Epidemiology of Shigella-Associated diarrhea in Gorgan, north of Iran

Objective : Shigella is an important etiological agent for diarrhea and especially dysentery. Shigellosis is an intestinal infection that is a major public health problem in many developing countries. The aim of this study was to evaluate the prevalence of Shigella and its various species in diarrheal samples in Gorgan located in the north of Iran. Materials and Methods: Between January-December 2005, the epidemiology of Shigella- associated diarrhea was studied among 634 patients in Gorgan. The diarrheal samples accompanied with a questionnaire, which contained the demographic and main symptoms of the patients, were transported to the laboratory and inoculated in different culture media. Colonies suspected to be of Shigella were detected using differential biochemical tests and subsequently, the serotype of Shigella was defined using antisera. Results : Shigella was isolated from 56/634 diarrheal samples) (8.8%) of which S. sonnei was the predominant species (55%). Occurrence of Schigella was highest in the 2-5 years′ age group (70.9%) and highest in summer (73.2%) with the most frequent clinical manifestation being abdominal pain (67.8%). The prevalence of Shigella in males and females was 8 and 9.8% respectively, but this difference was not statistically significant. Conclusion: It has been shown that Shigella sonnei is the most common Shigella serogroup among 2-5 year-old children in Gorgan. It is therefore suggested that hygienic training be given to childcare attendants and the children themselves

Minimal Invasive Ostheosintesis For Treatment Of Diaphiseal Transverse Humeral Shaft Fractures

Objective: To evaluate patients with transverse fractures of the shaft of the humerus treated with indirect reduction and internal fixation with plate and screws through minimally invasive technique. Methods: Inclusion criteria were adult patients with transverse diaphyseal fractures of the humerus closed, isolated or not occurring within 15 days of the initial trauma. Exclusion criteria were patients with compound fractures. Results: In two patients, proximal screw loosening occurred, however, the fractures consolidated in the same mean time as the rest of the series. Consolidation with up to 5 degrees of varus occurred in five cases and extension deficit was observed in the patient with olecranon fracture treated with tension band, which was not considered as a complication. There was no recurrence of infection or iatrogenic radial nerve injury. Conclusion: It can be concluded that minimally invasive osteosynthesis with bridge plate can be considered a safe and effective option for the treatment of transverse fractures of the humeral shaft. Level of Evidence III, Therapeutic Study.2229498Angelini, A.J., Livani, B., Flierl, M.A., Morgan, S.J., Belangero, W.D., Less invasive percutaneous wave plating of simple femur shaft fractures. A prospective series (2010) Int Orthop., 41 (6), pp. 624-628Heitemeyer, U., Claes, L., Hierholzer, G., Körber, M., Significance of postoperativestability for bony reparation of comminuted fractures. An experimental study Arch Orthop Trauma Surg., 1990 (3), pp. 144-149Gerber, C., Mast, J.W., Ganz, R., Biological internal fixation of fractures (1990) Arch Orthop Trauma Surg., 109 (6), pp. 295-303Miclau, T., Martin, R.E., The evolution of modern plate osteosynthesis (1997) Injury., 28 (SUPPL. 1), pp. A3-6Farouk, O., Krettek, C., Miclau, T., Schandelmaier, P., Guy, P., Tscherne, H., Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study (1997) Injury, 28 (SUPPL. 1), pp. A7-12Farouk, O., Krettek, C., Miclau, T., Schandelmaier, P., Guy, P., Tscherne, H., Minimally invasive plate osteosynthesis: does percutaneous plating disrupt femoral blood supply less than the traditional technique? (1999) J Orthop Trauma., 13 (6), pp. 401-406Perren, S.M., Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology (2002) J Bone Joint Surg Br., 84 (8), pp. 1093-1110Livani, B., Belangero, W.D., Bridging plate osteosynthesis of humeral shaft fractures (2004) Injury., 35 (6), pp. 587-595Apivatthakakul, T., Arpornchayanon, O., Bavornratanavech, S., Minimally invasive plate osteosynthesis (MIPO) of the humeral shaft fracture. Is it possible? A cadaveric study and preliminary report (2005) Injury., 36 (4), pp. 530-538Apivatthakakul, T., Patiyasikan, S., Luevitoonvechkit, S., Danger zone for locking screw placement in minimally invasive plate osteosynthesis (MIPO) of humeral shaft fractures: a cadaveric study (2010) Injury., 41 (2), pp. 169-172Livani, B., Belangero, W.D., Castro de Medeiros, R., Fractures of the distal third of the humerus with palsy of the radial nerve: management usingn minimally- invasive percutaneous plate osteosynthesis (2006) J Bone Joint Surg Br., 88 (12), pp. 1625-1628Ziran, B.H., Belangero, W., Livani, B., Pesantez, R., Percutaneous plating of the humerus with locked plating: technique and case report (2007) J Trauma., 63 (1), pp. 205-210Schwarz, N., Windisch, M., Mayr, B., Minimally Invasive anterior plate osteosynthesis in humeral shaft fractures (2009) Eur J Trauma Emerg Surg., 35 (3), pp. 271-276Concha, J.M., Sandoval, A., Streubel, P.N., Minimally invasive plate osteosynthesis for humeral shaft fractures: are results reproducible? (2010) Int Orthop., 34 (8), pp. 1297-1305Hudak, P.L., Amadio, P.C., Bombardier, C., Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG) (1996) Am J Ind Med., 29 (6), pp. 602-608Thompson (1918) e Henry (1924 e 1966) - The humerus (2003) Surgical Exposures in Orthopaedics, pp. 67-103. , in: Hoppenfeld S., De Boer P., The anatomic Approach 3rd Ed;Charpter 2Livani, B., Belangero, W.D., Osteossíntese de fratura diafisária do úmero com placa em ponte: apresentação e descrição da técnica (2004) Acta Ortop Bras., 12 (2), pp. 113-117Gustilo, R.B., Anderson, J.T., Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses (1976) J Bone Joint Surg Am., 58 (4), pp. 453-458Gustilo, R.B., Mendoza, R.M., Williams, D.N., Problems in the management of type III (severe) open fractures: a new classification of type III open fractures (1984) J Trauma., 24 (8), pp. 742-746Benegas, E., Amódio, D.T., Correia, L.F.M., Malavolta, E.A., Ramadan, L.B., Ferreira Neto, A.A., Estudo comparativo prospectivo e randomizado entre o tratamento cirúrgico das fraturas diafisárias do úmero com placa em ponte e haste intra medular bloqueada (analise preliminar) (2007) Acta Ortop Bras., 15 (2), pp. 87-92Kobayashi, M., Watanabe, Y., Matsushita, T., Early full range of shoulder and elbow motion is possible after minimally invasive plate osteosynthesis for humeral shaft fractures (2010) J Orthop Trauma., 24 (4), pp. 212-216Hunsaker, F.G., Cioffi, D.A., Amadio, P.C., Wright, J.G., Caughlin, B., The American academy of orthopaedic surgeons outcomes instruments: normative values from the general population (2002) J Bone Joint Surg Am., 84 (2), pp. 208-21

Use Of The Vascularized Iliac-crest Flap In Musculoskeletal Lesions.

Bone loss was in the past treated by several methods, such as bone distraction and the use of nonvascularized or tissue-bank bone grafts. With the advent of modern microsurgical techniques, the vascularized bone flap has been used with good results; it resolves local nutritional problems, repairs soft tissue that is often damaged by severe trauma, and treats bone loss due to tumors, pseudarthroses, and osteomyelitis. This paper reports the authors' experience with the use of vascularized iliac-crest flaps to treat orthopedic pathologies in five patients with traumatic bone loss (<10 cm), three with osteomyelitis, and three with atrophic nonunion. In all cases, the same surgeon obtained a vascularized iliac-crest flap with a pedicle based on the deep iliac circumflex artery. All flaps consolidated within a mean period of 3 months. These findings demonstrate that the use of an iliac-crest flap is a treatment option in cases of bone loss and that it is associated with good functional results and minimal donor-site morbidity.201323714

No evidence of association between CTLA-4 polymorphisms and systemic lupus erythematosus in Iranian patients

Aim: Cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) is an important negative regulator of T-cell responses. CTLA-4 polymorphisms have been confirmed to be associated with several autoimmune diseases such as systemic lupus erythematosus (SLE). We analyzed the role of CTLA-4 polymorphism at positions -1661 and -1722 in Iranian patients suffering from SLE. Methods: One hundred and eighty SLE patients and 304 ethnically and age-matched healthy controls were studied. Polymerase chain reaction restriction fragments length polymorphism (PCR-RFLP) was used to analyze the genotype and allele frequencies of these polymorphisms. Results: There was no significant association between the studied genotypic and allelic frequencies between SLE patients and the controls. Although the TC genotype in 1722TC polymorphism was more common among the control group, the correlation was not statistically significant. Conclusion: Our results suggest that the -1661AG and -1722TC polymorphisms in the promoter region of the CTLA-4 gene does not play any role in genetic susceptibility to SLE. However, further studies on larger sample sizes are needed to approve our results. © 2013 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd

EXOGEN ultrasound bone healing system for long bone fractures with non-union or delayed healing: a NICE medical technology guidance

Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.This article has been made available through the Brunel Open Access Publishing Fund.A routine part of the process for developing National Institute for Health and Care Excellence (NICE) medical technologies guidance is a submission of clinical and economic evidence by the technology manufacturer. The Birmingham and Brunel Consortium External Assessment Centre (EAC; a consortium of the University of Birmingham and Brunel University) independently appraised the submission on the EXOGEN bone healing system for long bone fractures with non-union or delayed healing. This article is an overview of the original evidence submitted, the EAC’s findings, and the final NICE guidance issued.The Birmingham and Brunel Consortium is funded by NICE to act as an External Assessment Centre for the Medical Technologies Evaluation Programme

Can spontaneous pneumothorax be resolved in COVID-19 without hospital care? A case report

Background: We encountered the novel coronavirus infection as a pandemic in 2020. The infection started in Wuhan, China, and spread rapidly all over the world. CT scan has been used as an important diagnostic method in the detection of suspicious patients. One of the uncommon complications of coronavirus disease 2019 (COVID-19) is pneumothorax. Case presentation: A 47-year-old smoker male with COVID-19 diagnosis, good general condition and no respiratory complaint, complicated by pneumothorax. He refused hospitalization. After educating him about the red flags and quarantine protocols, he continued treatment at home .Cap amoxicillin/clavulanic acid 625mg was prescribed for one week. A follow-up CT represented only small involvement of lungs. Pneumothorax was resolved spontaneously without any medical intervention and hospitalization. O2 saturation was in normal range an there was no dry cough anymore. Conclusion: According to our clinical experience, pneumothorax is resolved spontaneously in a COVID-19 case. Considering general status and hemodynamic stability, it is suggested to reduce invasive interventions in COVID-19 cases with pneumothorax. © The Author(s

Scaphoid Fracture Nonunion: Correlation Of Radiographic Imaging, Proximal Fragment Histologic Viability Evaluation, And Estimation Of Viability At Surgery: Diagnosis Of Scaphoid Pseudarthrosis

Purpose: The purpose of this study was to correlate the pre-operative imaging, vascularity of the proximal pole, and histology of the proximal pole bone of established scaphoid fracture non-union. Methods: This was a prospective non-controlled experimental study. Patients were evaluated pre-operatively for necrosis of the proximal scaphoid fragment by radiography, computed tomography (CT) and magnetic resonance imaging (MRI). Vascular status of the proximal scaphoid was determined intra-operatively, demonstrating the presence or absence of puncate bone bleeding. Samples were harvested from the proximal scaphoid fragment and sent for pathological examination. We determined the association between the imaging and intra-operative examination and histological findings. Results: We evaluated 19 male patients diagnosed with scaphoid nonunion. CT evaluation showed no correlation to scaphoid proximal fragment necrosis. MRI showed marked low signal intensity on T1-weighted images that confirmed the histological diagnosis of necrosis in the proximal scaphoid fragment in all patients. Intra-operative assessment showed that 90 % of bones had absence of intra-operative puncate bone bleeding, which was confirmed necrosis by microscopic examination. Conclusions: In scaphoid nonunion MRI images with marked low signal intensity on T1-weighted images and the absence of intra-operative puncate bone bleeding are strong indicatives of osteonecrosis of the proximal fragment.3916772Chang, M., Bishop, A., Moran, S., The outcomes and complications of 1,2-intercompartmental supraretinacular artery pedicled vascularized bone grafting of scaphoid nonunions (2006) J Hand Surg [Am], 31, pp. 387-396Dias, J., Brenkel, I., Finlay, D., Patterns of union in fractures of the waist of the scaphoid (1989) J Bone Joint Surg, 71B, pp. 307-310Compson, J., The anatomy of acute scaphoid fractures. A three-dimensional analysis of patterns (1998) J Bone Joint Surg, 80-B, pp. 218-224Taljanovic, M., Karantanas, A., Griffith, J.F., DeSilva, G.L., Rieke, J.D., Sheppard, J.E., Imaging and treatment of scaphoid fractures and their complications (2012) Semin Musculoskelet Radiol, 16 (2), pp. 159-174. , PID: 22648431Geissler, W., Adams, J.E., Bindra, R.R., Lanzinger, W.D., Slutsky, D.J., Scaphoid fractures: what’s hot, what’s not (2012) Instr Course Lect, 61, pp. 71-84. , PID: 22301223Benis, J., Turpin, F., The role of imaging in the assessment of vascularity at hand and wrist (2010) Chir Main, 29, pp. S21-S27. , PID: 21075667Schmitt, R., Christopoulos, G., Wagner, M., Krimmer, H., Fodor, S., van Schoonhoven, J., Avascular necrosis (AVN) of the proximal segment in scaphoid nonunion: is intravenous contrast agent necessary in MRI (2011) Eur J Radiol, 77 (2), pp. 222-227. , COI: 1:STN:280:DC%2BC3M7ltFKksg%3D%3D, PID: 20965679Pao, V., Chang, J., Scaphoid nonunion: diagnosis and treatment (2003) Plast Reconstr Surg, 112, pp. 1666-1676. , PID: 14578801Alnot, J., Bellan, N., Oberlin, C., De Cheveigné, D.C., Fractures and nonunions of the proximal pole of the carpal scaphoid bone internal fixation by a proximal to distal screw (1988) Ann Chir Main, 7, pp. 101-108. , COI: 1:STN:280:DyaL1M%2FkvFarsQ%3D%3D, PID: 3190298Barton, N., Twenty questions about scaphoid fractures (1992) J Hand Surg (Br), 17, pp. 289-310. , COI: 1:STN:280:DyaK38zisFGqsA%3D%3DZaidemberg, C., Siebert, J., Angrigiani, C., A new vascularized bone graft for scaphoid nonunion (1991) J Hand Surg [Am], 16, pp. 474-478. , COI: 1:STN:280:DyaK3MzhvVSrsA%3D%3DDerby, B., Murray, P., Shin, A., Bueno, R., Mathoulin, C., Ade, T., Neumeister, M., Vascularized bone grafts for the treatment of carpal bone pathology (2013) J Hand Surg [Am], 8, pp. 27-40Green, D., The effect of avascular necrosis on Russe bone grafting for scaphoid nonunion (1985) J Hand Surg [Am], 10, pp. 597-605. , COI: 1:STN:280:DyaL28%2FgvFCksw%3D%3DImaeda, T., Nakamura, R., Miura, T., Makino, N., Magnetic resonance imaging in scaphoid fractures (1992) J Hand Surg (Br), 17, pp. 20-27. , COI: 1:STN:280:DyaK38zkvV2lsg%3D%3DSmith, M., Using computed tomography to assist with diagnosis of avascular necrosis complicating chronic scaphoid nonunion (2009) J Hand Surg [Am], 34, pp. 1037-1043Cerezal, L., Abascal, F., Canga, A., García-Valtuille, R., Bustamante, M., del Piñal, F., Usefulness of gadolinium-enhanced MR imaging in the evaluation of the vascularity of scaphoid nonunions (2000) Am J Roentgenol, 174, pp. 141-149. , COI: 1:STN:280:DC%2BD3c%2Fpt1Smsw%3D%3DQu, G., von Schroeder, H.P., Trabecular microstructure at the human scaphoid nonunion (2008) J Hand Surg [Am], 33 (5), pp. 650-655Ribak, S., Medina, C., Mattar, R., Ulson, H., Resende, M., Etchebehere, M., Treatment of scaphoid nonunion with vascularised and nonvascularised dorsal bone grafting from the distal radius (2010) Int Orthop, 34, pp. 683-688. , PID: 19730861Sakuma, M., Nakamura, R., Imaeda, T., Analysis of proximal segment sclerosis and surgical outcome of scaphoid non-union by magnetic resonance imaging (1995) J Hand Surg (Br), 20, pp. 201-205. , COI: 1:STN:280:DyaK2MzhvVGqsA%3D%3DFondi, C., Franchi, A., Definition of bone necrosis by the pathologist (2007) Clin Cases Miner Bone Metab, 4 (1), pp. 21-26. , PID: 22460748Marcus, R., Normal and abnormal bone remodeling in man (1987) Annu Rev Med, 38, pp. 129-141. , COI: 1:STN:280:DyaL2s3htFyjuw%3D%3D, PID: 3555287McClure, J., Smith, P., Consequences of avascular necrosis of the femoral head in aluminium-related renal osteodystrophy and the role of endochondral ossification in the repair process (1983) J Clin Pathol, 36, pp. 260-268. , COI: 1:STN:280:DyaL3s7js1ertg%3D%3D, PID: 6402524Parfitt, A., Drezner, M., Glorieux, F., Kanis, J., Malluche, H., Meunier, P., Ott, S., Recker, R., Bone histomorphometry: standardization of nomenclature, symbols, and units. Report of the ASBMR histomorphometry nomenclature committee (1987) J Bone Miner Res, 2 (6), pp. 595-610. , COI: 1:STN:280:DyaL1czjvVemsQ%3D%3D, PID: 3455637Schuind, F., Prognostic factors in the treatment of carpal scaphoid nonunions (1999) J Hand Surg [Am], 24, pp. 761-776. , COI: 1:STN:280:DyaK1MznsVygtg%3D%3DBuijze, G., Ochtman, L., Ring, D., Management of scaphoid nonunion (2012) J Hand Surg [Am], 37 (5), pp. 1095-1100Waitayawinyu, T., McCallister, W., Katolik, L., Schlenker, J., Trumble, T., Outcome after vascularized bone grafting of scaphoid nonunions with avascular necrosis (2009) J Hand Surg [Am], 34 (3), pp. 387-394Dinah, A., Vickers, R., Smoking increases failure rate of operation for established non-union of the scaphoid bone (2007) Int Orthop, 31 (4), pp. 503-505. , COI: 1:STN:280:DC%2BD2snjslKqtw%3D%3D, PID: 16947049Buchler, U., Nagy, L., The issue of vascularity in fractures and nonunion of the scaphoid (1995) J Hand Surg (Br), 20B (6), pp. 726-735Bilic, R., Simic, P., Jelic, M., Stern-Padovan, R., Dodig, D., van Meerdervoort, H., Martinovic, S., Vukicevic, S., Osteogenic protein-1 (BMP-7) accelerates healing of scaphoid non-union with proximal pole sclerosis (2006) Int Orthop, 30 (2), pp. 128-134. , COI: 1:STN:280:DC%2BD287mslGrtg%3D%3D, PID: 16506027Ricardo, M., The effect of ultrasound on the healing of muscle-pediculated bone graft in scaphoid non-union (2006) Int Orthop, 30 (2), pp. 123-127. , PID: 16474939Dawson, J., Martel, A., Davis, T., Scaphoid blood flow and acute fracture healing. A dynamic MRI study with enhancement with gadolinium (2001) J Bone Joint Surg (Br), 83 (6), pp. 809-814. , COI: 1:STN:280:DC%2BD3MvnvVKjtA%3D%3DPaul, P., O’Byrne, E., Blancuzzi, V., Wilson, D., Gunson, D., Douglas, F., Wang, L.Z., Mezrich, R., Magnetic resonance imaging reflects cartilage proteoglycan degradation in the rabbit knee (1991) Skelet Radiol, 20 (1), pp. 31-36. , COI: 1:STN:280:DyaK3M7lslSgsw%3D%3DDonati, O., Zanetti, M., Nagy, L., Bode, B., Schweizer, A., Pfirrmann, C., Is dynamic gadolinium enhancement needed in MR imaging for the preoperative assessment of scaphoidal viability in patients with scaphoid nonunion? (2011) Radiology, 260, pp. 808-816. , PID: 21712471Gunal, I., Ozcelik, A., Gokturk, E., Ada, S., Demirtas, M., Correlation of magnetic resonance imaging and intraoperative punctate bleeding to assess the vascularity of scaphoid nonunion (1999) Arch Orthop Trauma Surg, 119, pp. 285-287. , COI: 1:STN:280:DyaK1Mzns1Kmsw%3D%3D, PID: 10447624Maurer, P., Sandulescu, T., Kriwalsky, M., Rashad, A., Hollstein, S., Stricker, I., Hölzle, F., Kunkel, M., Bisphosphonate-related osteonecrosis of the maxilla and sinusitis maxillaris (2011) Int J Oral Maxillofac Surg, 40 (3), pp. 285-291. , COI: 1:STN:280:DC%2BC3M3hvFyisw%3D%3D, PID: 21163624Stahl, S., Hentschel, P.J., Held, M., Manoli, T., Meisner, C., Schaller, H.E., Santos Stahl, A., Characteristic features and natural evolution of Kienböck’s disease: five years’ results of a prospective case series and retrospective case series of 106 patients (2014) J Plast Reconstr Aesthet Surg, 67 (10), pp. 1415-142