An unusual median nerve formation; A case report and literature review

The Median nerve anatomical variation is commonly encountered. During the dissection of about 65 years of formalin-fixed male cadaver at the  Department of Human Anatomy at National University Faculty of Medicine for undergraduate students in 2016-2017, the left upper limb showed that the  median nerve was formed by the union of the three roots. However, the third root arose from the musculocutaneous nerve inside the coracobrachialis  muscle, perforating the lower part of the muscle and joining the median nerve at the middle of the arm region. Knowledge of these variations is useful  clinically, especially when evaluating symptoms of upper limb trauma, and it is also useful when performing surgical approaches.&nbsp

Cost saving with ultrasonography in a developing country district hospital

Objective: To estimate the potential monetary reduction induced by the introduction of an ultrasound unit in a major district hospital in a developing country. Design: Propective study. Subjects: Patients referred with abnominal diseases and pregnancy. Setting: 'Wad Medani Teaching Hospital, Central Sudan. Results: Local specialists referring the patients stated that an estimated 792 radiologic procedures would have been carried out to obtain the same amount of information as achieved by ultrasound. Such procedures budgeted approximately 8100 US dollars, in terms of equipment, material and personnel by 1987 rates. Such savings have benefited all departments of the hospital. Conclusion: The authors consider this as evidence for the fact that despite its initial high investment (15000 US dollars), availability of ultrasound virtually reduced expenditure on other radiological diagnostic procedures. This is of special benefit for the limited budgets of hospitals in non-industrialiied countries.East African Medical Journal, May 1999, 272-27

Tungsten Bronze Barium Neodymium Titanate (Ba 6–3 Nd 8+2 Ti 18 O 54 ): An Intrinsic Nanostructured Material and Its Defect Distribution

We investigated the structure of the tungsten bronze barium neodymium titanates Ba6–3nNd8+2nTi18O54, which are exploited as microwave dielectric ceramics. They form a complex nanostructure, which resembles a nanofilm with stacking layers of ∼12 Å thickness. The synthesized samples of Ba6–3nNd8+2nTi18O54 (n = 0, 0.3, 0.4, 0.5) are characterized by pentagonal and tetragonal columns, where the A cations are distributed in three symmetrically inequivalent sites. Synchrotron X-ray diffraction and electron energy loss spectroscopy allowed for quantitative analysis of the site occupancy, which determines the defect distribution. This is corroborated by density functional theory calculations. Pentagonal columns are dominated by Ba, and tetragonal columns are dominated by Nd, although specific Nd sites exhibit significant concentrations of Ba. The data indicated significant elongation of the Ba columns in the pentagonal positions and of the Nd columns in tetragonal positions involving a zigzag arrangement of atoms along the b lattice direction. We found that the preferred Ba substitution occurs at Nd[3]/[4] followed by Nd[2] and Nd[1]/[5] sites, which is significantly different to that proposed in earlier studies. Our results on the Ba6–3nNd8+2nTi18O54 “perovskite” superstructure and its defect distribution are particularly valuable in those applications where the optimization of material properties of oxides is imperative; these include not only microwave ceramics but also thermoelectric materials, where the nanostructure and the distribution of the dopants will reduce the thermal conductivity

Genetic variation in GABRβ1 and the risk for developing alcohol dependence

Associations between the [gamma]-aminobutyric acid type-A receptors (GABAA) and alcohol dependence risk have been reported, although the receptor subunit driving the association is unclear. Recent work in mice has highlighted a possible role for variants in the Gabr [beta]1 subunit (Gabr[beta]1) in alcohol dependence risk, although this gene does not contain any common nonsynonymous variants in humans. However, the GABAA receptor is a heteropentamer so multiple potential variants within the gene complex could generate the alcohol dependence phenotype. The association between GABR[beta]1 variants and alcohol dependence risk was explored in a British and Irish population of alcohol-dependent cases (n=450) and ancestrally-matched controls screened to exclude current or historical alcohol misuse (n=555). Twelve common single nucleotide polymorphisms (SNPs) and a rare nonsynonymous variant, rs41311286, were directly genotyped; imputation was then performed across the whole gene. No allelic association was observed between alcohol dependence risk and any of the directly genotyped or imputed SNPs. However, post-hoc testing for genotypic association identified five common intronic SNPs that showed modest evidence for association after correction for multiple testing; two, rs76112682 and rs141719901, were in complete linkage disequilibrium [Pcorrected=0.02, odds ratio (95% confidence interval)=5.9 (1.7-2.06)]. These findings provide limited support for an association between GABR[beta]1 and the risk for developing alcohol dependence; further testing in expanded cohorts may be warranted

Impact of the introduction of ultrasound services in a limited resource setting: rural Rwanda 2008

<p>Abstract</p> <p>Background</p> <p>Over the last decade, utilization of ultrasound technology by non-radiologist physicians has grown. Recent advances in affordability, durability, and portability have brought ultrasound to the forefront as a sustainable and high impact technology for use in developing world clinical settings as well. However, ultrasound's impact on patient management plans, program sustainability, and which ultrasound applications are useful in this setting has not been well studied.</p> <p>Methods</p> <p>Ultrasound services were introduced at two rural Rwandan district hospitals affiliated with Partners in Health, a US nongovernmental organization. Data sheets for each ultrasound scan performed during routine clinical care were collected and analyzed to determine patient demographics, which ultrasound applications were most frequently used, and whether the use of the ultrasound changed patient management plans. Ultrasound scans performed by the local physicians during the post-training period were reviewed for accuracy of interpretation and image quality by an ultrasound fellowship trained emergency medicine physician from the United States who was blinded to the original interpretation.</p> <p>Results</p> <p>Adult women appeared to benefit most from the presence of ultrasound services. Of the 345 scans performed during the study period, obstetrical scanning was the most frequently used application. Evaluation of gestational age, fetal head position, and placental positioning were the most common findings. However, other applications used included abdominal, cardiac, renal, pleural, procedural guidance, and vascular ultrasounds.</p> <p>Ultrasound changed patient management plans in 43% of total patients scanned. The most common change was to plan a surgical procedure. The ultrasound program appears sustainable; local staff performed 245 ultrasound scans in the 11 weeks after the departure of the ultrasound instructor. Post-training scan review showed the concordance rate of interpretation between the Rwandese physicians and the ultrasound-trained quality review physicians was 96%.</p> <p>Conclusion</p> <p>We suggest ultrasound is a useful modality that particularly benefits women's health and obstetrical care in the developing world. Ultrasound services significantly impact patient management plans especially with regards to potential surgical interventions. After an initial training period, it appears that an ultrasound program led by local health care providers is sustainable and lead to accurate diagnoses in a rural international setting.</p

Exploring UK Knife crime and its associated factors: A content analysis of online newspapers

Knife crime has become a common phrase used by the media, but it is not always clear what it refers to or what they mean when they use the term. Knife crime can cover many offences, making it challenging to define and estimate its prevalence. This review aimed to evaluate potential knife crimes in the UK from 2011 to 2021 and analyse the causes and risk factors associated with the crimes. Six UK online news portals were purposefully chosen to be included in the study, and knife crime news was searched retrospectively. The term "knife crime" was used to search. The news portals were the: Metro, the Sun, the Guardian, Daily Mail, Daily Mirror and the Evening Standard. In the assigned news portals, 692 reports were found between January 2011 and December 2021. The study revealed that the 11-20 years of age group individuals are more vulnerable as victims, and males are more reported as victims when compared to females. About 61.8% of knife crimes are reported from South England. Knife crime risk is higher in early adulthood and among males. Street violence, fights/gang attacks, family issues and robbery are the leading causes of knife crime and have all been identified as risk factors that must be addressed with caution

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty