Navigating challenges: a case report on complications in clavicle fracture management with 'K' wire fixation

Orthopaedic metallic pins and wires are commonly used for the fixation of fractures and dislocations, with the shoulder girdle being one of the common areas for their application. Despite recent precautionary measures, complications related to migration of these devices into the pleural cavity continue to be reported. We present a case of a Kirschner wire (K-wire) migration from a left clavicle fracture to the first rib, highlighting the importance of vigilance and immediate intervention in such cases. A 35-year-old female, previously operated for a left clavicle fracture using K-wire and tension band wiring, presented with left shoulder and chest pain eight years later. Radiological investigations revealed a broken K-wire in the pleural cavity, with one portion near the acromio-clavicular region and the other at the posterior aspect of the first rib. Surgical intervention was performed, involving the removal of the K-wire from the chest cavity and clavicle, with subsequent patient recovery. The migration of orthopaedic pins and wires into the chest cavity is a rare but well-documented complication. Previous reports have demonstrated severe consequences, including cardiovascular complications and fatalities. Theories explaining wire migration include muscle action, shoulder mobility, negative intrathoracic pressure during respiration, regional bone resorption, gravitational forces, and even capillary action. To minimize such complications, subcutaneous K-wire ends should be bent, and restraining devices should be used. Close clinical and radiographic follow-up is essential until the pins and wires are removed after achieving the therapeutic goal. In case of migration, prompt removal is necessary to prevent fatal complications. This case report emphasizes the significance of vigilance and proper precautions when using orthopaedic pins and wires for shoulder girdle fractures. Timely intervention is crucial to mitigate severe complications associated with migration. Sharing experiences and lessons learned can contribute to the safer application of these fixation devices in orthopaedic practice

Image interpolation using Shearlet based iterative refinement

This paper proposes an image interpolation algorithm exploiting sparse representation for natural images. It involves three main steps: (a) obtaining an initial estimate of the high resolution image using linear methods like FIR filtering, (b) promoting sparsity in a selected dictionary through iterative thresholding, and (c) extracting high frequency information from the approximation to refine the initial estimate. For the sparse modeling, a shearlet dictionary is chosen to yield a multiscale directional representation. The proposed algorithm is compared to several state-of-the-art methods to assess its objective as well as subjective performance. Compared to the cubic spline interpolation method, an average PSNR gain of around 0.8 dB is observed over a dataset of 200 images

A case of reversible upper brachial plexopathy following CRT-P implantation

Brachial plexus injury is a challenging field of hand and upper extremity surgery. Presently available microsurgical techniques and functional gains are rewarding in upper plexus injuries. Cardiac electronic devices implantation rate is the required to manage long-term complications. Cardiac resynchronization therapy (CRT) implantation is a commoner procedure done for severe ischaemic and non ischaemic cardiomyopathy. A 65-year-old male patient underwent CRT device implantation via utilizing his left subclavian vein with a classical incision over the delto pectoral groove, with right ventricular lead on the inter ventricular septum and left ventricular lead into the posterolateral branch of coronary sinus with RA threshold, impedance and amplitude (P) of 1V and 690ohm and 7.8mv respectively. CRT with adjacent nerve structure is carefully selected for vein puncture to minimize the risk of Brachial plexus injury, i.e. pacing lead induces nerve injury. Peripheral nerve injuries are sparsely reported due to procedural as well as indwelling trans venous pacing leads and isolated posterior cord involvement is a rarer presentation hence is reported

Biosystematics studies on medicinal plant Urginea indica Kunth. liliaceae - A review

Indian squill, Urginea spp. is a very important and rare medicinal plant endemic to India, Africa and Meditteranian Regions. It has magical potential to heal many human diseases with cardiatonic, anticarcinomic, anti jaundice, anti dropsy, anti asthmatic, anti epileptic, dermatological and diuretic properties. Besides it has abortifacient effects and affects on menstrual cycle. It also finds its use as pesticides against fungus, insects and rats. Wide genetic and chromosomal variations were also still being researched to differentiate the different populations of Urginea. The biodiversity and germplasm collection is also a major area of emphasis to protect the rare genus. The basic taxonomic work to higher molecular developmental studies are still being explored in this genus. It is also a great source for many organic compounds yet to be characterized and discovered for its extensive possibility as potential bioactive molecule. The genetic variability and genomic studies are still being a hot topic in research

A novel school-based intervention to improve nutrition knowledge in children: cluster randomised controlled trial.

BACKGROUND: Improving nutrition knowledge among children may help them to make healthier food choices. The aim of this study was to assess the effectiveness and acceptability of a novel educational intervention to increase nutrition knowledge among primary school children. METHODS: We developed a card game 'Top Grub' and a 'healthy eating' curriculum for use in primary schools. Thirty-eight state primary schools comprising 2519 children in years 5 and 6 (aged 9-11 years) were recruited in a pragmatic cluster randomised controlled trial. The main outcome measures were change in nutrition knowledge scores, attitudes to healthy eating and acceptability of the intervention by children and teachers. RESULTS: Twelve intervention and 13 control schools (comprising 1133 children) completed the trial. The main reason for non-completion was time pressure of the school curriculum. Mean total nutrition knowledge score increased by 1.1 in intervention (baseline to follow-up: 28.3 to 29.2) and 0.3 in control schools (27.3 to 27.6). Total nutrition knowledge score at follow-up, adjusted for baseline score, deprivation, and school size, was higher in intervention than in control schools (mean difference = 1.1; 95% CI: 0.05 to 2.16; p = 0.042). At follow-up, more children in the intervention schools said they 'are currently eating a healthy diet' (39.6%) or 'would try to eat a healthy diet' (35.7%) than in control schools (34.4% and 31.7% respectively; chi-square test p < 0.001). Most children (75.5%) enjoyed playing the game and teachers considered it a useful resource. CONCLUSIONS: The 'Top Grub' card game facilitated the enjoyable delivery of nutrition education in a sample of UK primary school age children. Further studies should determine whether improvements in nutrition knowledge are sustained and lead to changes in dietary behaviour.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Premenopausal abnormal uterine bleeding and risk of endometrial cancer.

BACKGROUND: Endometrial biopsies are undertaken in premenopausal women with abnormal uterine bleeding but the risk of endometrial cancer or atypical hyperplasia is unclear. OBJECTIVES: To conduct a systematic literature review to establish the risk of endometrial cancer and atypical hyperplasia in premenopausal women with abnormal uterine bleeding. SEARCH STRATEGY: Search of PubMed, Embase and the Cochrane Library from database inception to August 2015. SELECTION CRITERIA: Studies reporting rates of endometrial cancer and/or atypical hyperplasia in women with premenopausal abnormal uterine bleeding. DATA COLLECTION AND ANALYSIS: Data were independently extracted by two reviewers and cross-checked. For each outcome, the risk and a 95% CI were estimated using logistic regression with robust standard errors to account for clustering by study. MAIN RESULTS: Sixty-five articles contributed to the analysis. Risk of endometrial cancer was 0.33% (95% CI 0.23-0.48%, n = 29 059; 97 cases) and risk of endometrial cancer or atypical hyperplasia was 1.31% (95% CI 0.96-1.80, n = 15 772; 207 cases). Risk of endometrial cancer was lower in women with heavy menstrual bleeding (HMB) (0.11%, 95% CI 0.04-0.32%, n = 8352; 9 cases) compared with inter-menstrual bleeding (IMB) (0.52%, 95% CI 0.23-1.16%, n = 3109; 14 cases). Of five studies reporting the rate of atypical hyperplasia in women with HMB, none identified any cases. CONCLUSIONS: The risk of endometrial cancer or atypical hyperplasia in premenopausal women with abnormal uterine bleeding is low. Premenopausal women with abnormal uterine bleeding should first undergo conventional medical management. Where this fails, the presence of IMB and older age may be indicators for further investigation. Further research into the risks associated with age and the cumulative risk of co-morbidities is needed. TWEETABLE ABSTRACT: Contrary to practice, premenopausal women with heavy periods or inter-menstrual bleeding rarely require biopsy.The work was undertaken under the auspices of the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence which is funded by the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust

Inclusive Urbanisation and Cities in the Twenty-First Century

In academic and policy discourse, urbanisation and cities are currently receiving a great deal of attention, and rightly so. Both have been central to the enormous transformation the world has been going through during the past few centuries. Many parts of the world have experienced and are experiencing an urban transformation. While these processes have taken distinct regional forms across Latin America, East and South Asia, and Africa, it is clear that, globally, the urban transformation has coincided with major societal and ecological changes. Some of these developments have been heralded as progress – notably millions of people being lifted out of poverty – while others, such as entrenching inequalities and accelerating climate change, are alarming. In recent years the pro-urban voices have been louder, but accounts of the wonders of cities need to be balanced with a recognition of the violence, inequity and environmentally destructive forces that cities can embody and reproduce. Equally important is to explore how cities and urbanisation can be made to contribute more to human wellbeing and to international and local development goals. This report is particularly concerned with whether and under what conditions more inclusive urbanisation and cities can support these development goals.UK Department for International Developmen

Cardiotonic Activity of Coconut Water (Cocos nucifera)

The coconut (Cocos nucifera) is a member of the family Arecaceae (Palm family). Various parts of this tree is used in the treatment of, cancer (due to hexane fraction of coconut peel), indomethacin-induced ulceration (coconut milk).Coconut water consumption reduces diastolic blood pressure (due to the presence of potassium).In the present work fresh coconut water, dilution 1:1(coconut water: distilled water), are used to evaluate cardiac activity on the isolated frog heart and are labeled as T1, & T2 respectively and compared with Digoxin (S1) as standard solution. It was found that sample T1(Undiluted coconut water) showed better response as compared to the diluted coconut water(T2).These preliminary studies confirm the cardiotonic activity of the coconut water(Cocos nucifera)

(3R*,4R*,5S*)-4-(4-Methyl­phen­yl)-2,3-diphenyl-7-[(R*)-1-phenyl­ethyl]-1-oxa-2,7-diaza­spiro­[4.5]decan-10-one oxime

In the title compound, C34H35N3O2, the polysubstituted piperidine ring adopts a chair conformation and the isoxazolidine ring is in an envelope form. The mol­ecules are linked into a chain along the b axis by O—H⋯N, C—H⋯O and C—H⋯N inter­actions. The chains are cross-linked via weak C—H⋯π inter­actions

The Role of MAPKs in B Cell Receptor-Induced Down-Regulation of Egr-1 in Immature B Lymphoma Cells

Cross-linking of the B cell receptor (BCR) on the immature B lymphoma cell line BKS-2 induces growth inhibition and apoptosis accompanied by rapid down-regulation of the immediate-early gene egr-1. In these lymphoma cells, egr-1 is expressed constitutively and has a prosurvival role, as Egr-1-specific antisense oligonucleotides or expression of a dominant-negative inhibitor of Egr-1 also prevented the growth of BKS-2 cells. Moreover, enhancement of Egr-1 protein with phorbol 12-myristate 13-acetate or an egr-1 expression vector rescued BKS-2 cells from BCR signal-induced growth inhibition. Nuclear run-on and mRNA stability assays indicated that BCR-derived signals act at the transcriptional level to reduce egr-1 expression. Inhibitors of ERK and JNK (but not of p38 MAPK) reduced egr-1 expression at the protein level. Transcriptional regulation appears to have a role because egr-1 promoter-driven luciferase expression was reduced by ERK and JNK inhibitors. Promoter truncation experiments suggested that several serum response elements are required for MAPK-mediated egr-1 expression. Our study suggests that BCR signals reduce egr-1 expression by inhibiting activation of ERK and JNK. Unlike ERK and JNK, p38 MAPK reduces constitutive expression of egr-1. Unlike the immature B lymphoma cells, normal immature B cells did not exhibit constitutive MAPK activation. BCR-induced MAPK activation was modest and transient with a small increase in egr-1 expression in normal immature B cells consistent with their inability to proliferate in response to BCR cross-linking