Fractures De La diaphyse humérale Une étude rétrospective comparative de technique HACKETHAL Vs plaque vissée : A propos de 19 cas

Introduction: They represent 2% of all fractures. The main debate around recent fractures focuses on the therapeutic indications for all types of surgical stabilization have sometimes unconditional and strident defenders. Material and Methods: A series of 19 osteosynthesis was reviewed: 4 with other traumas, 1 case of skin incision and two initial radial nerve palsy. The osteosynthesis by plate was performed in 7 patients and by bundle pinning in 12 patients. The outcome evaluation was made with the listing for Stewart & Hundley amended. Results: For patients treated with plate: 2 postoperative radial nerve palsy. There were 1 non- union and no case of sepsis.71, 4% of patients had good and excellent results. For patients treated by bundle pinning: no radial nerve palsy, 1 case of non-union, and no cases of sepsis, under-acromial conflict, or of pin protrusion in the top. Good and very good results concerned 91, 7% of patients. Conclusion: The choice of therapeutic methods is difficult. There is no method that could lead to unanimous. The bundle pinning fixation could be this method, but the risk of stiffness of the shoulder is a feared complicationIntroduction Elles représentent 2% de l’ensemble des fractures ; Le débat principal autour des fractures de la diaphyse humérale se centre sur les indications thérapeutiques car tout type de stabilisation chirurgicale trouve des défenseurs parfois inconditionnels et véhéments. Matériels et Méthodes : Une série de 19 ostéosynthèses a été revue dont 4 polytraumatisés, 1 cas d’ouverture cutanée et deux paralysies radiales initiales. L'ostéosynthèse par plaque a été réalisée chez 7 patients et par embrochage fasciculé chez 12 malades. L’évaluation des résultats s'est faite avec la cotation de Stewart & Hundley modifiée. Résultats Pour les patients traités par plaque : Deux paralysies radiales post-opératoires, pas de pseudarthrose, pas de cas de sepsis. Les bons et très bons résultats concernent 71,4% des patients. Pour les patients traités par embrochage : pas de paralysie radiale ; 1 cas de pseudarthrose, pas de cas de sepsis, aucun cas de conflit sous acromiale ou de protrusion du clou en haut. Les bons et très bon résultats concernent 91,7% des patients. Conclusion Le choix entre les méthodes thérapeutiques est difficile. Il n'existe pas de méthode pouvant entraîner une adhésion unanime. L'embrochage fasciculé pourrait être cette méthode, mais le risque de raideur de l’épaule en fait une technique redoutée. L'ostéosynthèse par plaque aussi pourrait l’être mais son principal reproche est l’atteinte neurologique

Pralidoxime in Acute Organophosphorus Insecticide Poisoning-A Randomised Controlled Trial

Background: Poisoning with organophosphorus (OP) insecticides is a major global public health problem, causing an estimated 200,000 deaths each year. Although the World Health Organization recommends use of pralidoxime, this antidote's effectiveness remains unclear. We aimed to determine whether the addition of pralidoxime chloride to atropine and supportive care offers benefit. Methods and Findings: We performed a double-blind randomised placebo-controlled trial of pralidoxime chloride (2 g loading dose over 20 min, followed by a constant infusion of 0.5 g/h for up to 7 d) versus saline in patients with organophosphorus insecticide self-poisoning. Mortality was the primary outcome; secondary outcomes included intubation, duration of intubation, and time to death. We measured baseline markers of exposure and pharmacodynamic markers of response to aid interpretation of clinical outcomes. Two hundred thirty-five patients were randomised to receive pralidoxime (121) or saline placebo (114). Pralidoxime produced substantial and moderate red cell acetylcholinesterase reactivation in patients poisoned by diethyl and dimethyl compounds, respectively. Mortality was nonsignificantly higher in patients receiving pralidoxime: 30/121 (24.8%) receiving pralidoxime died, compared with 18/114 (15.8%) receiving placebo (adjusted hazard ratio HR] 1.69, 95% confidence interval CI] 0.88-3.26, p = 0.12). Incorporating the baseline amount of acetylcholinesterase already aged and plasma OP concentration into the analysis increased the HR for patients receiving pralidoxime compared to placebo, further decreasing the likelihood that pralidoxime is beneficial. The need for intubation was similar in both groups (pralidoxime 26/121 21.5%], placebo 24/114 21.1%], adjusted HR 1.27 95% CI 0.71-2.29]). To reduce confounding due to ingestion of different insecticides, we further analysed patients with confirmed chlorpyrifos or dimethoate poisoning alone, finding no evidence of benefit. Conclusions: Despite clear reactivation of red cell acetylcholinesterase in diethyl organophosphorus pesticide poisoned patients, we found no evidence that this regimen improves survival or reduces need for intubation in patients with organophosphorus insecticide poisoning. The reason for this failure to benefit patients was not apparent. Further studies of different dose regimens or different oximes are required

Variable Selection-based Multivariate Cumulative Sum Control Chart

High-dimensional applications pose a significant challenge to the capability of conventional statistical process control techniques in detecting abnormal changes in process parameters. These techniques fail to recognize out-of-control signals and locate the root causes of faults especially when small shifts occur in high-dimensional variables under the sparsity assumption of process mean changes. In this paper, we propose a variable selection-based multivariate cumulative sum (VS-MCUSUM) chart for enhancing sensitivity to out-of-control conditions in high-dimensional processes. While other existing charts with variable selection techniques tend to show weak performances in detecting small shifts in process parameters due to the misidentification of the 'faulty' parameters, the proposed chart performs well for small process shifts in identifying the parameters. The performance of the VS-MCUSUM chart under different combinations of design parameters is compared with the conventional MCUSUM and the VS-multivariate exponentially weighted moving average control charts. Finally, a case study is presented as a real-life example to illustrate the operational procedures of the proposed chart. Both the simulation and numerical studies show the superior performance of the proposed chart in detecting mean shift in multivariate processes.Scopu