton protocol was used. The FRAX UK tool (without BMD) was used to calculate 10 year probability of major osteoporotic fractures. Patients were included if they were 60 years and above. Younger patients were excluded as were stroke patients. Patients with incomplete data were excluded from analysis. The SPSS 27 package was used for statistical analysis. Baseline characteristics were calculated using descriptive statistics. Pearson’s correlation coefficient and linear regression were used to calculate correlation.

Results

104 patients were analysed—41 males and 63 females. Mean age was 83 years (SD 8.2). Grip strength was inversely correlated with FRAX UK in predicting 10 year probability of major osteoporotic fractures in all patients, male patients and female patients (r = −0.452; p < 0.001, r = −0.351; p = 0.02 and r = −0.271; p = 0.03 respectively).

Conclusion

Grip strength is negatively associated with increased probability of major osteoporotic fractures in older inpatients. Reference(s) Ma Y, Fu L, Jia L, et al. Muscle strength rather than muscle mass is associated with osteoporosis in older Chinese adults. J Formos Med Assoc. 2018;117(2):101–108. doi:10.1016/j.jfma.2017.03.004

New Measurements of the Beam-Normal Single Spin Asymmetry in Elastic Electron Scattering over a Range of Spin-0 Nuclei

We report precision determinations of the beam-normal single spin asymmetries (A_{n}) in the elastic scattering of 0.95 and 2.18 GeV electrons off ^{12}C, ^{40}Ca, ^{48}Ca, and ^{208}Pb at very forward angles where the most detailed theoretical calculations have been performed. The first measurements of A_{n} for ^{40}Ca and ^{48}Ca are found to be similar to that of ^{12}C, consistent with expectations and thus demonstrating the validity of theoretical calculations for nuclei with Z≤20. We also report A_{n} for ^{208}Pb at two new momentum transfers (Q^{2}) extending the previous measurement. Our new data confirm the surprising result previously reported, with all three data points showing significant disagreement with the results from the Z≤20 nuclei. These data confirm our basic understanding of the underlying dynamics that govern A_{n} for nuclei containing ≲50 nucleons, but point to the need for further investigation to understand the unusual A_{n} behavior discovered for scattering off ^{208}Pb.

Form Factors and Two-Photon Exchange in High-Energy Elastic Electron-Proton Scattering

We present new precision measurements of the elastic electron-proton scattering cross section for momentum transfer (Q^{2}) up to 15.75  (GeV/c)^{2}. Combined with existing data, these provide an improved extraction of the proton magnetic form factor at high Q^{2} and double the range over which a longitudinal or transverse separation of the cross section can be performed. The difference between our results and polarization data agrees with that observed at lower Q^{2} and attributed to hard two-photon exchange (TPE) effects, extending to 8  (GeV/c)^{2} the range of Q^{2} for which a discrepancy is established at >95% confidence. We use the discrepancy to quantify the size of TPE contributions needed to explain the cross section at high Q^{2}.

378 Endovascular Stenting vs. Open Surgery in Cerebral AVF Patients

Introduction

Intracranial dural arteriovenous fistulae (dAVF), typically found in the dural leaflets, are vascular malformations defined by a pathological communication between meningeal arteries and dural sinus or cortical veins. Despite many of them spontaneously resolving, they are still at high risk of hemorrhage and mortality if not effectively treated and monitored. Treatment options include endovascular embolization, surgical disconnection, and radiosurgery. With the rise of endovascular treatments now widely available, there is a massive shift towards minimally invasive surgical options while it can still be argued they are not the end of open surgical repairs.

Method

We reviewed 12 cases each of endovascular embolization and microsurgical resection in our Neurosurgical Unit retrospectively and compare between length of hospital stay, hemorrhage, need for open surgery following endovascular technique and wound infection. Cases will be selected at random over a period of 6 months.

Results

We compared surgical outcomes of 12 cases each of dural AvFs that were either managed as surgical repair or endovascular embolization. In cases with associated complication, surgical repair was the preferred method although endovascular repairs had shorter length of hospital stay, lower rates of infections and rarely needed to be followed by surgical repair.

Conclusions

Based on the result we conclude that endovascular repairs have a shorter length of hospital stay, infections and hemorrhage, yet there are instances where surgical disconnection may be the preferred treatment method on a case-by-case basis. Endovascular treatment may not have replaced open surgical procedures just yet, but the future may hold more advances in this field.

353 The Rise of the Exoscope

Introduction

An exoscope is a next generation HD telescope video monitoring system used to perform microsurgeries that is now a formidable rival to the existing operating microscope in neurosurgery. While the microscope revolutionised neurosurgery with its advent in 1957, the exoscope allows surgeons to operate utilising high-definition images enhancing the field of vision and focus. The exoscope opens new avenues with regards to ergonomics, teaching in theatre and enhances the surgeon’s experience.

Method

We will do a literature review on available literature on the use of exoscope in neurosurgery with regards to the operating microscope. Both qualitative and quantitative data will be reviewed. Personal experience of Neurosurgeons in our unit will also be reviewed using questionnaires.

Results

The exoscope has many benefits when compared to the operating microscope where it surpasses its predecessor in many ways. 15 studies were reviewed where the exoscope was compared to the operating microscope which concluded the exoscope equal or superior in many aspects such as teaching, ergonomics, image definition and being user friendly. There were some pitfalls of the exoscope reported such as the image being in 2D which limited the surgeon’s stereoscopic vision and the costs involved.

Conclusions

The exoscope is a revolutionary advent in neurosurgery and may soon make the operating microscope obsolete but there is still room for improvement.

79 Yellow Nail Syndrome Management with Nail Ablation and Reconstruction with a Full-Thickness Skin Graft

Aim

Yellow nail syndrome is a very rare and complex syndrome associated with aberrant nail growth multiple digits, in this case, the report we offer this as a solution to a challenging and rare condition.

Method

A 56-year-old lady underwent nail ablation and reconstruction with a full-thickness skin graft (FTSG).

Results

The patient had good cosmetic results.

Conclusions

Yellow nail syndrome is a rare but complex condition that is not yet fully understood. Nail plate deformity and discoloration are on the way the disease can manifest itself. Although not often encountered by plastic surgeons; The role of surgical excision for patients affected by dystrophic nails in yellow nail syndrome was given more emphasis within the literature. It is an effective technique that can be adapted as a standardized treatment modality

343 Medical Teaching in the Covid Era: The Rise of the Webinar

Background

Since the emergence of COVID-19, virtually the whole world has been forced to into lockdown and adapt to a way of life not seen in living memory. Although pandemics are not new, nor will this likely be the last, the modern era has one major advantage that our ancestors did not have: the internet.

Through the usage of modern technology and the internet, we have been able to continue our professional lives through a virtual medium through programs like Zoom. As part of this virtual shift, medical teaching is also mainly online. A QI study was conducted on webinars.

Aim

To determine whether medical students and junior doctors find online teaching to be an effective medium of learning, as well as to determine the advantages and disadvantages, including mental health impact.

Method

A webinar series was created, entitled back2basics (B2B) surgery, which was run for around 2 months with weekly, 1-hour long webinars on a surgical topic. Feedback was collected following each session specific to that week’s webinar as a general opinion of our participants on webinars.

Results

Both qualitative and quantitative data was collected. The majority (83%) of participants agreed by the 8th week that webinars were an effective mode of medical teaching compared to 48% in the 1st week. Participants pointed out that webinars are ‘low pressure’ and ‘less competitive’ than in person lectures, so good for mental health.

Conclusions

Participants agree that the webinars are effective for medical teaching and that there are mental health benefits.

Evaluation of the Status of Glycated Haemoglobin in Male type 2 Diabetic Patients

The incidence of type 2 diabetes mellitus is increasing in Bangladesh with its attendant complications. Glycated haemoglobin (HbA1c) is broadly used as an index of mean glycaemia. This study was planned to evaluate the status of glycated haemoglobin (HbA1c) in male type 2 diabetic patients. This cross-sectional analytical study was executed in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2019 to June 2020. This study included in total 200 male subjects who are above 40 years in age. Among them, one hundred (100) male type 2 diabetic patients were taken as study group (Group I) and one hundred (100) age matched healthy male subjects were taken as control group (Group II). Glycated haemoglobin was assessed by ion-exchange high performance liquid chromatography (HPLC) method. Mean±SD was used to express data and unpaired Student's 't' test was used to calculate the statistical significance of difference amongst the groups. Pearson's correlation coefficient test was done to correlate the relationship between serum fasting glucose and glycated haemoglobin. The mean±SD of fasting serum glucose of Group I and Group II were 9.79±2.88mmol/L and 5.23±0.48mmol/L respectively. The mean±SD of glycated haemoglobin of Group I and Group II were 8.38±1.28mmol/L and 5.19±0.46mmol/L respectively. The mean±SD of glycated haemoglobin is found to be significantly higher in the study group compared to the control group and there is a positive correlation between fasting serum glucose and glycated haemoglobin. So, routine estimation of this parameter (HbA1c) is important for prevention of complications related to type 2 diabetes mellitus for leading healthy life.

Socio-demographic and Clinico-epidemiological Study of Scrub Typhus in A Tertiary Care Hospital of Mymensingh, Bangladesh

Scrub typhus is one of the leading causes of undifferentiated treatable febrile illness in Asia pacific region. It is grossly under diagnosed in many tropical countries of South Asia including Bangladesh, due to wide range of non-specific clinical presentations, low index of suspicion among clinicians, limited awareness and lack of accurate diagnostic facilities. This cross sectional observational study was conducted at department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh from March 2019 to February 2020 enrolling 113 diagnosed cases of scrub typhus by Immunochromatographic test (ICT) and / or Nested PCR to characterize the socio-demographic and clinico-epidemiological features of scrub typhus in Mymensingh area. Majority of the scrub typhus cases came from rural areas (63.83%) and there was a slight female predominance (52.21%). The young (32.74%) and the young-adult age group (28.31%) were mostly affected. Most of the scrub typhus cases were housewives (30.98%), followed by farmers (23.89%) and students (21.23%). All the enrolled cases presented with fever. Other findings were myalgia (76.10%), headache (56.63%), cough (30.97%), vomiting (12.38%) and Respiratory distress (9.73%). Typical eschar of scrub typhus was present only in 9(7.96%) cases and 4(3.53%) patients had rashes on their skin. Few cases (3.53%) had jaundice and 15.96% cases were anaemic. Oliguria (7.96%) and neck rigidity (1.76%) were also documented. Most of the Nested PCR positive scrub typhus cases were documented during late rainy season and beginning of winter months. Findings of the study may offer increased awareness about high burden of scrub typhus as well as heightened suspicion among clinicians for early diagnosis, timely treatment and prevention of complications.

Trajectories of antidepressant use and characteristics associated with trajectory groups among young refugees and their Swedish-born peers with diagnosed common mental disorders-findings from the REMAIN study

PURPOSE

This study aimed to (1) identify the trajectories of prescribed antidepressants in refugee youth and matched Swedish-born peers diagnosed with common mental disorder (CMD) and (2) characterize the trajectories according to sociodemographic and medical factors.

METHODS

The study population comprised 2,198 refugees and 12,199 Swedish-born individuals with both Swedish-born parents, aged 16-25 years in 2011, residing in Sweden and treated in specialised healthcare for CMD 2009-11. Group-based trajectory modelling was used to identify different trajectory groups of antidepressant use-based on annual defined daily dosages (DDDs). Multinomial logistic regression was applied to investigate the association of sociodemographic and medical characteristics with the identified trajectories. Nagelkerke pseudo-R² values were estimated to evaluate the strength of these associations.

RESULTS

Four trajectory groups of antidepressant use among young refugees were identified with following proportions and DDD levels in 2011: 'low constant' (88%, < 100), 'low increasing' (2%, ≈710), 'medium decreasing' (8%, ≈170) and 'high increasing' (2%, ≈860). Similar trajectories, however, with different proportions were identified in Swedish-born: 67%, 7%, 21% and 5%, respectively. The most influential factors discriminating the trajectory groups among refugees were 'duration of stay in Sweden' (R² = 0.013), comorbid 'other mental disorders' (R² = 0.009) and 'disability pension' (R² = 0.007), while 'disability pension' (R² = 0.017), comorbid 'other mental disorders' (R² = 0.008) and 'educational level' (R² = 0.008) were the most important determinants discriminating trajectory groups among Swedish-born youth.

CONCLUSION

The lower use of antidepressants in refugees with CMDs compared to their Swedish-born counterparts warrants health literacy programs for refugees and training in transcultural psychiatry for healthcare professionals.

The impact of adolescent nicotine exposure on alcohol use during adulthood: The role of neuropeptides

Nicotine and alcohol abuse and co-dependence represent major public health crises. Indeed, previous research has shown that the prevalence of alcoholism is higher in smokers than in non-smokers. Adolescence is a susceptible period of life for the initiation of nicotine and alcohol use and the development of nicotine-alcohol codependence. However, there is a limited number of pharmacotherapeutic agents to treat addiction to nicotine or alcohol alone. Notably, there is no effective medication to treat this comorbid disorder. This chapter aims to review the early nicotine use and its impact on subsequent alcohol abuse during adolescence and adulthood as well as the role of neuropeptides in this comorbid disorder. The preclinical and clinical findings discussed in this chapter will advance our understanding of this comorbid disorder's neurobiology and lay a foundation for developing novel pharmacotherapies to treat nicotine and alcohol codependence.

Adolescent opioid abuse: Role of glial and neuroimmune mechanisms

Opioids are widely prescribed for pain management, and prescription opioid misuse in adolescents has become a major epidemic in the United States and worldwide. Emerging data indicate that adolescence represents a critical period of brain development, and exposure to opioids during adolescence may increase the risk of addiction in adulthood. There is growing evidence that disruptions in brain glial function may be implicated in numerous chronic neuropathologies. Evidence suggests that glial mechanisms have an important role in the development and maintenance of opioid abuse and the risk for addiction. This review will describe glial and neuroimmune mechanisms involved in opioid use disorders during adolescence, which may increase substance use disorder liability later in life. Moreover, this review will identify some important neuro-glial targets, involved in opioid abuse and addiction, to develop future preventions and treatment strategies.

Early life stress and susceptibility to addiction in adolescence

Early life stress (ELS) is a risk factor for developing a host of psychiatric disorders. Adolescence is a particularly vulnerable period for the onset of these disorders and substance use disorders (SUDs). Here we discuss ELS and its effects in adolescence, especially SUDs, and their correlates with molecular changes to signaling systems in reward and stress neurocircuits. Using a maternal separation (MS) model of neonatal ELS, we studied a range of behaviors that comprise a "drug-seeking" phenotype. We then investigated potential mechanisms underlying the development of this phenotype. Corticotropin releasing factor (CRF) and serotonin (5-HT) are widely believed to be involved in "stress-induced" disorders, including addiction. Here, we show that ELS leads to the development of a drug-seeking phenotype indicative of increased susceptibility to addiction and concomitant sex-dependent upregulation of CRF and 5-HT system components throughout extended brain reward/stress neurocircuits.

Trajectories of labour market marginalisation among young adults with newly diagnosed attention-deficit/hyperactivity disorder (ADHD)

AIMS

Labour market marginalisation (LMM), i.e. severe problems in finding and keeping a job, is common among young adults with attention-deficit/hyperactivity disorder (ADHD). This study aimed to disentangle the extent of LMM as well as the heterogeneity in patterns of LMM among young adults with ADHD and what characterises those belonging to these distinct trajectories of LMM.

METHODS

This population-based register study investigated all 6287 young adults, aged 22-29 years, who had their first primary or secondary diagnosis of ADHD in Sweden between 2006 and 2011. Group-based trajectory (GBT) models were used to estimate trajectories of LMM, conceptualised as both unemployment and work disability, 3 years before and 5 years after the year of an incident diagnosis of ADHD. Odds ratios (ORs) with 95% confidence intervals (CIs) for the association between individual characteristics and the trajectory groups of LMM were estimated by multinomial logistic regression.

RESULTS

Six distinct trajectories of LMM were found: 'increasing high' (21% belonged to this trajectory group) with high levels of LMM throughout the study period, 'rapidly increasing' (19%), 'moderately increasing' (21%), 'constant low' (12%) with low levels of LMM throughout the study period, 'moderately decreasing' (14%) and finally 'fluctuating' (13%), following a reversed u-shaped curve. Individuals with the following characteristics had an increased probability of belonging to trajectory groups of increasing LMM: low educational level (moderately increasing: OR: 1.4; CI: 1.2-1.8, rapidly increasing: OR: 1.7; CI: 1.3-2.1, increasing high: OR: 2.9; CI: 2.3-3.6), single parents (moderately increasing: OR: 1.6; CI: 1.1-2.4, rapidly increasing: OR: 2.0; CI: 1.3-3.0), those born outside the European Union/the Nordic countries (rapidly increasing: OR: 1.7; CI: 1.1-2.5, increasing high: OR: 2.1; CI: 1.4-3.1), persons living in small cities/villages (moderately increasing: OR: 2.4; CI: 1.9-3.0, rapidly increasing: OR: 2.1; CI: 1.6-2.7, increasing high: OR: 2.6; CI: 2.0-3.3) and those with comorbid mental disorders, most pronounced regarding schizophrenia/psychoses (rapidly increasing: OR: 6.7; CI: 2.9-19.5, increasing high: OR: 12.8; CI: 5.5-37.0), autism spectrum disorders (rapidly increasing: OR: 4.6; CI: 3.1-7.1, increasing high: OR: 9.6; CI: 6.5-14.6), anxiety/stress-related disorders (moderately increasing: OR: 1.3; CI: 1.1-1.7, rapidly increasing: OR: 2.0; CI: 1.6-2.5, increasing high: OR: 1.8; CI: 1.5-2.3) and depression/bipolar disorder (moderately increasing: OR: 1.3; CI: 1.0-1.6, rapidly increasing: OR: 1.7; CI: 1.4-2.2, increasing high: OR: 1.5; CI: 1.2-1.9).

CONCLUSIONS

About 61% of young adults were characterised by increasing LMM after a diagnosis of ADHD. To avoid marginalisation, attention should especially be given to young adults diagnosed with ADHD with a low educational level, that are single parents and who are living outside big cities. Also, young adults with comorbid mental disorders should be monitored for LMM early in working life.

Evolution of Structural and Electronic Properties of TiSe2 under High Pressure

A pressure-induced structural phase transition and its intimate link with the superconducting transition was studied for the first time in TiSe₂ up to 40 GPa at room temperature using X-ray diffraction, transport measurement, and first-principles calculations. We demonstrate the occurrence of a first-order structural phase transition at 4 GPa from the standard trigonal structure (S.G.P3̅m1) to another trigonal structure (S-G-P3̅c1). Additionally, at 16 GPa, the P3̅c1 phase spontaneously transforms into a monoclinic C2/m phase, and above 24 GPa, the C2/m phase returns to the initial P3̅m1 phase. Electrical transport results show that metallization occurs above 6 GPa. The charge density wave observed at ambient pressure is suppressed upon compression up to 2 GPa with the emergence of superconductivity at 2.5 GPa, with a critical temperature (T_c) of 2 K. A structural transition accompanies the emergence of superconductivity that persists up to 4 GPa. The results demonstrate that the pressure-induced phase transitions explored by the experiments along with the theoretical predictions may open the door to a new path for searching and controlling the phase diagrams of transition metal dichalcogenides.

Deep Exclusive Electroproduction of π^{0} at High Q^{2} in the Quark Valence Regime

We report measurements of the exclusive neutral pion electroproduction cross section off protons at large values of x_{B} (0.36, 0.48, and 0.60) and Q^{2} (3.1 to 8.4  GeV^{2}) obtained from Jefferson Lab Hall A experiment E12-06-014. The corresponding structure functions dσ_{T}/dt+εdσ_{L}/dt, dσ_{TT}/dt, dσ_{LT}/dt, and dσ_{LT^{'}}/dt are extracted as a function of the proton momentum transfer t-t_{min}. The results suggest the amplitude for transversely polarized virtual photons continues to dominate the cross section throughout this kinematic range. The data are well described by calculations based on transversity generalized parton distributions coupled to a helicity flip distribution amplitude of the pion, thus providing a unique way to probe the structure of the nucleon.

Effect of microwave plasma treatment on magnetic and photocatalytic response of manganese ferrite nanoparticles for wastewater treatment

The conventionally synthesized nano-ferrite materials do not possess bulk properties, generally required for their use in mainstream industry. To make ferrite nanoparticles clinically applicable materials, it is important to have good control over morphology and optical properties of these materials. In this study, low-pressure microwave plasma was used to tailor the structural properties and surface chemistry of manganese ferrite nanoparticles. A facile sol-gel method was used to prepare cubic spinal structures of manganese ferrite nanoparticles. These nanoparticles were exposed to oxygen plasma sustained with a microwave source for improving their magnetic and photocatalytic activities. The techniques like XRD, SEM, PL, UV-Vis DRS, transient photocurrent response and EIS were used to characterize the samples. The plasma treated nanoparticles were used to degraded methyl blue (MB) dye in the solution. The photocatalytic activity showed 85% degradation of MB after 100 min of exposure of visible light. The second part of the paper studied the magnetic properties of the nanoparticles. The saturation magnetization decreased from 0.78 emu/g to 0.68 emu/g after plasma treatment of nanoparticles.

Rapid Serologic and Molecular Diagnosis of Scrub Typhus among Suspected Febrile Patients Visiting Mymensingh Medical College Hospital

Scrub typhus, caused by the bacterium- Orientia tsutsugamushi is one of the leading causes of undifferentiated treatable febrile illness in Asia pacific region. It is grossly under diagnosed in many tropical countries of South Asia including Bangladesh, due to wide range of non-specific clinical presentations, low index of suspicion among clinicians, limited awareness and lack of accurate diagnostic facilities. This cross-sectional descriptive study was conducted at Department of Microbiology, Mymensingh Medical College to diagnose scrub typhus by rapid Immunochromatographic test (ICT) as well as molecular detection of O. tsutsugamushi by Nested PCR and automated nucleotide sequencing among suspected febrile patients in Mymensingh, Bangladesh during 2019-20. Blood samples were collected from 402 febrile patients of suspected Rickettsial illness, referred from inpatient and outpatient departments of Medicine and Pediatrics, Mymensingh Medical College Hospital (MMCH). Among the enrolled 402 patients, 89 samples (22.13%) were seropositive by Immunochromatographic test (ICT) and 65 samples (16.16%) were positive for O. tsutsugamushi DNA by Nested PCR, targeting 47KDa gene. Therefore, 113/402 (28.10%) samples were positive for scrub typhus by PCR and/ or ICT. Highest number of patients was detected positive by nested PCR during the first 5-10 days of fever but only 2 cases were positive after 20 days. In case of ICT, highest positivity for only IgM (8.13%) and both antibodies (2.43%) were documented in first 5-10 days of fever, but IgG positivity was highest (41.66) in >20 days of fever. From 65 PCR positive samples, automated nucleotide sequencing was performed on 20 randomly selected samples and all were genetically confirmed to be O. tsutsugamushi.