A comparative evaluation of the efficacy between skeletal traction and skin traction in pre-operative management of femur shaft fractures in Korle Bu Teaching Hospital

Objectives: This study is to compare the outcomes of pre-operative skeletal and skin traction in adult femoral shaft fractures awaiting surgical fixation within two weeks of presentation to the Accident Center of Korle Bu Teaching Hospital.Methods: This study was a clinical trial on 86 recruited patients with closed femoral shaft fractures sustained within 24 hours of presentation grouped into 2 groups. Descriptive and inferential statistics comprising frequency, percentage, Chi-square, independent sample t-test and Mann-Whitney U test were used in analysing the data.Results: Of the total number of patients involved in the study, 74% (n=64) were males and 26% (n=22) were females with a mean age of 39.49 (SD ±15). There was no statistically significant difference in the mean visual analogue scale (VAS) pain assessment between the Skin traction group and Trans-tibia skeletal traction group after traction. With regards to complications, the difference between the Skin traction group and the Skeletal traction group was statistically significant (P=0.001). Moreover, the mean blood loss compared with the open type of reduction in the Transtibia skeletal traction group was significantly less than the Skin traction group (p=0.000).Conclusion: This study has shown that both Skeletal traction and Skin traction were equally effective in controlling pre-operative pain in adult patients with femoral shaft fractures and does not affect intra-operative blood loss and postoperative management. Therefore, pre-operative Skin traction can be considered a useful and cost-effective method of maintaining alignment and pain relief in adult femoral shaft fractures.Keywords: Skin traction, Trans-tibia skeletal, reamed Intramedullary nailing, Intra-operative blood loss, Visual Analogue ScaleFunding: Personal Fundin

Strategy for Merging Unhealthy Churches and Leading the Merged Congregation to A Healthy Christ-Centered New Testament Church

The hypothesis of this project is that merging two or more local churches is a practical option to growing a healthy Christ-centered New Testament church as opposed to closing those declined and dying churches. This project will examine and evaluate the merger process of Charles Wesley United Methodist Church and Earle\u27s Chapel United Methodist Church in 2005, led by the author to form a new congregation called New Life Community United Methodist Church. A post-merger questionnaire will be developed and used to evaluate the merger process. Second, a healthy growth ministry plan will be developed and implemented to lead the merged congregation to a Christ-centered New Testament Church. Finally, a National Church Development assessment tool will be used to evaluate the health of New Life Community United Methodist Church to produce a healthy Christ-centered New Testament church

Factors affecting early re-displacement of paediatric diaphyseal forearm fractures at Korle Bu Teaching Hospital

Background: Complete fractures of the forearm have the potential to displace and angulate with overriding fracture fragments. Maintaining acceptable reduction is not always possible, and re- displacement or re-angulation is the most commonly reported complication. Factors responsible for the re-displacement after an initial acceptable reduction have not been clearly defined. The study aimed to determine the factors that influence early re-displacement of paediatric diaphyseal forearm fractures in Korle-Bu Teaching Hospital.Methods: A prospective study in a cohort of 72 children below the age of 12 years with diaphyseal forearm fracture attending the Orthopaedic clinic were followed with close reduction casting from April 2017-December, 2017. Factors analysed included demographics, initial fracture features and the radiographic indices of the cast quality.Results: 93.1% (67) of the fractures were because of the children falling on an outstretched arm. Majority of the children had a fracture of the distal 1/3 of the radius (n=38, 52.6%). The overall C.I was 0.8 (SD 0.1). The only significant predictor for predicting re-displacement was children falling on an outstretched hand (p-value=0.0).Conclusion: This study has shown that the degree of initial displacement and the ability to achieve good reduction with a well moulded cast, constitute the major factors for early re-displacement of paediatric forearm fracturesKeywords: cast index, intermedullary nailing, elastic stable intramedullary nail, open reduction, internal fixationFunding: Personal fundin

Dynamics of crowded vesicle: local and global responses to membrane composition

The bacterial cell envelope is composed of a mixture of different lipids and proteins, making it an inherently complex organelle. The interactions between integral membrane proteins and lipids are crucial for their respective spatial localization within bacterial cells. We have employed microsecond timescale coarse-grained molecular dynamics simulations of vesicles of varying sizes and with a range of protein and lipid compositions, and used novel approaches to measure both local and global system dynamics, the latter based on spherical harmonics analysis. Our results suggest that both hydrophobic mismatch, enhanced by embedded membrane proteins, and curvature based sorting, due to different modes of undulation, may drive assembly in vesicular systems. Interestingly, the modes of undulation of the vesicles were found to be altered by the specific protein and lipid composition of the vesicle. Strikingly, lipid dynamics were shown to be coupled to proteins up to 6 nm from their surface, a substantially larger distance than has previously been observed, resulting in multi-layered annular rings enriched with particular types of phospholipid. Such large protein-lipid complexes may provide a mechanism for long-range communication. Given the complexity of bacterial membranes, our results suggest that subtle changes in lipid composition may have major implications for lipid and protein sorting under a curvature-based membrane-sorting model

Diet modulates the relationship between immune gene expression and functional immune responses

Nutrition is vital to health and the availability of resources has long been acknowledged as a key factor in the ability to fight off parasites, as investing in the immune system is costly. Resources have typically been considered as something of a "black box", with the quantity of available food being used as a proxy for resource limitation. However, food is a complex mixture of macro- and micronutrients, the precise balance of which determines an animal's fitness. Here we use a state-space modelling approach, the Geometric Framework for Nutrition (GFN), to assess for the first time, how the balance and amount of nutrients affects an animal's ability to mount an immune response to a pathogenic infection. Spodoptera littoralis caterpillars were assigned to one of 20 diets that varied in the ratio of macronutrients (protein and carbohydrate) and their calorie content to cover a large region of nutrient space. Caterpillars were then handled or injected with either live or dead Xenorhabdus nematophila bacterial cells. The expression of nine genes (5 immune, 4 non-immune) was measured 20 h post immune challenge. For two of the immune genes (PPO and Lysozyme) we also measured the relevant functional immune response in the haemolymph. Gene expression and functional immune responses were then mapped against nutritional intake. The expression of all immune genes was up-regulated by injection with dead bacteria, but only those in the IMD pathway (Moricin and Relish) were substantially up-regulated by both dead and live bacterial challenge. Functional immune responses increased with the protein content of the diet but the expression of immune genes was much less predictable. Our results indicate that diet does play an important role in the ability of an animal to mount an adequate immune response, with the availability of protein being the most important predictor of the functional (physiological) immune response. Importantly, however, immune gene expression responds quite differently to functional immunity and we would caution against using gene expression as a proxy for immune investment, as it is unlikely to be reliable indicator of the immune response, except under specific dietary conditions. [Abstract copyright: Copyright © 2019. Published by Elsevier Ltd.

Successional trajectory of dung beetle communities in a tropical grassy ecosystem after livestock grazing removal

Grazing by large herbivorous mammals is still a structuring force in tropical grassy ecosystems, and cattle grazing is one of the main economic activities carried out in these ecosystems in modern times. Therefore, understanding the impacts of cattle grazing removal on biodiversity may be a key step for conservation of this ecosystem. Here, we studied the successional trajectory of dung beetle communities in a tropical grassy ecosystem after cattle removal. For this, we assessed the patterns of dung beetle taxonomic and functional diversity of 14 natural grasslands with distinct cattle grazing removal ages (from 3 months to 22 years) along a chronosequence, applying the space-for-time substitution method. Our results show a strong decrease in dung beetle abundance (93 times) and species richness (6 times) in the first ten years of cattle removal. However, after ten years there is an increase in dung beetle abundance (73 times) and species richness (5 times). Taxonomic composition was also influenced by cattle removal time demonstrating the importance of cattle in the structuring of dung beetle communities in natural grasslands. In contrast, functional composition and diversity were not affected by cattle grazing removal, indicating these metrics are less sensitive to cattle absence than taxonomic diversity and composition. Our results provide evidence that cattle grazing removal, at least in the short term (10 years), may be an inefficient management tool for restoration and conservation of tropical grassy ecosystems. However, we highlight the need to investigate the reintroduction of cattle grazing after different removal times to provide complimentary information to livestock management able to integrate human use and conservation of tropical grassy ecosystems

Osmolality as a novel mechanism explaining diet effects on the outcome of infection with a blood parasite

Recent research has suggested that the outcome of host-parasite interactions is dependent on the diet of the host, but most previous studies have focused on ‘top down’ mechanisms i.e. how the host’s diet improves the host immune response to drive down the parasite population and improve host fitness. In contrast, the direct impacts of host nutrition on parasite fitness or the mechanisms underpinning these effects are relatively unexplored. Here, using a model host-pathogen system (Spodoptera littoralis caterpillars and Xenorhabdus nematophila, an extracellular bacterial blood parasite), we explore the effects of host dietary macronutrient balance on pathogen growth rates both in vivo and in vitro, allowing us to compare pathogen growth rates both in the presence and absence of the host immune response. In vivo, high dietary protein resulted in lower rates of bacterial establishment, slower bacterial growth, higher host survival and slower speed of host death; in contrast, the energy content and amount of carbohydrate in the diet explained little variation in any measure of pathogen or host fitness. In vitro, we show that these effects are largely driven by the impact of host dietary protein on host hemolymph (blood) osmolality (i.e. its concentration of solutes), with bacterial growth being slower in protein-rich, high osmolality, hemolymphs, highlighting a novel ‘bottom up’ mechanism by which host diet can impact both pathogen and host fitness

Insights into the autotransport process of a trimeric autotransporter, Yersinia Adhesin A (YadA)

Trimeric autotransporter adhesins (TAAs) are a subset of a larger protein family called the type V secretion systems. They are localized on the cell surface of Gram‐negative bacteria, function as mediators of attachment to inorganic surfaces and host cells, and thus include important virulence factors. Yersinia adhesin A (YadA) from Yersinia enterocolitica is a prototypical TAA that is used extensively to study the structure and function of the type Vc secretion system. A solid‐state NMR study of the membrane anchor domain of YadA previously revealed a flexible stretch of small residues, termed the ASSA region, that links the membrane anchor to the stalk domain. In this study, we present evidence that single amino acid proline substitutions produce two different conformers of the membrane anchor domain of YadA; one with the N‐termini facing the extracellular surface, and a second with the N‐termini located in the periplasm. We propose that TAAs adopt a hairpin intermediate during secretion, as has been shown before for other subtypes of the type V secretion system. As the YadA transition state intermediate can be isolated from the outer membrane, future structural studies should be possible to further unravel details of the autotransport process