The Impact of the COVID-19 Pandemic and Lockdown on Adult Foot and Ankle Fractures Presenting to the Largest Trust in the United Kingdom

Background The COVID-19 pandemic induced unprecedented changes in medical practices, prompting a reassessment of their impact on adult foot and ankle fractures within the National Health Service (NHS). This study employs a retrospective observational approach, leveraging the Pathpoint™ eTrauma platform for a comprehensive analysis of prospectively collected data. Methods Data encompassing weekly fracture incidence, weekly surgical procedures, patient demographics, and mean wait time from injury presentation to surgery were systematically evaluated. The study population included all adults (18+) admitted during five distinct periods: pre-pandemic, national lockdown 1, post-lockdown, national lockdown 2, and national lockdown 3. Results An analysis of 434 foot and ankle fractures revealed that national lockdown 1 exhibited the lowest fracture incidence (4.97 per week) and surgeries performed (4.77 per week), reflecting a notable reduction in trauma cases and elective procedures. Conversely, post-lockdown displayed the highest fracture incidence (7.46 per week) and surgeries performed (6.31 per week), suggesting a resurgence in both trauma and elective surgical activities. The pre-pandemic cohort, characterized by the highest mean age (51.98 years) and mean wait time (8.74 days), served as a temporal baseline. Conclusion While the incidence of fractures decreased during all three national lockdowns compared to pre-pandemic or post-lockdown periods, a gradual increase was observed in subsequent lockdowns. Notably, mean wait times showed a significant reduction, reaching the lowest point (5.79 days) during national lockdown 3. These findings underscore the complex interplay between pandemic-related disruptions, evolving guidelines, and adaptive measures within the healthcare system, influencing the dynamics of foot and ankle fracture management.

The Impact of COVID-19 on the Neck of Femur Fracture Service in a Tertiary Care Hospital in the United Kingdom

Introduction The emergence of the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in late 2019 ushered in a global crisis that profoundly impacted healthcare systems worldwide. In the United Kingdom, COVID-19 resulted in a significant toll on public health and the National Health Service (NHS). As the virus surged, the NHS faced unprecedented challenges, including surges in COVID-19 cases, a dire need for medical equipment, and a strain on intensive care units. Simultaneously, stringent nationwide lockdowns were imposed to curb the virus's spread, disrupting daily life and healthcare access. Amid this crisis, the interactions between COVID-19 and other prevalent health conditions came to the forefront of medical research, sparking interest in understanding their connections. This study delves into the intriguing interplay between COVID-19 and neck of femur (NoF) fractures, exploring shared risk factors, resource implications, and potential alterations in patient pathways. Given the severity of both conditions and their impact on the vulnerable elderly population, elucidating these connections is crucial for comprehensive patient care and resource allocation within the healthcare system. Methods This study used data from the National Hip Fracture Audit (NHFA) database, focusing on NoF fracture patients at Wythenshawe Hospital. We examined two cohorts: pre-pandemic (from March 2019 to March 2020) and pandemic (from March 2020 to March 2021). We compared key parameters and incorporated COVID-19 data. Graphs showed trends and cohort similarities. We also analyzed demographic data (age, gender, fracture type, times, COVID-19 status, and mortality), removing outliers for accuracy. Results The data revealed that while certain factors such as patient age and mobilization remained largely unaffected, there was a modest association between COVID-19 incidence and NoF fracture patients. Notably, regional lockdown measures had a substantial impact on patient care. The initial lockdown effectively reduced COVID-19-positive cases upon admission but led to prolonged intervals and surgical delays. However, the second lockdown showed improvements, attributed to lessons learned, increased resource allocation, and better familiarity with hospital-specific lockdown measures. This research sheds light on the intricate relationship between a global pandemic and orthopedic patient care, highlighting the importance of adapting healthcare systems to evolving challenges. Conclusion This study explores the impact of COVID-19 on neck of femur (NoF) fracture patients, highlighting key findings from Wythenshawe Hospital. It uncovers a dynamic relationship between the pandemic and patient care, with increased COVID-19 cases coinciding with reduced NoF fracture rates. Lockdowns influenced outcomes, with the first causing delays and higher post-discharge mortality, while the second improved efficiency and safety. These insights extend beyond Wythenshawe Hospital, offering implications for healthcare practices in the United Kingdom and beyond, especially in countries with limited vaccination resources. This research underscores the need for tailored strategies to optimize NoF fracture patient outcomes during pandemics and lockdowns.

TU8.6 Pharmacological management of post-operative pain following appendicectomy: a meta-analysis

Introduction

Appendicectomy is an increasingly common procedure internationally, and is the most frequent emergency surgery performed in the UK. Post-operative pain is common after surgery, if poorly controlled it can cause many negative outcomes for patients. Despite the large number of patients that undergo appendicectomy and the potentially severe outcomes of post-operative pain, there is no clear guidance on how best to control pain following appendicectomy. The aim of this meta-analysis is to compare the efficacy of different modalities of analgesics following appendicectomy, to identify which is best at controlling post-operative pain

Methods

A literature search was conducted across online libraries for trials assessing pain scores after appendicectomy with different analgesics administered. These were grouped based off modality. Using the data in these trials a forest plot was created for each modality with an effect estimate and confidence intervals calculated for each trial

Results

6 studies investigated nerve-blocks; an estimated effect of -1.01 with CIs of -1.39 to -0.4 was calculated. 3 studies investigated NSAIDs; an estimated effect of -0.46 with CIs of -0.70 to -0.23 was calculated. 3 studies investigated local anaesthetics; an estimated effect of -0.83 with CIs of -1.91 to 0.26 was calculated. 1 study investigated opiates with an estimated effect of -0.82 with CIs of -1.47 to -0.17 was calculated

Conclusion

Nerve-blocks were the most effective modality of analgesic followed by NSAIDs. No clinically significant effect was proved for local anaesthetics as the CIs crossed the null hypothesis. Opiates were not compared due to insufficient data

Cost-Utility Analysis of Oxybutynin vs. OnabotulinumtoxinA (Botox) in the Treatment of Overactive Bladder Syndrome

Background: The UK National Health Service (NHS) propose the use of oxybutynin prior to onabotulinumtoxinA (Botox) in the management of overactive bladder syndrome (OAB). Oxybutynin is costly and associated with poor adherence, which may not occur with Botox. We conducted a cost-utility analysis (CUA) to compare the medications. Methods: we compared the two treatments in quality-adjusted life years (QALYS), through the NHS’s perspective. Costs were obtained from UK-based sources and were discounted. Total costs were determined by adding the treatment cost and management cost for complications on each branch. A 12-month time frame was used to model the data into a decision tree. Results: Our results found that using Botox first-line had greater cost utility than oxybutynin. The health net benefit calculation showed an increase in 0.22 QALYs when Botox was used first-line. Botox also had greater cost-effectiveness, with the exception of pediatric patients with an ICER of £42,272.14, which is above the NICE threshold of £30,000. Conclusion: Botox was found to be more cost-effective than antimuscarinics in the management of OAB in adults, however less cost-effective in younger patients. This predicates the need for further research to ascertain the age at which Botox becomes cost-effective in the management of OAB.

The Identification and Referral to Improve Safety Programme and the Prevention of Intimate Partner Violence

Introduction: Intimate Partner Violence (IPV) is a global epidemic which 30% of women experience world-wide. Domestic violence has serious health consequences, with an estimated cost of 1.7 billion annually to the NHS. However, healthcare professionals remain uncertain on how to manage IPV. In 2007, the Identification and Referral to Improve Safety (IRIS) was introduced within primary care to address this shortcoming. The aim of this project is to analyse the impact of IRIS, whilst discussing the extension into secondary care. Materials and Methods: A literature review was conducted using PubMed, Cochrane Library and Google scholar. The official IRIS publication list for randomized controlled trial data. Results: General practices with IRIS displayed a threefold increase in the identification of IPV and sevenfold increase in referrals. IRIS is cost-effective and under the NICE threshold of £20,000 per quality-adjusted life year gained. Additionally, a systematic review illustrated that one in six women presenting to the fracture clinic experienced IPV within the last year. Conclusions: The implementation of IRIS into general practice proved to be cost-effective. Orthopaedic fracture clinics are at the forefront of dealing with IPV, and therefore an adapted IRIS programme within this setting has potential in the prevention of IPV.

The Medical Benefits of Vitamin K2 on Calcium-Related Disorders

BACKGROUND

Due to the potentially crucial role of vitamin K2 in calcium metabolism, a deficit can disrupt many mechanisms, resulting in an array of different issues, such as broken bones, stiff arteries and poor fertility. Although there has been existing research, the potential of vitamin K2 as a treatment for conditions including cerebral palsy, parathyroid disease, heart disease and gastrointestinal disease is unknown. This review discusses the biochemistry of vitamin K and the metabolism of calcium, followed by an analysis of the current literature available on vitamin K2 and its prospects.

METHODS

Using public libraries including PubMed and Wiley, we searched for existing research on the metabolism and use of vitamin K2 that has been conducted in the preceding two decades.

RESULTS

Data indicated that vitamin K2 had a positive impact on osteoporosis, cardiovascular disease, parathyroid disorders, cerebral palsy and sperm motility.

CONCLUSION

Due to the existence of confounding variables and limitations in the quality and volume of research conducted, further investigation must be done to see whether the beneficial effects seen are reproducible and must assess the viability of vitamin K2 as treatment in isolation for these conditions.

Scientific trends on research on denture stomatitis based on Scopus database: A bibliometric analysis

Background

Denture stomatitis is a clinical condition that affects people who wear removable maxillary dentures. It causes redness, soreness, and erythema and ultimately affects the general condition of the patient. The objective of this study was to analyze the leading countries, journals, organizations, and authors and the frequently used keywords associated with denture stomatitis.

Material and Methods

A bibliometric analysis of publications indexed in the Scopus database was conducted, and the article titles, abstracts, and keywords were analyzed using the VOSviewer software. Denture stomatitis-related publications from 1960 to 2021 were collected. This study included only research papers published in English with "article" as the paper type and dentistry as the subject area.

Results

Data from a total of 461 articles and 10 different journals were obtained. The papers were published in 64 different countries. Brazil and the United States of America were the top contributing countries, and the University of Sydney was the leading organization. Papers published in the Journal of Oral Rehabilitation received the highest number of citations, while author Gordon Ramage from the University of Glasgow received the highest number of citations.

Conclusions

The bibliometric analysis revealed that the number of denture stomatitis-related publications indexed in the Scopus database is increasing globally. Since 2007, there has been an increase in research interest regarding denture stomatitis, with more publications from several countries expected to be published in different journals. Key words:Bibliometric analysis, denture, candida, VOSviewer, maxilla.

Prevalence of stroke above forty years

Number of elderly persons gradually increased in Bangladesh due to improved health awareness and health care. Age is the single most important risk factor for stroke. This study aims at finding the prevalence of stroke in a Bangladeshi population aged forty years and above. The cases of stroke were ascertained in two phases of door-to-door survey. In phase-I, trained interviewers performed face-to-face interview with subjects for the detection stroke cases using the World Health Organization (WHO) screening protocol for neurological diseases. In phase-II, subjects suspected to have a stroke underwent a clinical evaluation for diagnosis or exclusion of stroke by a neurological team. The study involved 15627 participants aged 40 years and above. A total of 47 participants found to have stroke, expressing an overall prevalence rate of 3.00 per 1000 (95% CI 0.95 to 2.45). Prevalence of stroke were 2.0, 3.0, 2.0, 10.0, and 10.0 per 1000 within age groups of 40-49 years, 50-59 years, 60-69 years, 70-79 years and 80 years and above age group respectively. Prevalence of stroke in people with age range 70-79 years compared to 40-49 years age range is 4.988 (95% CI 2.309 to 10.77) times and people with age range ≥80 years compared to 40-49 years age range is 4.798 (95% CI 1.597 to14.416) times. Prevalence was higher among men in comparison with women. The male: female ratio is 3.44:2.41 per 1000 respectively. Bangladeshi male populations in rural areas are found to have stroke more than urban people. A large community based study should be undertaken to further confirm the result of this present study.

Workplace-related burns

Introduction. The key element of a safe workplace for employees is the maintenance of fire safety. Thermal, chemical, and electrical burns are common types of burns at the workplace. This study assessed the epidemiology of work-related burn injuries on the basis of the workers treated in a regional burn centre. Methods. Two years' retrospective data (2005-2006) from the Trauma Registry of the American College of Surgeons of the Joseph M. Still Burn Center at Doctors Hospital in Augusta, Georgia, were collected and analysed. Results. During the time period studied, 2510 adult patients with acute burns were admitted; 384 cases (15%) were work-related. The average age of the patients was 37 yr (range, 15-72 yr). Males constituted the majority (90%) of workrelated burn injury admissions. The racial distribution was in accordance with the Centre's admission census. Industrial plant explosions accounted for the highest number of work-related burns and, relatively, a significant number of patients had chemical burns. The average length of hospital stay was 5.54 days. Only three patients did not have health insurance and four patients (1%) died. Conclusion. Burn injuries at the workplace predominantly occur among young male workers, and the study has shown that chemical burns are relatively frequent. This study functions as the basis for the evaluation of work-related burns and identification of the causes of these injuries to formulate adequate safety measures, especially for young, male employees working with chemicals.

Epilepsy and abnormal electroencephalogram in children with autism spectrum disorder

Epilepsy occurs in 30 to 40% of individuals with autism spectrum disorder (ASD). However the association of epilepsy or abnormal electroencephalogram is not known in our population. This study addresses the incidence of epilepsy and or abnormal electroencephalogram in Bangladeshi children with autism spectrum disorder. The clinical history and electroencephalogram of 18 children diagnosed with autism spectrum disorder were retrospectively reviewed. Forty four percent were diagnosed with epilepsy or abnormal electroencephalogram. This abnormal electroencephalogram or epilepsy occurred at significantly higher rates in children with more impaired range of autism spectrum disorder. These finding suggest that the use of neurological investigative technique such as electroencephalogram (EEG) should be considered routinely in children with autism spectrum disorder especially in more impaired individuals.

Burn Functional Outcomes - Ventilator Usage and Discharge Ambulation Status of Patients in a Burn Wound in-Patient Centre

Anticipating functional outcomes of patients managed in an in-patient burn wound centre can help in advising patients and their families of prognosis as well as assist case managers in discharge planning. The records of 37 burn patients were reviewed; one patient expired and was removed from further analysis. Data were obtained regarding patient characteristics, types and locations of burns and other wounds, ventilator use, level of mobility at hospital discharge, and disposition; three patients lacked discharge ambulation status and were removed from the outcome comparison analysis. Of the 36 patients, 17 had thermal burns and nine (25%) had associated inhalation injuries. Thermal burn patients (p = 0.02), patients requiring ventilator support during their hospital stay (p = 0.04), and those with inhalation injuries (p = 0.04) were less likely to be ambulating independently or with assistance at discharge from the burn wound centre than other patients. This preliminary study suggests that patients with thermal burns and inhalation injuries and those requiring ventilator support were less likely to be ambulatory at hospital discharge. Further studies appear indicated.

Association of lipid profile with ischemic stroke

This study is an observational case control study conducted in the Neurology department of Dhaka Medical college Hospital (DMCH) to see the relation of ischemic stroke with different components of serum lipids. Cases and controls were selected following certain inclusion and exclusion criteria. Result showed that ischemic stroke was more common after the age of 50 years with mean age of 63.58+/-10.22 years. Male suffered more than female from ischemic stroke (M:F=2.57:1). 80% of the stroke patients belong to middle class economic condition who avail free services of Govt. hospitals. Hypertension and diabetes mellitus (DM) were found to be significant risk factors for ischemic stroke (P<0.01 and P<0.05 respectively). High level of serum total cholesterol and low density lipoprotein (LDL) cholesterol showed significant risk in ischemic stroke (p<0.05). In contrast, low level of high density lipoprotein (HDL) cholesterol appeared as a significant risk factor (p<0.01) indicating beneficial effect of HDL cholesterol on atherosclerotic process. Serum triglyceride level showed no significant effect on ischemic stroke (p>0.05).

Carpal tunnel syndrome following burns

The commonest cause of carpal tunnel syndrome (CTS) is a congenital predisposition - the carpal tunnel is simply narrower in some people than in others. The development of CTS due to various burn causes has never been reported. This study describes some demographic features of all reported CTS cases following different types of burn in patients admitted to our burns centre in the USA. A retrospective case study was carried out to identify CTS following different types of burns among the patients admitted between January 2001 and January 2006. A descriptive data analysis was carried out to observe CTS following hand burns. There were 36 CTS cases in 28 patients presenting various kinds of burns in the upper extremities. The mean age of the CTS patients was 52 years (SD, 10.51 yr) and 79% were male. Of these, 57% had sustained thermal burns, 32% electrical burns, and the remainder had scalds or chemical burns. More patients (56%) had second-degree burns than third-degree burns and all but one of the patients with electrical burns had second-degree burns. This observation demonstrates that there were a considerable number of CTS cases following thermal burn injury compared to previous reporting. This study also suggests the need of a prospective study to examine the association between burns in the upper extremities and the likelihood of their progression to CTS and whether any specific type of burn is more likely to result in CTS.

Radioactivity in building materials used in and around Dhaka city

The activity levels of (226)Ra, (232)Th and (40)K were determined using gamma-ray spectroscopy in different commercial brands of cement, sand and hollow concrete bricks, which were collected from the building material suppliers of Dhaka City. The activity concentrations in the samples were found to be somewhat higher than in other countries. An effort has been made to assess the radiation hazard associated with these materials by determining the gamma activity concentration index I. It was found that the value of I for all the samples was <or=2, which indicates that the gamma dose contribution was not more than 0.3 mSv y(-1). The samples considered were safe for use in the construction of urban dwellings in Bangladesh and do not pose any significant source of radiation hazard.