Perspectives and practices of dietitians with regards to social/mass media use during the transitions from face-to-face to telenutrition in the time of COVID-19: A cross-sectional survey in 10 Arab countries

During the COVID-19 pandemic, most healthcare professionals switched from face-to-face clinical encounters to telehealth. This study sought to investigate the dietitians' perceptions and practices toward the use of social/mass media platforms amid the transition from face-to-face to telenutrition in the time of COVID-19. This cross-sectional study involving a convenient sample of 2,542 dietitians (mean age = 31.7 ± 9.5; females: 88.2%) was launched in 10 Arab countries between November 2020 and January 2021. Data were collected using an online self-administrated questionnaire. Study findings showed that dietitians' reliance on telenutrition increased by 11% during the pandemic, p = 0.001. Furthermore, 63.0% of them reported adopting telenutrition to cover consultation activities. Instagram was the platform that was most frequently used by 51.7% of dietitians. Dietitians shouldered new difficulties in dispelling nutrition myths during the pandemic (58.2% reported doing so vs. 51.4% pre-pandemic, p < 0.001). Compared to the pre-pandemic period, more dietitians perceived the importance of adopting tele nutrition's clinical and non-clinical services (86.9% vs. 68.0%, p = 0.001), with 76.6% being confident in this practice. In addition, 90.0% of the participants received no support from their work facilities for social media usage. Following the COVID-19 outbreak, the majority of dietitians (80.0%) observed a rise in public interest in nutrition-related topics, particularly those pertaining to healthy eating habits (p = 0.001), healthy recipes (p = 0.001), nutrition and immunity (p = 0.001), and medical nutrition therapies (p = 0.012). Time constraint was the most prevalent barrier to offering telenutrition for nutrition care (32.1%), whereas leveraging a quick and easy information exchange was the most rewarding benefit for 69.3% of the dietitians. In conclusion, to ensure a consistent provision of nutrition care delivery during the COVID-19 pandemic, dietitians working in Arab countries adopted alternative telenutrition approaches through social/mass media.

Outcomes Following the Use of Subtalar Arthroereisis in the Correction of Adult Acquired Flatfoot: A Systematic Review

BACKGROUND

Adult acquired flatfoot deformity (AAFD) is a condition affecting approximately 3% of the adult population. It can lead to severe morbidity, and therefore, prompt treatment is of the upmost importance in maintaining and restoring function. Recently, the use of subtalar arthroereisis has become more widespread in the treatment of AAFD. The purpose of this systematic review is to examine the clinical and radiological outcomes of AAFD when treated with subtalar arthroereisis.

METHODS

Studies involving the use of subtalar arthroereisis for the management of AAFD were reviewed, and appropriate studies selected based on inclusion and exclusion criteria. Studies were reviewed for both clinical and radiological outcomes following the use of subtalar arthroereisis as well as reported complications.

RESULTS

Nine studies met our inclusion criteria, with most of these involving stage II AAFD. A total of 190 subtalar arthroereisis procedures were performed with all studies demonstrating improvement in both clinical and radiological scores with a low rate of complications.

CONCLUSION

Subtalar arthroereisis may have benefits when used as an adjunct to treat stage II AAFD. However, more high-quality studies are needed to establish its best use.

LEVELS OF EVIDENCE

Level IV: Systematic review.

Bilateral anterior superior iliac spine apophysis avulsion fractures in a skeletally mature patient: case report and literature review

We present a case of bilateral anterior superior iliac spine avulsion fractures in an adult patient who was involved in a road traffic collision. Her injuries were managed conservatively and she has had an uncomplicated recovery with a good outcome. This is, to our knowledge, the only reported case of bilateral simultaneous anterior superior iliac spine apophyseal avulsion fractures in an adult.

Freiberg’s Disease of Bilateral and Adjacent Metatarsals

Freiberg’s disease is a rare condition characterized by avascular necrosis of the lesser metatarsal heads. The incidence is highest in females, and the disease is usually unilateral, affecting just a single metatarsal. In this report, we describe the first male case of Freiberg’s disease involving the second and third metatarsals in both feet, with the aim of highlighting the condition as a potential cause of such forefoot pain. One year of follow-up is provided.

Diagnosis of glenoid labral tears using 3-tesla MRI vs. 3-tesla MRA: a systematic review and meta-analysis

BACKGROUND

Various protocols exist for magnetic resonance arthrogram (MRA) of the shoulder, including 3D isotropic scanning and positioning in neutral (2D neutral MRA), or abduction-external-rotation (ABER).

HYPOTHESIS

MRA does not improve diagnostic accuracy for labral tears when compared to magnetic resonance imaging (MRI) performed using 3-Tesla (3T) magnets.

METHOD

Systematic review of the Cochrane, MEDLINE, and PubMed databases according to PRISMA guidelines. Included studies compared 3T MRI or 3T MRA (index tests) to arthroscopic findings (reference test). Methodological appraisal performed using QUADAS-2. Pooled sensitivity and specificity were calculated.

RESULTS

Ten studies including 929 patients were included. Index test bias and applicability were a concern in the majority of studies. The use of arthroscopy as the reference test raised concern of verification bias in all studies. For anterior labral lesions, 3T MRI was less sensitive (0.83 vs. 0.87 p = 0.083) than 3T 2D neutral MRA. Compared to 3T 2D neutral MRA, both 3T 3D Isotropic MRA and 3T ABER MRA significantly improved sensitivity (0.87 vs. 0.95 vs. 0.94). For SLAP lesions, 3T 2D neutral MRA was of similar sensitivity to 3T MRI (0.84 vs. 0.83, p = 0.575), but less specific (0.99 vs. 0.92 p < 0.0001). For posterior labral lesions, 3T 2D neutral MRA had greater sensitivity than 3T 3D Isotropic MRA and 3T MRI (0.90 vs. 0.83 vs. 0.83).

CONCLUSIONS

At 3-T, MRA improved sensitivity for diagnosis of anterior and posterior labral lesions, but reduced specificity in diagnosis of SLAP tears. 3T MRA with ABER positioning further improved sensitivity in diagnosis of anterior labral tears.

LEVEL OF EVIDENCE

IV.

Does a daily consultant ward round affect the outcomes of orthopaedic patients?

INTRODUCTION

In the UK, more than 60 000 patients present with a fractured neck of femur each year. These patients represent a huge financial cost. This study looks at the 30-day readmissions and total length of hospital stay of patients presenting with a fractured neck of femur, as well as length of stay in non-hip fracture trauma patients, following the change to a daily consultant-led ward round.

METHODS

A total of 200 records of patients with fractured neck of femur were reviewed with data collected retrospectively and prospectively following the introduction of the daily consultant-led ward round. Readmissions were classed as patients who spent a period of time admitted to hospital. Those who only attended an emergency unit were not included. Reasons for readmission and length of readmission were reviewed as were the initial and total length of stay. The authors also evaluated the length of stay in trauma patients (non-hip fracture emergency admissions) for a period of 6 months before and 4 months after the new working model was introduced.

RESULTS

With the new working pattern, there was a reduction in the length of stay in those readmitted (13 vs 8 days), and the total length of stay of readmitted patients was also considerably lower (23 vs 13 days). In non-hip fracture trauma patients, there was a reduction in length of stay (8 vs 6 days).

CONCLUSIONS

This study demonstrates that by adopting a daily orthopaedic consultant-led ward round, it is possible to reduce the length of stay for patients with a fractured neck of femur, both on initial and subsequent hospital admissions, as well reducing the length of stay for non-hip fracture trauma patients.

Diagnosis of rotator cuff tears using 3-Tesla MRI versus 3-Tesla MRA: a systematic review and meta-analysis

OBJECTIVE

To compare the diagnostic accuracy of magnetic resonance imaging (MRI), 2-dimensional magnetic resonance arthrogram (MRA) and 3-dimensional isotropic MRA in the diagnosis of rotator cuff tears when performed exclusively at 3-T.

MATERIALS AND METHODS

A systematic review was undertaken of the Cochrane, MEDLINE and PubMed databases in accordance with the PRISMA guidelines. Studies comparing 3-T MRI or 3-T MRA (index tests) to arthroscopic surgical findings (reference test) were included. Methodological appraisal was performed using QUADAS 2. Pooled sensitivity and specificity were calculated and summary receiver-operating curves generated. Kappa coefficients quantified inter-observer reliability.

RESULTS

Fourteen studies comprising 1332 patients were identified for inclusion. Twelve studies were retrospective and there were concerns regarding index test bias and applicability in nine and six studies respectively. Reference test bias was a concern in all studies. Both 3-T MRI and 3-T MRA showed similar excellent diagnostic accuracy for full-thickness supraspinatus tears. Concerning partial-thickness supraspinatus tears, 3-T 2D MRA was significantly more sensitive (86.6 vs. 80.5 %, p = 0.014) but significantly less specific (95.2 vs. 100 %, p < 0.001). There was a trend towards greater accuracy in the diagnosis of subscapularis tears with 3-T MRA. Three-Tesla 3D isotropic MRA showed similar accuracy to 3-T conventional 2D MRA.

CONCLUSION

Three-Tesla MRI appeared equivalent to 3-T MRA in the diagnosis of full- and partial-thickness tears, although there was a trend towards greater accuracy in the diagnosis of subscapularis tears with 3-T MRA. Three-Tesla 3D isotropic MRA appears equivalent to 3-T 2D MRA for all types of tears.

An alternative method of fixation of calcaneal tuberosity fractures using the Tightrope(®) technique

Calcaneal tuberosity fractures account for 1% to 3% of all calcaneal fractures. These fractures are frequently seen in the osteoporotic or diabetic elderly population. The patient's comorbidities, coupled with the usually osteoporotic bone, make fixing this fracture pattern a challenge. Numerous surgical techniques have been advocated for this fracture, including the standard lag screw fixation, tension band wiring, suture anchors, and direct suture repair. Whichever method is used, the construct must resist the massive pull of the gastrocnemius-soleus complex. We have described a method of fixing the avulsed calcaneal tuberosity using the TightRope(®) ankle syndesmosis fixation device (Arthrex(®), Naples, FL), which offers the advantages of allowing a robust and reliable fixation of a small or comminuted fragment. It is particularly advantageous in osteoporotic bone because of concern regarding the use of standard lag screw fixation, and it also may eliminate complications associated with retained hardware.

Chemical Burns and Multiorgan Failure following Acute Ingestion of White Spirit: A Case Report and Review of the Literature

Organic solvents are chemically different compounds with one common feature: they dissolve fats, oils and resins, which makes them widely used in industry. Organic solvents are used in paint and lacquer industries, in the production of pesticides, plastics, explosives and in the pharmaceutical industry. The most common household solvent is white spirit, used as a paint remover. We report a case of acute white spirit ingestion causing multiorgan failure and a prolonged intensive care unit admission. Such a case has not been documented previously and highlights a number of diagnostic and therapeutic considerations. The patient also represents the first reported case of chemical burns from erosive diarrhoea secondary to white spirit ingestion.

Trigger finger presenting secondary to leiomyoma: a case report

INTRODUCTION

WE PRESENT A PREVIOUSLY UNDESCRIBED ENTITY: trigger finger secondary to a leiomyoma. This is the first time such a case has been reported and highlights the fact that common conditions can sometimes present secondary to rare diseases.

CASE PRESENTATION

A 39-year-old Caucasian man presented with a fairly typical presentation of trigger finger. During surgical treatment, the lesion was excised and sent for histology, which showed tissue consistent with a leiomyoma. The patient made an uneventful recovery.

CONCLUSION

Trigger finger is a common condition that is usually easily diagnosed and managed. However, it is important to appreciate that uncommon conditions, such as leiomyoma, can present with what is sometimes considered trivial disease, and one should always consider the differential diagnoses even when faced with relatively benign conditions.

Bilateral congenital absence of internal iliac arteries, prominent lumbar arteries, and a ruptured mycotic aneurysm of the abdominal aorta

A 46-year-old man was admitted for surgery on a ruptured mycotic abdominal aortic aneurysm. Emergency repair was performed, during which certain anomalies were noted. First, the bifurcation of the aorta was posterior to the left common iliac vein. Second there were no internal iliac arteries. Also, there were prominent lumbar arteries compensating for the absent internal iliac arteries bilaterally. This, we consider, is the first reported case of congenitally absent bilateral internal iliac arteries.

Differential dependence of eosinophil chemotactic responses on phosphoinositide 3-kinase (PI3K)

BACKGROUND

Control of eosinophil migration to sites of inflammatory responses is a potentially therapeutic intervention in diseases such as bronchial asthma. Chemoattractants, their receptors and the associated signalling pathways may, therefore, be important targets for novel therapeutics. While several potentially important chemoattractants have been identified, the signalling pathways mediating their actions are incompletely understood.

AIMS OF THE STUDY

The role of phosphoinositide 3-kinase (PI3K) in responses of human eosinophils to two important eosinophil chemoattractants -- platelet-activating factor (PAF) and eotaxin (CCL11) -- was studied to determine whether this enzyme activity might be crucial for eosinophil migration.

METHODS

Eosinophils were isolated from atopic donor blood by immunomagnetic selection. Chemotaxis was assayed in a 96-well blind-chamber cell fluorescence assay. Respiratory burst and leukotriene C(4) secretion were also assayed.

RESULTS

Two PI3K inhibitors, wortmannin and LY294002, caused concentration-dependent inhibition of PAF-induced eosinophil chemotaxis (IC(50) = 0.54 nM and 0.15 microM, respectively) but exhibited at least 100-fold lower potency against eotaxin-induced responses (IC(50) = 48 nM and >100 microM, respectively), indicating that these responses were not dependent upon PI3K. Wortmannin and LY294002 also inhibited PAF induced respiratory burst but not PAF-induced LTC(4) secretion.

CONCLUSIONS

We conclude that PI3K-dependence varies with stimulus and response, and that eotaxin-induced eosinophil migration is not controlled by PI3K. This may indicate a limit to the potential of PI3K inhibitors to suppress tissue eosinophilia in diseases such as asthma.

Genetic marker variation in coastal populations of Chile

Gene frequencies for nine genetic marker systems are presented for the following Chilean coastal populations: Paposo, Carelmapu, Laitec and Ukika. Historical and anthropological data suggest the presence of descendants of the Amerindian populations, specifically of Changos, Cuncos, Chonos and Yamanas in these populations. Results indicate that the studied groups maintain an important aboriginal genetic composition. According to Amerindian admixture estimates, the genetic isolation of coastal populations is lower than that of inland populations, suggesting that proximity to the sea facilitated gene flow. Genetic distances and dendrograms were obtained for these populations and another four Chilean Indian populations. Results agree with expectations, taking geographic isolation and non-aboriginal admixture into account.

[Coastal Chilean populations: genetic markers in four locations]

BACKGROUND

Historical and anthropological data suggest the presence of descendents of Changos, Cuncos, Chonos and Yamanas, South American indian populations, in certain Chilean coastal villages.

AIM

To assess the degree of South American indian admixture in Chilean coastal villages using protein markers, to complete the assessment of human biological diversity in Chile.

SUBJECTS AND METHODS

ABO, Rh, MNS, Duffy and Kidd blood group systems were assessed in 47, 48, 55 and 24 individuals from Paposo, Carelmapu, Laitec and Ukika respectively. Phenotypic and gene frequencies were calculated. The degree of South American indian admixture was estimated from the ABO*O allele and Rh*dce haplotypes.

RESULTS

High frequencies of ABO*O, Fy*a, Jk*b alleles, Dce and Ms haplotypes were found in all villages, consistent with the pattern expected for South American Aboriginal populations. The highest presence of South American indian admixture was present in Laitec with 80% and in Ukika with 74%. The figures for Paposo and Carelmapu were 60 and 65% respectively.

CONCLUSIONS

According to South American indian admixture estimates, the genetic isolation of coastal populations is lower than that of inland subjects, suggesting that sea proximity facilitates gene flow.

[Genetic composition of the Chilean population: the Yamanas from Ukika]

The genetic composition of a group of 24 Yamana indians that survive in Puerto Williams, Navarino Island, Chile (parallel 55 south of Tierra del Fuego), was studied. Results showed that these indians have a different genetic composition than Pehuenche indians, specially for HLA system and esterase D. This fact validates the hypothesis, based on archeological and anthropological evidence, about the paleoindian origin of Yamanas.

[Genetic composition of Chilean population: the Pehuenches from Trapa-Trapa]

This study describes the genetic composition of Pehuenche indians from Trapa-Trapa. The admixture analysis revealed that this group has conserved most of its pre-Columbian gene pool and therefore, is representative of the indians that lived in Southern Chile before the Spanish conquest. A relatively high frequency of a esterase D variant seems to indicate that this is a Chilean aboriginal population marker. The Chilean Pehuenches are genetically similar to their Argentinean relatives, which is not surprising since this last group crossed the Andes Mountains in historic times.

Association between Rh and plasma iron binding (transferrin)

In order to establish the mechanism involved in the maintenance of the Rh polymorphism and fetomaternal compatibility relationships, we examined a sample of children from the North Area of Santiago (Chile), with respect to their growth and development patterns since 1973. This sample had shown large sib-sib segregation distortions for the Rh system. Metric variables, such as plasma protein fractions and iron, academic performance at the end of the last secondary grade and adult stature, were studied in relation to genetic markers, viz., sex, ABO, Xg, MN, Rh, haptoglobins, phosphoglucomutase, and esterase D, by means of unbalanced one way analyses of variance. Highly significant results were found for Rh phenotypes and total iron binding capacity (TIBC, transferrin). However, plasma iron did not differ significantly among Ph phenotypes. Children with the C (Rh) specificity had higher values of TIBC than non-C or c individuals (P less than 0.00001). Evolutionary considerations regarding iron transport and erythroblastosis, relationships between Rh and the transferrin receptor at the plasma membrane, and the location of the Blym-I oncogene (that shares common sequences with transferrins) close to Rh in chromosome 1 are discussed. Less significant results were found between phosphoglucomutase and stature, gamma globulin level and sex, and academic performance (history) and sex.

A mother-child segregation distortion for the Rh system. New evidence for another compatibility system associated with Rh

In the maternity service of a private hospital in Santiago, Chile, 6,974 mother-infant pairs typed for the D-d alleles of the Rh system were collected. In our analysis, all the paris attended from October 1974 to December 1975 and from January 1977 to September 1979 were used. The segregation analysis, made by means of the T mother-child matrix, assuming Hardy-Weinberg equilibrium, reveals that: Rh(-) mothers have a higher rate of admission than do Rh(+) mothers; Rh(+) mothers produce fewer Rh(-) infants than expected; and, with less significance, Rh(-) mothers produce more Rh(+) infants than expected. This leads to a reduction in the proportion of dd individuals from mothers to their children. Ethnic subdivisions of the sample, the period considered, and the extension of the antiisoimmunization therapy do not seem to affect the general pattern of the distortion. The only plausible hypothesis to explain this finding is that selection is not related to the known Rh antigenic specificities. The reduction of the proportion of dd individuals in 1 generation leads us to review models on Rh polymorphism. It seems clear that no classical compensation is possible and d must disappear unless another mechanism maintains it in populations.

A large phenotypic sib-sib discordance for the Rh blood system. A possible new feto-maternal compatibility system

A large sib-sib phenotypic discordance for the Rh system has been found in a longitudinal follow-up study on growth and development. Sibs born no more than 3 years later than their respective indexes show a significant tendency to have a different phenotype from that of their indexes. The hypothesis that distortion is due to eggs or fetal loss finds support in the existence of increased time intervals between indexes' and sibs' births in those cases in which the losses were suspected. Two groups of index families made according to the presence or absence of the cde haplotype in their genotype show important differences in segregation and reproductive patterns. The observed distortions cannot be explained by the differences in known antigenic Rh specificities. The existence of a new feto-maternal compatibility system would better fit these facts and would also allow the reinterpretation of several distortions associated with Rh described in the literature that have never been satisfactorily explained.