Avulsion Fractures at the Base of the 2^nd Metacarpal Due to the Extensor Carpi Radialis Longus Tendon: A Case Report and Review of the Literature

Introduction: Simultaneous contraction of the extensor carpi radialis longus (ECRL) with forced hyperflexion of the wrist can result in avulsion of the tendon and its bony attachment at its insertion at the dorsum of the base of the second metacarpal. This is a rare and often unreported fracture pattern. Case Presentation: We present a 31- year- old male who sustained a hyperflexion injury. He was managed surgically and had good post-operative outcomes. A literature search revealed 16 papers covering 18 cases of similar injuries. 12 were initially managed surgically and 6 were managed conservatively. Conclusions: Of the open reductions and internal fixations, 11 (92%) were successful and patients made a full recovery. Conservative management was unsuccessful in 4 cases; one patient required surgery for metacarpal boss, one patient had retraction of the tendon at one week follow up and another had weak flexion of the wrist. We recommend open reduction and internal fixation for these injuries. It may allow a faster recovery and therefore allow an earlier return to work and activit

Crystal structure of 1-methanesulfonyl-1, 2, 3, 4-tetrahydroquinoline

SJ thanks Vision Group on Science and Technology, Government of Karnataka, for awarding a major project under CISE scheme (reference No. VGST/CISE/GRD-192/ 2013–14). BSP thanks Rajegowda, Department of Studies and Research in Physics, UCS, Tumkur University, Karnataka 572103, India, for his support.Peer reviewedPublisher PD

Influence of Eysenckian Personality Traits in Choice of Specialization by Young Omani Doctors.

Objectives:The role of personality in occupational specialty choices has been explored in many parts of the world. To our knowledge, there is a dearth of such studies in the Arab/Islamic population and Oman is no exception. This study aimed to explore the relationship between personality traits and specialty choice among residents of Oman Medical Specialty Board (OMSB). Methods: A cross-sectional study was carried out among Omani resident physicians working under OMSB. The Eysenck Personality Questionnaire–Revised was employed to quantify personality subtypes (e.g., psychoticism, extraversion, and neuroticism). Specialties were categorized as surgical, medical, and diagnostics as per standard of North American medical specialties. A total of 255 residents in 17 medical specialties participated in the study (m = 40.4%; f = 59.6%) of 300 eligible subjects giving a response rate of 85.0%. Results: Respondents who had chosen surgical specialties scored significantly higher on the psychoticism subscale than those who had opted for medical and diagnostic specialties. As for individual specialties, orthopedic respondents had statistically significant higher mean scores on psychoticism and neuroticism compared to radiologists and psychiatrists who scored the lowest in the two personality traits, respectively. Conclusions: This study found statistically significant associations between personality traits and choices of specialty by young Omani doctors. We recommend more detailed studies that examine further psychological and cultural variables that are likely to affect the choices of specializations by young Omani professionals in both medical and non-medical fields

Evaluation of uroprotective efficacy of amifostine against cyclophosphamide induced hemorrhagic cystitis

The role of amifostine in the prevention of cyclophosphamide-induced hemorrhagic cystitis (HC) was evaluated in the rat model. Urinary bladders from control rats that received no drugs (group I) were compared with those from rats receiving cyclophosphamide alone at a dose of 150 mg/kg (group II), and two other groups receiving amifostine at 100 mg/kg (group III) and 200 mg/kg (group IV), 15 min prior to cyclophosphamide. Bladders were assessed macroscopically and histologically at 24 h and after 7 days. All the animals that received cyclophosphamide alone developed severe HC. On the basis of the scores of macroscopic and histologic changes, animals that received amifostine showed excellent uroprotection. Only 2/6 rats in group III and 1/6 rats in group IV developed mild HC at 24 h. None of the rats in either of these groups showed any evidence of HC at 7 days. It is concluded that amifostine protects the urothelium against cyclophosphamide-induced HC

Differential item functioning for items in Berger's HIV Stigma Scale: an analysis of cohorts from the Indian, Swedish, and US contexts

PURPOSE: To examine whether items in Berger's HIV Stigma Scale function differently with persons of different age, gender, and cultural backgrounds. METHODS: Secondary data from cohorts, collected in South India (n = 250), Sweden (n = 193), and the US (n = 603) were reanalyzed to evaluate DIF within, between, and across these cohorts. All participants had answered the revised version of the HIV stigma scale consisting of 32 items forming the subscales Personalized stigma, Disclosure concerns, Concerns about public attitudes, and Negative self-image. Differential Item Functioning (DIF) for these items was assessed using hybrid ordinal regression-IRT technique. When DIF was detected, the cumulative impact of DIF on individual subscale scores was evaluated. RESULTS: DIF was detected for 9 items within, between, or across cohorts, but the DIF was negligible in general. Detected DIF between the Swedish and Indian cohorts had a cumulative salient impact on individual scores for the subscale Disclosure Concerns; Disclosure concerns were overestimated in the Swedish cohort and both over- and underestimated in the Indian cohort. CONCLUSIONS: The items in the 32-item version of the HIV stigma scale did not seem to be particularly prone to present DIF. The DIF between the Indian and Swedish cohort for items in the subscale Disclosure Concerns could, however, result in both type I and type II errors if scores should be compared between the Indian and Swedish cohort

Differential item functioning for items in Berger's HIV Stigma Scale: an analysis of cohorts from the Indian, Swedish, and US contexts

PURPOSE: To examine whether items in Berger's HIV Stigma Scale function differently with persons of different age, gender, and cultural backgrounds. METHODS: Secondary data from cohorts, collected in South India (n = 250), Sweden (n = 193), and the US (n = 603) were reanalyzed to evaluate DIF within, between, and across these cohorts. All participants had answered the revised version of the HIV stigma scale consisting of 32 items forming the subscales Personalized stigma, Disclosure concerns, Concerns about public attitudes, and Negative self-image. Differential Item Functioning (DIF) for these items was assessed using hybrid ordinal regression-IRT technique. When DIF was detected, the cumulative impact of DIF on individual subscale scores was evaluated. RESULTS: DIF was detected for 9 items within, between, or across cohorts, but the DIF was negligible in general. Detected DIF between the Swedish and Indian cohorts had a cumulative salient impact on individual scores for the subscale Disclosure Concerns; Disclosure concerns were overestimated in the Swedish cohort and both over- and underestimated in the Indian cohort. CONCLUSIONS: The items in the 32-item version of the HIV stigma scale did not seem to be particularly prone to present DIF. The DIF between the Indian and Swedish cohort for items in the subscale Disclosure Concerns could, however, result in both type I and type II errors if scores should be compared between the Indian and Swedish cohort

Feasibility of store-and-forward teledermatology in out-patient care: A prospective study from rural India utilising specialist referral services through an instant messaging platform - "WhatsApp"

Objectives: The COVID-19 pandemic has placed unprecedented demands on the delivery of health care in rural areas of India. We examined the feasibility of store-and-forward mobile teledermatology for outpatient access to specialist dermatologic care in underserved areas in India. Methods: We conducted a prospective study using smartphone-based teledermatology, connecting six underserved clinics manned by primary care physicians (PCP) to three dermatologists, using the instant messaging platform WhatsApp. We assessed the concordance between PCPs and dermatologists (using prevalence adjusted bias adjusted kappa), consultation time, the spectrum of conditions, and the outcome. Results: Of the 730 dermatology patients screened in the clinics, 95 (13%) (36 males and 59 females) required teleconsultation, among which 61.1% were non-infective, 34.7% were infective, and the diagnosis could not be ascertained in 4.2 %. The mean time taken for the first response was 13.5\ub118.4 minutes. Twenty per cent (n=19) required referral, and 80% (n=76) of consultations could be resolved at the clinic, of whom 36.8 % were cured, 38.2% had moderate, 4% had minimal improvement, 13% were lost to follow-up, and 8% refused treatment. Cure was observed in viral infections and eczema. The diagnostic concordance ranged from low values [0.38 (95% CI: 0-0.68)] in infective to moderate [0.66 (95% CI: 0.42 -0.83), p=0.033] in non-infective disorders. Conclusion: Asynchronous mobile teledermatology, using specialist referral via instant messaging platforms, is a powerful modality for providing real-time dermatologic care, while offering a very promising alternative for decreasing healthcare disparities and continuity of services even in adverse situations like the Covid-19 pandemic

Task shifting to frontline community health workers for improved Diabetes care in low-resource settings in India : A phase II Non-randomized controlled clinical trial

Acknowledgments: We are indebted to the our research team who worked passionately to complete the study, health workers who were willing to function as patient navigators to improve diabetes management, and to all the participants who responded to our screening invitations and structured care Funding: We acknowledge the funding received from Friends of Vellore, UK and NHS Grampian Endowment fund, University of Aberdeen- Approval Number: EA0852Peer reviewedPublisher PD

Inducing remission of Type 2 diabetes in the Caribbean: findings from a mixed methods feasibility study of a low-calorie liquid diet-based intervention in Barbados.

AIM: In a high proportion of people with recently diagnosed Type 2 diabetes, a short (2-3-month) low-calorie diet is able to restore normal glucose and insulin metabolism. The aim of this study was to determine the feasibility of this approach in Barbados. METHODS: Twenty-five individuals with Type 2 diabetes diagnosed within past 6 years, not on insulin, BMI ≥ 27 kg/m2 were recruited. Hypoglycaemic medication was stopped on commencement of the 8-week liquid (760 calorie) diet. Insulin response was assessed in meal tests at baseline, 8 weeks and 8 months. Semi-structured interviews, analysed thematically, explored participants' experiences. 'Responders' were those with fasting plasma glucose (FPG) < 7 mmol/l at 8 weeks. RESULTS: Ten men and 15 women (mean age 48, range 26-68 years) participated. Mean (sd) BMI was 34.2 kg/m2 (6.0); FPG 9.2 mmol/l (2.2). Mean weight loss at 8 weeks and 8 months was 10.1 kg [95% confidence interval (CI) 8.1, 12.0] and 8.2 kg (95% CI 5.8, 10.6); FPG was lower by 2.2 mmol/l (95% CI 1.2, 3.2) and 1.7 mmol/l (95% CI 0.8, 2.7) respectively. Nine of 11 (82%) of those who lost ≥ 10 kg were 'responders' compared with 6 of 14 (43%) who lost < 10 kg (P = 0.048). The 30-min insulin increment was higher in responders at baseline and follow-up (P ≤ 0.01). A food culture based on starchy foods and pressures to eat large amounts at social events were among the challenges identified by participants. CONCLUSIONS: The feasibility of this approach to weight loss and diabetes remission in a predominantly black population in Barbados was demonstrated