Frequency of Agenesis Palmaris Longus through Clinical Examination - An East African Study

INTRODUCTION: The Palmaris longus, one of the most variable muscles in the body both flexes the wrist and tenses the palmar fascia. It is used by surgeons as a source of tendon graft and racial differences in its variation have been documented. We sought to determine the frequency of the absence of the Palmaris longus in an East African population. METHODS: A prospective study was conducted using ten common clinical tests among patients and students in a large teaching hospital in East Africa to determine the presence of a Palmaris longus. RESULTS: The overall rate of absence was 4.4% with unilateral absence at 3.3% and bilateral absence at 1.1%. The overall difference between males and females was not statistically significant (p = 0.605). Participants were more likely to have absence in their non dominant hand. DISCUSSION: Our findings though in contrast to many studies worldwide, it concurs with most studies done in the African setting. These differences may be due to the higher levels of manual labour and the more use of the right hand in these activities. The frequency of the absence of Palmaris longus in East Africa has been determined. Surgeons should acquaint themselves with prevalence in their areas of practice

Overall Absence.

<p>Table showing the overall absence of the Palmaris longus muscle in the study.</p

Overall PL absence by hand dominance.

<p>Table showing the distribution of agenesis of the PL by hand dominance of the subjects.</p

Is There an Increased Risk of Post-Operative Surgical Site Infection after Orthopaedic Surgery in HIV Patients? A Systematic Review and Meta-Analysis

Background: There is dilemma as to whether patients infected with the Human Immunodeficiency Virus (HIV) requiring implant orthopaedic surgery are at an increased risk for post-operative surgical site infection (SSI). We conducted a systematic review to determine the effect of HIV on the risk of post-operative SSI and sought to determine if this risk is altered by antibiotic use beyond 24 hours. Methods: We searched electronic databases, manually searched citations from relevant articles, and reviewed conference proceedings. The risk of postoperative SSI was pooled using Mantel-Haenszel method. Results: We identified 18 cohort studies with 16 mainly small studies, addressing the subject. The pooled risk ratio of infection in the HIV patients when compared to non-HIV patients was 1.8 (95% Confidence Interval [CI] 1.3-2.4), in studies in Africa this was 2.3 (95% CI 1.5-3.5). In a sensitivity analysis the risk ratio was reduced to 1.4 (95% CI 0.5-3.8). The risk ratio of infection in patients receiving prolonged antibiotics compared to patients receiving antibiotics for up to 24 hours was 0.7 (95% CI 0.1-4.2). Conclusions: The results may indicate an increased risk in HIV infected patients but these results are not robust and inconclusive after conducting the sensitivity analysis removing poor quality studies. There is need for larger good quality studies to provide conclusive evidence. To better develop surgical protocols, further studies should determine the effect of reduced CD4 counts, viral load suppression and prolonged antibiotics on the risk for infectio

Table showing the characteristics of studies included and the data abstracted

<p>* = Excluded from meta-analysis</p><p>** = Study answering question two, group with standard of care</p><p>*** = Study answering question two, group with enhanced measure</p><p>? = Value of Item unclear from study</p><p>% = Percentage</p

SEARCH STRATEGY PUBMED.

<p>SEARCH STRATEGY PUBMED.</p

Table showing the quality of studies comparing HIV infected and Non HIV infected cohorts.

<p>Y = Item Catered for in Study</p><p>? = Unclear if Item is catered for</p><p>N = Item not catered for</p

Overall risk of Infection in patients suffering from haemophilia.

<p>Study or Subgroup on the Y-axis refers to first author and publication year; events refers to the number of patients who suffered post operative surgical site infections while total refers to the number of patients in that group. Weight refers to influence of each study on overall estimate (weights are from fixed effect analyses); for each study the central square indicates risk ratio, line represents 95% confidence interval (CI), and the size of the square reflects the study's weight in the pooling; overall estimate refers to pooled estimate of risk ratio after mathematical combination of all studies; the X-axis indicates the scale and the direction of the effect of HIV status on the risk of post operative surgical site infection. I-squared denotes the extent of heterogeneity in study outcomes, with a (hypothetical) value of 100% meaning considerable heterogeneity and 0% meaning no heterogeneity between studies.</p