Short term results with the use of PLA antibiotic coated nail in open tibia fractures: A prospective study

Background

Antibiotic impregnated cement coated nails have been described in literature with promising success rates. However, they need removal at a later stage. This study focuses on use of a PLA-precoated antibiotic nail that stops eluting antibiotic after a while and can be retained later as it behaves as a standard interlocking nail in the long run.

Purpose

To study if PLA (polylactic acid) -antibiotic coated nails reduces infection and non-union rates and improve the functional outcome in open tibial shaft fracture cases.

Materials and methods

In this prospective cohort study, we included 54 patients with open tibia shaft fractures treated with wound debridement and internal fixation using a reamed PLA (polylactic acid)-antibiotic coated nail (CE-certified, OSSIPRO, MatrixTM).

Results

Forty patients with a Grade 2 and ten with grade 3A open tibial fracture, according to the Gustilo-Anderson classification, completed a minimum of six months of follow-up and were included in the analysis. At the final follow-up, four patients (all with grade 3A fracture) had an active infection, 10 (four of grade 2 and six of grade 3A) had non-union, the mean physical component score (SF-36 score) was 55.2 ± 20.10 (grade 2; 58.95 ± 9.99, grade 3A; 40.19 ± 16.37, P value 0.002), and the mean mental component score (SF-36 score) was 54.96 ± 23.5 (grade 2; 57.96 ± 16.63, grade 3A; 42.94 ± 23.75, P value 0.04). Furthermore, Multivariate analysis showed age and grade of fracture to be independently related to the development of infection and non-union.

Conclusion

Although the use PLA-antibiotic coated nail looks promising, short-term results have revealed no additional benefit in terms of reduced infection rates, improved union rates or functional outcomes. Large multicentric randomized controlled trials and a long term follow up are advised to further explore the role of PLA coated antibiotic nails in open tibial fractures.

AHP-based multi-criteria decision-making for forest sustainability of lower Himalayan foothills in northern circle, India-a case study

Forest degradation is a major issue worldwide. The study area, situated in the lower Himalayan foothills of northern India, is also witnessing the same. A ground survey of the area revealed that socio-economic factors are a major cause of forest degradation. Therefore, sustainable forest management is required to maintain forest resources and health. This study aims to develop the most suitable and agreeable alternatives for ensuring the sustainability of forest use, increase economic benefits, and improve the living conditions of the people surrounding the forest area. This study uses the analytical hierarchy process (AHP) as a decision-making method. A pre-test was conducted prior to the main survey, which helped validate the questionnaires and deliver more reliable survey responses. The authors identified three criteria (C) and nine indicators (I).The pre-tested criteria and indicators arranged in hierarchical order were prioritized by applying the AHP. A list of 36 alternatives (A) was prepared in ascending order to select the best alternatives and was used to make suitable judgments for enhancing forest management efficiency. C, I, and A were developed based on a literature review, pre-test, and questionnaire-based field survey that recorded the preferences of different stakeholders. The survey was conducted in 77 fringe villages surrounding the forest and responses were collected from 302 respondents. The overall AHP implementation was simplified using "Super Decisions." The results advocate adopting valid options such as afforestation, agro-forestry, plantation, forest boundary demarcation, capital investment, and others to strengthen the sustainable development of the region. Furthermore, some of the major findings were shared with decision-making authorities (forest officials and village representatives). The stakeholders realized the need to accelerate participatory forest management practices, capacity building, and training of the local populations, together with other options to improve their livelihoods.

Diagnostic accuracy of saliva as a specimen for detection of SARS-CoV-2 by RT-PCR

CONTEXT

COVID-19 caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is an emerging pandemic that is rapidly spreading with more than 114 million confirmed cases and 2.5 million deaths by far. Nasopharyngeal swab (NPS) in VTM has been used as the gold standard respiratory specimen for SARS-CoV-2 reverse-transcriptase real-time PCR (rRT-PCR) tests. But now the virus can also be detected in other clinical specimens like bronchoalveolar lavage, sputum, saliva, throat swab, blood, and stool specimens.

AIMS

The aim of this study was to determine the diagnostic potential of saliva as a sample in comparison to NPS for detection of SARS-CoV-2 by rRT-PCR.

SETTINGS AND DESIGN

A cross-sectional study was conducted among 256 paired samples (NPS and Saliva) received in the Department of Microbiology, SMS Medical College, Jaipur over a period of 2 months.

METHODS AND MATERIAL

NPS from individuals were collected in a sterile tube containing Viral Transport Medium™. Before swab collection, whole saliva was collected by spitting from the suspected patient into a sterile container. Both were stored at room temperature and transferred to the diagnostic laboratory within four hours of collection where extraction was done using Perkin Elmer chemagic extractor and rRT- PCR was performed using NIV, Pune mastermix.

RESULTS

Sensitivity, specificity, PPV, and NPV of RT-PCR for the diagnosis of COVID-19 in saliva were 84.26%, 100%, 100%, and 54.05%, respectively. The accuracy of detection of COVID-19 by saliva samples compared to the routinely used NPS samples (considered as the standard reference) for RT PCR was 86.72%.

CONCLUSIONS

Our results show that saliva as a reliable sample type for SARS-CoV-2 detection.