859 A Single Center Retrospective Study Comparing Retrograde TibioTaloCalcaneal Nailing vs Open Reduction Internal Fixation of Ankle Fractures in a Comorbid Elderly Population

Aim

The aim of this paper is to compare the functional outcomes and complication rates of ankle fractures treated with retrograde tibiotalocalcaneal nail (TTC) and open reduction internal fixation (ORIF).

Method

Matched cohorts according to age and Charlson Comorbidities Index (CCI) (mean=6) were established by performing a retrospective search of a prospectively collated Bluespier® database for patients within our unit who underwent TTC nailing and open reduction internal fixation (ORIF) for acute trauma from 2015 to 2021.

Results

32 patients (8 males/ 24 females) were identified in both the TTC and ORIF groups with mean ages of 78.4 (55–96) and 78.3 (52–93) respectively. Mean follow-up length was 6 months in both groups. All fractures were classified according to AO classification. 3.1% of fractures were 44A, 71.9% 44B, 25% 44C in the TTC group compared to 3.1% 44A, 59.4% 44B and 37.5% 44C fractures in the ORIF group. Surgical site infection rate was 9.4% in the TTC group compared to 6.3% in the ORIF group. Both groups had a similar implant failure rate of 9.4%. 2/32 (6.3%) suffered from periprosthetic fractures in the TTC group and 1 of them required re-operation. 45% of patients in the TTC group returned to their pre-injury level of mobility compared to 40.6% in the ORIF group at their last follow up.

Conclusions

Our study showed that retrograde TTC nailing can be a useful treatment option for ankle fractures in the comorbid elderly, restoring function and enabling return to full weight bearing immediately after surgery.

Office hysteroscopy: back to the future!

Hysteroscopy and anesthesia have come a long way in the last 150 years. While traditionally performed in the operating theater under general anesthesia, the alternative approach - so-called 'office' hysteroscopy - has gained popularity in recent years. Supporters of this modality cite the 'see and treat' capabilities, avoidance of anesthesia, more rapid turn-around time, and favorable economics as advantages. On the other hand, some question the success rate, capabilities, and patient comfort levels as potential drawbacks. In this article, we review the evidence behind all of these points as well as the requirements for setting up an office hysteroscopy service.

Randomized controlled trial on the effect of Al-Quran recitation vs counseling on smoking intensity among Muslim men who are trying to quit smoking

INTRODUCTION

Nicotine cravings and withdrawal symptoms are associated with higher rates of relapse. It has been shown that combining behavioral therapy and pharmacotherapy leads to a higher long-term abstinence rate in those who quit smoking. Al-Quran recitation has been proven to reduce anxiety among athletes before tournaments and pulse and heart rates among patients awaiting cardiac operations. As most of the patients who wish to stop smoking experience high-anxiety states, we postulate that Al-Quran recitation will also able to reduce craving among smokers attempting to quit smoking.

METHODS

Fifty smokers from an outpatient clinic were randomly assigned to control and intervention groups. They were taught different ways of coping with smoking urges, i.e., counseling using the 12'M' method (control group) versus Al-Quran recitation (intervention group). They met for four consecutive weeks of counselling and to fill out a withdrawal scale. Carbon monoxide (CO) levels were tested at baseline and at week 4. At week 12, the number of cigarettes smoked was measured again. The decrease in the number of cigarettes considered to be clinically significant for the calculation of sample size was based on expert opinion.

RESULTS

The reduction in the number of cigarettes smoked was 7 cigarettes in the counselling group and 9 cigarettes in Al-Quran recitation group over 12 weeks duration. There was a statistically significant difference in the number of cigarettes smoked between the groups. There was also a statistically significant difference in the change in cravings between the groups at week 4 (p-value = 0.005). However, the difference in the changes in CO levels between the two groups was not statistically significant.

CONCLUSION

Al-Quran recitation produced a statistically significant reduction in the number of cigarettes smoked at week 12 and a significant change in cravings at week 4 among smokers attempting to quit. Difference in smoking abstinence rates was not measured in this study.

Who accompanies patients to the chronic pain clinic?

BACKGROUND

Patients may be accompanied to the pain clinic consultation and these accompanying persons are relevant in the communication process.

AIMS

We sought to characterize if patients were accompanied and by whom to the pain clinic. We also wished to determine the accompanying persons influence on the doctor-patient interaction. This has not been studied previously in this clinical setting.

METHODS

Local ethics committee approval followed by written informed consent was obtained. Patients attending the pain clinic for the first time and review patients were included (n = 219).

RESULTS

Twenty-one percent of patients (n = 46) were accompanied. Adult accompanied by spouse 19 (41.3 %) and adult child accompanied by parent 18 (39.1 %) were the most common dyads. The accompanying person's role was most frequently described by doctors as an advocate for the patient 30/46 (65.2 %) [for an adult accompanied by spouse (63.1 %)]. The influence of the main accompanying person on the patient doctor encounter was described as positive [adult accompanied by spouse (78.9 %)] [(adult accompanied by parent (94.4 %)].

CONCLUSIONS

Patients are accompanied to the pain clinic with a typically positive influence on doctor patient relationship and communication. Awareness of these issues is important in good communication in the pain clinic.

Plant species affect colonization patterns and metabolic activity of associated endophytes during phytoremediation of crude oil-contaminated soil

Plants coupled with endophytic bacteria hold great potential for the remediation of polluted environment. The colonization patterns and activity of inoculated endophytes in rhizosphere and endosphere of host plant are among the primary factors that may influence the phytoremediation process. However, these colonization patterns and metabolic activity of the inoculated endophytes are in turn controlled by none other than the host plant itself. The present study aims to determine such an interaction specifically for plant-endophyte systems remediating crude oil-contaminated soil. A consortium (AP) of two oil-degrading endophytic bacteria (Acinetobacter sp. strain BRSI56 and Pseudomonas aeruginosa strain BRRI54) was inoculated to two grasses, Brachiaria mutica and Leptochloa fusca, vegetated in crude oil-contaminated soil. Colonization patterns and metabolic activity of the endophytes were monitored in the rhizosphere and endosphere of the plants. Bacterial augmentation enhanced plant growth and crude oil degradation. Maximum crude oil degradation (78%) was achieved with B. mutica plants inoculated with AP consortium. This degradation was significantly higher than those treatments, where plants and bacteria were used individually or L. fusca and endophytes were used in combination. Moreover, colonization and metabolic activity of the endophytes were higher in the rhizosphere and endosphere of B. mutica than L. fusca. The plant species affected not only colonization pattern and biofilm formation of the inoculated bacteria in the rhizosphere and endosphere of the host plant but also affected the expression of alkane hydroxylase gene, alkB. Hence, the investigation revealed that plant species can affect colonization patterns and metabolic activity of inoculated endophytic bacteria and ultimately the phytoremediation process.

Knowledge of and attitudes towards of menstrual disorders adults in north-eastern state of Peninsular Malaysia

INTRODUCTION

In Malaysia, the prevalence of menstrual disorders among adolescents and young adults is high. However, most of them are not aware of the signs and symptoms of menstrual disorders in terms of medical issue as well as Islamic ruling. Awareness of the menstrual disorder symptoms is important so that early and appropriate treatment can be given.

OBJECTIVES

The objective of the study was to compare the knowledge and attitude of premarital men and women on menstrual disorders.

METHODS

This was a comparative cross sectional study conducted in Kota Bharu, Kelantan. Selfadministered questionnaires were given for data collection. The questionnaires consisted of 3 parts that required information on the women's and men's socio-demographic data, women's menstrual history and information in knowledge and attitude of men and women on menstrual disorders.

RESULTS

A total of 460 respondents were involved in this study with a response rate of 93.5%. The prevalence of good knowledge was higher among women compared to men with 73.2% and 26.8%, respectively. There was a significant difference on knowledge and attitude on menstrual disorders between premarital men and women.

CONCLUSION

Both premarital men and women had low knowledge on menstrual disorder with men knowing less than the women.

Black tea polyphenols: a mechanistic treatise

Dietary interventions are among the emerging trends to curtail physiological malfunctioning like cancer, diabetes, cardiac complications, etc. The essence of phytonutrients has developed the concept of nutraceuticals at the junction of diet health linkages. In this context, theaflavin & thearubigins are the oxidized derivatives of black tea catechins during fermentation having nutraceutical potential owing to esterification of hydroxyl ring with digallate esters. Theaflavin may influence activation of transcription factors such as NFnB or AP-1 that ultimately hinder the formation of nitric oxide expression gene. Likewise, black tea contains a unique amino acid theanine acts as neurotransmitter owing to its ability to cross the blood-brain barrier. Moreover, it boasts immunity by enhancing the disease-fighting ability of gamma delta T cells. Theaflavin & thearubigins act as safeguard against oxidative stress thereby effective in the cardiac functioning. The mechanistic approach of these antioxidants is likely to be associated with inhibition of redox sensitive transcription factors & pro-oxidant enzymes such as xanthine oxidase or nitric oxide synthase. However, their involvement in antioxidative enzyme induction as in glutathione-S-transferases is also well documented. They act as curative agent against numerous pathological disorders by disrupting the electron chain thus inhibiting the progression of certain ailments. Black tea polyphenols established themselves as strong antioxidants due to their standard one-electron potential, and their vitality is dependent on the concentration of polyphenols and pH for their inclusive execution. Present review is an attempt to enrich the readers regarding the health promoting aspects of black tea polyphenols. Concomitantly, it needs core attention of researchers for the exploitations of black tea flavanols as an important dietary constituent for the vulnerable segment.

Viscometric Behaviour and Micellization of Complexes of Copper (II) Stearate with N-donor Heterocyclic Dyes

Colloido-chemical behavior of copper (II) stearate and N-donor ligands in benzene-methanol mixture of varying composition has been investigated by viscometric measurements. The critical micelle concentration values depend upon the composition of solvent mixture and are to be found in close agreement with each other. The general trend observed is that the viscometric parameters with concentration are quite different and the plots are obtained with curvature at a definite concentration corresponding to critical micelle concentration at which there is marked change in the aggregation of the complex molecules. The results of phenylthiourea and benzothiazole complexes in regards to solute-solvent and solute-solute interactions in mixed solvent systems have been discussed in terms of the equations proposed by Moulik and Jones-Dole. The complexes were synthesized with N-donor ligands and copper (II) stearate and characterized by their elemental analysis, molecular weight, melting point, IR and NMR spectral studies. Due to the surface-active properties of copper stearate, the complexes show remarkable applications in industries and are used as emulsifiers, dispersing agents, foaming and wetting agents. N-donor ability of ligands make them useful as intermediates for many organic compounds such as colorants, agrochemical and pharmaceutical. They are good antiviral, antibacterial and antimalerial agents.

Screening for neonatal hearing loss in the Eastern region of United Arab Emirates

The incidence of sensorineural hearing loss among infants in the neonatal intensive unit (NICU) is higher than in normal infants. This study determined the rate of hearing loss in healthy newborns and in NICU patients before hospital discharge at a single institution in the Eastern region of the United Arab Emirates; 96.5% of all eligible infants were screened. Hearing deficit was diagnosed in 25/13 854 healthy newborns (0.18%; 95% CI: 0.12%-0.27%) and 14/826 infants in the NICU (1.7%; 95% CI: 0.9%-2.8%). Although hearing impairment was significantly more common in those admitted to the NICU (RR = 9.4; 95% CI: 4.9-17.9), healthy newborns accounted for 25 of the 39 cases with hearing loss. The rate of congenital hearing deficit was comparable to international data. Universal screening is recommended since selective screening of high-risk infants missed two-thirds of newborns with hearing loss.

Ochrobactrum ciceri sp. nov., isolated from nodules of Cicer arietinum

A Gram-staining-negative, aerobic, rod-shaped, non-spore-forming bacterial strain, Ca-34(T), was isolated from nodules of chickpea (Cicer arietinum) in Pakistan and studied for its taxonomic affiliation. The almost full-length 16S rRNA gene sequence showed highest similarities to those of strains of the genus Ochrobactrum. Based on results of MALDI-TOF MS and 16S rRNA gene sequence similarity (98.6 %), strain Ca-34(T) and Ochrobactrum intermedium LMG 3301(T) are phylogenetic neighbours; the two strains shared DNA-DNA relatedness of 64 %. The fatty acid profile [predominantly C(18 : 1)omega7c (67.7 %) and C(19 : 0) cyclo omega8c (19.6 %)] also supported the genus affiliation. Metabolically, strain Ca-34(T) differed from other type strains of Ochrobactrum in many reactions and from all type strains in testing positive for gelatin hydrolysis and in testing negative for assimilation of alaninamide and l-threonine. Based on phenotypic and genotypic data, we conclude that strain Ca-34(T) represents a novel species, for which we propose the name Ochrobactrum ciceri sp. nov. (type strain Ca-34(T) =DSM 22292(T) =CCUG 57879(T)).

Prevalence of depression and its associated factors among elderly patients in outpatient clinic of Universiti Sains Malaysia Hospital

Depression among elderly primary care patients is a serious problem with significant morbidity and mortality. This is a cross sectional study to determine the prevalence of depression and its associated factors among the elderly patients attending the outpatient clinic, Universiti Sains Malaysia Hospital. This study utilized Malay version Geriatric Depression Scale 14 (M-GDS 14) to screen for elderly depression among Malaysian population. It also looked into associated risk factors for elderly depression using sociodemographic, family dynamics, and medically related questionnaires. Out of 244 subjects, 34 or 13.9% were found to have depression. Three variables were found to be significantly associated with depression. Elderly patient with any illness that limits the patient's activity or mobility has more risk of developing depression (OR 2.68 CI 1.15 - 6.24). Elderly patients who were satisfied with their personal incomes (OR 0.29 CI 0.10 - 0.85), and who had children or son/daughter-in-law to take care of them when they are sick (OR 0.10 CI 0.01 - 0.83) have a lower chance of having depression. Screening the elderly for depression, would help in diagnosing the elderly depression better and offer them the treatment needed.

Incidence of circulating antinuclear antibodies in cancer patients

The following study was conducted to know the incidence of antinuclear antibody [ANA] in various types of cancers in different age groups of both sexes. Results revealed that an overall level of ANA in female is higher than males. This study also showed that out of 50 only 20 cancer patients had raised level of ANA. Whereas in control group only one was positive for antinuclear antibody. Of these 20 positive cases, 4 were having very high titer of ANA, 13 showed high titer and 3 samples were moderately high titer of ANA. The high prevalence of autoantibodies found in aged cancer subjects could be attributed to several cellular and humoral immunological aberrations, which occur with the aging process. The results of this study confirm the earlier observation of necrosis of tumour tissue could be an important contributing factor for production of autoantibodies.

Costs and cost-effectiveness of different DOT strategies for the treatment of tuberculosis in Pakistan. Directly Observed Treatment

An economic study was conducted alongside a clinical trial at three sites in Pakistan to establish the costs and effectiveness of different strategies for implementing directly observed treatment (DOT) for tuberculosis. Patients were randomly allocated to one of three arms: DOTS with direct observation by health workers (at health centres or by community health workers); DOTS with direct observation by family members; and DOTS without direct observation. The clinical trial found no statistically significant difference in cure rate for the different arms. The economic study collected data on the full range of health service costs and patient costs of the different treatment arms. Data were also disaggregated by gender, rural and urban patients, by treatment site and by economic categories, to investigate the costs of the different strategies, their cost-effectiveness and the impact that they might have on patient compliance with treatment. The study found that direct observation by health centre-based health workers was the least cost-effective of the strategies tested (US dollars 310 per case cured). This is an interesting result, as this is the model recommended by the World Health Organization and International Union against Tuberculosis and Lung Disease. Attending health centres daily during the first 2 months generated high patient costs (direct and in terms of time lost), yet cure rates for this group fell below those of the non-observed group (58%, compared with 62%). One factor suggested by this study is that the high costs of attending may be deterring patients, and in particular, economically active patients who have most to lose from the time taken by direct observation. Without stronger evidence of benefits, it is hard to justify the costs to health services and patients that this type of direct observation imposes. The self-administered group came out as most cost-effective (164 dollars per case cured). The community health worker sub-group achieved the highest cure rates (67%), with a cost per case only slightly higher than the self-administered group (172 dollars per case cured). This approach should be investigated further, along with other approaches to improving patient compliance.

The variation in the orientations and moment arms of the knee extensor and flexor muscle tendons with increasing muscle force: a mathematical analysis

The orientations and moment arms of the knee extensor and flexor muscle tendons are evaluated with increasing values of muscle force during simulated isometric exercises. A four-bar linkage model of the knee in the sagittal plane was used to define the motion of the joint in the unloaded state during 0-120 degrees flexion. The cruciate and collateral ligaments were represented by arrays of elastic fibres, which were recruited sequentially under load or remained buckled when slack. A bi-articular model of the patello-femoral joint was used. Simple straight-line representation was used for the lines of action of the forces transmitted by the model muscle tendons. The effects of tissue deformation with increasing muscle force were considered. During quadriceps contraction resisted by an external flexing load, the maximum change in moment arm of the patellar tendon was found to be 2 per cent at 0 degree flexion when the quadriceps force was increased tenfold, from 250 to 2500 N. The corresponding maximum change in orientation of the tendon was 3 degrees at 120 degrees flexion. During hamstrings contraction resisted by an external extending load, the maximum change in moment arm of the hamstrings tendon was 8 per cent at 60 degrees flexion when the hamstrings force was increased tenfold, from 100 to 1000 N. During gastrocnemious contraction, the corresponding maximum change for the gastrocnemious tendon was 3 per cent at 0 degree. The orientations of the flexor muscle tendons in this range of force either remained constant or changed by 1 degree or less at any flexion angle. The general trend at any flexion angle was that, as the muscle force was increased, the moment arms and the orientations approached nearly constant values, showing asymptotic behaviour. It is concluded that experimental simulations of knee muscle action with low values of the externally applied load, of the order of 50 N, can provide reliable estimates of the relationships between muscle forces and external loads during activity.

Control of knee stability after ACL injury or repair: interaction between hamstrings contraction and tibial translation

OBJECTIVE: The aim of this study was to investigate the interaction between hamstrings contraction and tibial translation during isometric quadriceps contraction (IQC) and their effects on cruciate ligament forces. METHODS: A mathematical model of the knee in the sagittal plane was used with simple geometric representation for the model muscles, ligaments and bones. A mechanical analysis was used to calculate muscle, ligament and contact forces. RESULTS: The results show that isolated IQC requires a posterior force applied to the tibia at the knee over the range 0-85 degrees flexion, usually applied by the anterior cruciate ligament (ACL). The model hamstrings can provide this posterior force, except near extension, resulting in reduced anterior tibial translation (ATT) and, therefore, reduced ACL force. ATT varied inversely with the hamstrings force. The interaction between the two was highly dependent on flexion angle, the hamstrings force being least effective in reducing ATT near extension. CONCLUSIONS: Flexing loads placed distally on the tibia can stretch an injured or repaired ACL. The analysis suggests that modest hamstrings forces during IQC can help protect the ACL. In the complete absence of an ACL, hamstrings contraction as well as ATT may be inevitable while using quadriceps near extension.

Theoretical estimates of cruciate ligament forces: effects of tibial surface geometry and ligament orientations

A mathematical model of the knee in the sagittal plane was used to analyse the effect of tibial surface geometry and ligament orientations on the estimates of cruciate ligament forces. An elementary mechanical analysis was used to calculate the ligament forces L during a simulated antero-posterior (A-P) laxity test (passive test), and during isometric quadriceps contraction (IQE). Three sets of anatomical parameters (sites of bony attachments and lengths of the ligaments) were used from the literature. Flat, concave and convex shapes were considered for the tibial plateau articulating with a compatible convex femoral condyle. Also, the effects of position and posterior tilt of the tibial plateau were analysed for the concave and flat surfaces. The analysis showed that the ligament forces rose steeply as they approached collinearity with the contact force, C. For a flat tibia, the direction of C remained independent of flexion angle or position of the tibial plateau. For the concave tibia, the direction of C varied with flexion as well as with position of the centre of curvature, O, of the tibial plateau. C had an anterior component synergistic with the posterior cruciate ligament (PCL) when the point of contact, F, was anterior to O. On the other hand, C had a posterior component synergistic with the anterior cruciate ligament (ACL) when F was posterior to O. Also, posterior tilt of the flat or concave surfaces resulted in an increase in the anterior component of C. The effects of the convex tibial surface were opposite to those of the concave surface. During the A-P laxity test, the ligament forces arising from the concave tibia were very sensitive to the A-P position of O and to the posterior tilt of the plateau which allowed C and L to approach collinearity. Proximo-distal movement of O had a relatively insignificant effect on the ligament force. Similarly, compared to the concave surface, the posterior tilt of the flat tibia had a lesser effect on the ligament forces. Compared to the passive test, use of the muscle forces during IQE resulted in larger ligament forces, though the trends in force behaviour over the flexion range remained the same. The analysis emphasizes the importance of correct graft placement during ligament reconstruction, and the need to avoid steep inclination (more than 70 degrees to tibial plateau). Increasing the inclination from 70 to 80 degrees doubles the ligament force. Further, the analysis suggests that, in bicompartmental knee replacement, the efficacy of concave surfaces in replacing cruciate ligament function depends critically on the horizontal placement of the tibial component and its orientation about the mediolateral axis.

Benign ovarian cysts--a retrospective evaluation over two years

Histological analysis of 89 "benign" ovarian cysts received over a period of 2-1/2 years (January, 1991 to July, 1993) at the department of Pathology, Fatima Jinnah Medical College, Lahore showed that 44 were neoplastic, 22 dysfunctional, 19 simple and 4 endometriotic. Clinical presentation and gross features could not serve to differentiate these types. Routine histological examination had to be supplemented with ample blocking and deeper sections for a more specific typing. With this procedure the original diagnosis was altered in 11.2% cases, 7 cases originally labelled as "simple cysts", were categorized as dysfunctional (N = 2), neoplastic (N = 1) and endometriotic cysts (N = 3). Similarly in 3 cases the primary diagnosis of endometriotic cysts was altered in favour of dysfunctional (N = 2) and neoplastic (N = 1) cysts. The neoplastic and dysfunctional cysts have different clinical implications. It is proposed that the clinical diagnosis of benign ovarian cyst should be supported by a careful histological evaluation.