The association between sleep patterns and obesity in older adults.

BackgroundReduced sleep duration has been increasingly reported to predict obesity. However, timing and regularity of sleep may also be important. In this study, the cross-sectional association between objectively measured sleep patterns and obesity was assessed in two large cohorts of older individuals.MethodsWrist actigraphy was performed in 3053 men (mean age: 76.4 years) participating in the Osteoporotic Fractures in Men Study and 2985 women (mean age: 83.5 years) participating in the Study of Osteoporotic Fractures. Timing and regularity of sleep patterns were assessed across nights, as well as daytime napping.ResultsGreater night-to-night variability in sleep duration and daytime napping were associated with obesity independent of mean nocturnal sleep duration in both men and women. Each 1 h increase in the standard deviation of nocturnal sleep duration increased the odds of obesity 1.63-fold (95% confidence interval: 1.31-2.02) among men and 1.22-fold (95% confidence interval: 1.01-1.47) among women. Each 1 h increase in napping increased the odds of obesity 1.23-fold (95% confidence interval: 1.12-1.37) in men and 1.29-fold (95% confidence interval: 1.17-1.41) in women. In contrast, associations between later sleep timing and night-to-night variability in sleep timing with obesity were less consistent.ConclusionsIn both older men and women, variability in nightly sleep duration and daytime napping were associated with obesity, independent of mean sleep duration. These findings suggest that characteristics of sleep beyond mean sleep duration may have a role in weight homeostasis, highlighting the complex relationship between sleep and metabolism

Sacral Fractures and Associated Injuries.

STUDY DESIGN: Literature review. OBJECTIVE: The aim of this review is to describe the injuries associated with sacral fractures and to analyze their impact on patient outcome. METHODS: A comprehensive narrative review of the literature was performed to identify the injuries associated with sacral fractures. RESULTS: Sacral fractures are uncommon injuries that result from high-energy trauma, and that, due to their rarity, are frequently underdiagnosed and mistreated. Only 5% of sacral fractures occur in isolation. Injuries most often associated with sacral fractures include neurologic injuries (present in up to 50% of sacral fractures), pelvic ring disruptions, hip and lumbar spine fractures, active pelvic/ abdominal bleeding and the presence of an open fracture or significant soft tissue injury. Diagnosis of pelvic ring fractures and fractures extending to the lumbar spine are key factors for the appropriate management of sacral fractures. Importantly, associated systemic (cranial, thoracic, and abdominopelvic) or musculoskeletal injuries should be promptly assessed and addressed. These associated injuries often dictate the management and eventual outcome of sacral fractures and, therefore, any treatment algorithm should take them into consideration. CONCLUSIONS: Sacral fractures are complex in nature and often associated with other often-missed injuries. This review summarizes the most relevant associated injuries in sacral fractures and discusses on their appropriate management

‘old foley’s in a new bottle’- USE OF FOLEY’S CATHETER IN ANTERIOR MAXILLARY WALL FRACTURES

ABSTRACT Management of comminuted zygomaticomaxillary fractures are is an entity that has always tested the skill of surgeons. A variety of methods have been coined over the years for management of these fractures. Packing the antrum with a gauze or  balloon can be used in much comminuted fractures especially with anterior antral wall communication. Internal immobilization with a Foley’s balloon catheter is being used widely in Blow out fractures of orbit and rarely in tripod fractures. Despite a thorough search, not much literature could be found of its use in anterior maxillary wall fractures. The purpose of this article is to appraise this technique in anterior maxillary wall fractures.

Characterizing Natural Fractures and Their Interactions with Hydraulically Induced Fractures

Natural fractures are preexisting micro-cracks and fissures that can have a critical impact on hydraulic fracture treatments in shales. Most shale formations contain natural fractures, but the characteristics of these natural fractures can vary significantly. For example, the natural fractures in the Barnett Shale are mostly narrow, long, and sealed with calcite cement. The natural fractures in the Wolfcamp Shale are much more heterogeneous as a whole, but tend to be clustered in similar groupings based on the lithology of certain areas of the formation. The creation and development of natural fractures prior to any hydraulic fracturing treatments is primarily a function of mineralogy, total organic carbon, and in-situ stresses. During hydraulic fracturing treatments, certain characteristics, such as the relative angle between the natural and hydraulic fractures, the length of the natural fractures, the differential stress of the formation rock, and certain completion design variables, will determine how the natural and induced fractures interact and create a fracture network. The creation of a natural fracture network can have a positive effect on the ultimate hydrocarbon recovery in some cases. Natural fractures provide accumulation space and travel pathways for hydrocarbons, which is critical in low porosity and low permeability shales. However, natural fractures can result in higher rates of fluid leakoff, which will result in less efficient hydraulic fracture treatments overall. Also, natural fractures can provide an undesirable connection to water accumulations, which can negatively impact the economics of a well because of the disposal costs associated with water production. This thesis seeks to characterize natural fractures and also to describe the author's work on a hydraulic fracture simulation software that takes the impact of natural fractures into account.Petroleum and Geosystems Engineerin

Management and radiographic outcomes of femoral head fractures.

BackgroundFemoral head fractures are uncommon injuries. Small series constitute the majority of the available literature. Surgical approach and fracture management is variable. The purpose of this study was to evaluate the incidence, method of treatment, and outcomes of consecutive femoral head fractures at a regional academic Level I trauma center.Materials and methodsA retrospective review of a prospective database was performed over a 13-year period. All AO/OTA 31C femoral head fractures were identified. A surgical approach and fixation method was recorded. Clinical and radiographic evaluation was performed for patients with 6 months or greater follow-up. Radiographs were evaluated for fixation failure, heterotopic ossification (HO), avascular necrosis (AVN) and post-traumatic arthritis.ResultsWe identified 164 fractures in 163 patients; 147 fractures were available for review. Treatment was operative reduction and internal fixation (ORIF) in 78 (53.1%), fragment excision in 37 (25.1%) and non-operative in 28 (19%). An anterior approach and mini-fragment screws were used in the majority of patients treated with fixation. Sixty-nine fractures had follow-up greater than 6 months. Sixty-two fractures (89.9%) proceeded to uneventful union. All Pipkin III fractures failed operative fixation. Six patients developed AVN, seven patients had a known conversion to hip arthroplasty; HO developed in 28 (40.6%) patients and rarely required excision.ConclusionsFractures of the femoral head are rare. An anterior approach can be used for fragment excision or fixation using mini-fragment screws. Pipkin III fractures represent catastrophic injuries. Non-bridging, asymptomatic HO is common. AVN and posttraumatic degenerative disease of the hip occur but are uncommon.Level of evidenceIV-prognostic

Review of the financial and medicolegal implications of nasal fractures seen at St Luke’s Hospital

Simple nasal bone fractures are the third most common type of all fractures leading to numerous patient visits at the Accident & Emergency department. Nasal fractures are commonly over-investigated in St Luke’s hospital leading to a substantial financial burden on our health system. In this article we review the frequency of simple nasal fractures as well as the necessity or otherwise of nasal x-ray imaging in addition to the financial and health consequences that result from nasal x-ray imaging. These issues are also discussed from a legal perspective.peer-reviewe

Comorbidities only account for a small proportion of excess mortality after fracture: A record linkage study of individual fracture types

Background: Non-hip non-vertebral fractures (NHNV) constitute the majority of osteoporotic fractures but few studies have examined the association between these fractures, co-morbidity and mortality. Objective: To examine the relationship between individual non-hip non-vertebral fractures, co-morbidities and mortality. Methods: Prospective population-based cohort of 267,043 subjects (45 and Up Study, Australia) had baseline questionnaires linked to hospital administrative and all-cause mortality data from 2006 - 2013. Associations between fracture and mortality examined using multivariate, time dependent Cox models, adjusted for age, prior fracture, body mass index, smoking and co-morbidities (cardiovascular disease, diabetes, stroke, thrombosis and cancer) and survival function curves. Population attributable fraction calculated for each level of risk exposure. Results: During 1,490,651 person-years, women and men experienced 7,571 and 4,571 fractures and 7,064 deaths and 11,078 deaths, respectively. In addition to hip and vertebral fractures, pelvis, humerus, clavicle, rib, proximal tibia/fibula, elbow and distal forearm fractures in both sexes, and ankle fractures in men, were associated with increased multivariable adjusted mortality hazard ratios ranging from 1.3 to 3.4. Co-morbidity independently added to mortality such that a woman with a humeral fracture and one co-morbidity had a similarly reduced 5 year survival to that of a woman with a hip fracture and no co-morbidities. Population mortality attributable to any fracture without co-morbidity was 9.2% in women and 5.3% in men. Conclusion: All proximal non-hip, non-vertebral fractures in women and men were associated with increased mortality risk. Co-existent co-morbidities independently further increased mortality. Population attributable risk for mortality for fracture was similar to cardiovascular disease and diabetes, highlighting their importance and potential benefit for early intervention and treatment

Bisphosphonates : a cost benefit analysis patient

Introduction: Osteoporotic hip fractures are common in elderly. There is increased risk of sustaining other fractures that incur financial burden on the health system. Prescription of bisphosphonates after osteoporotic hip fracture surgery has been shown to reduce the overall incidence of re-fractures. Methods: All osteoporotic hip fractures treated surgically in Mater Dei Hospital in the year 2011 were analysed in this observational retrospective study. The inclusion criteria were all primary osteoporotic hip fractures. The initiation, or not, of anti-osteoporotic treatment upon discharge from hospital was reviewed. The mortality and re-fracture rate of this cohort was reviewed for a period of 3 years. The cost of hospitalization for hip fracture and re-fractures was calculated based on local health services costs and compared to the benefits of providing a free bisphosphonate medication to each patient. Results: The osteoporotic hip fracture care pathway did not include initiation of anti-osteoporotic therapy after operations. A re-fracture rate of 11.7% over three years predominantly in female patients was observed. In the first year following hip fracture, an estimated direct medical health expenditure due to re-fractures was of €37,642.55 - €48,835.19. Conclusion: Prescribing a bisphosphonate has been found to reduce both the re-fracture and mortality rates. In our study, a bisphosphonate prescription could have reduced the all cause mortality rate of 25.3% to 15.18% over the first year of hip fracture, as well as reduced the financial and social burden incurred due to a re-fracture.peer-reviewe