Hand numbness and carpal tunnel syndrome after volar plating of distal radius fracture

We report the incidence of late onset post-operative carpal tunnel syndrome (late carpal tunnel syndrome) and late median nerve neuropathy after volar plating of distal radius fracture by conducting a retrospective study on volar plating for distal radius fracture performed during 2002 to 2006. Two hundred eighty-two volar plating were performed for acute distal radius fracture after exclusion. Post-operative hand numbness occurred in 24 patients of which nine had carpal tunnel syndrome. Thus, the incidence of late carpal tunnel syndrome was 3.2% (9/282). Of the eight (8/24, 33%) patients with post-operative hand numbness that failed to respond to conservative treatment, five had carpal tunnel release and three had neurolysis of median nerve at distal forearm. All had clinical improvement except in one patient. The incidence of late carpal tunnel syndrome after volar plating of distal radius in the present series is similar to the prevalence of carpal tunnel syndrome in general population. The incidence is low compared with other series, regardless of treatment method (conservative treatment, volar or dorsal plating). The outcome of post-operative hand numbness is generally favourable

Investigation of α-Cellulose Content of Sugarcane Scrappings and Bagasse as Tablet Disintegrant

The aim of this study is to investigate the physicochemical and disintegrant properties of α – cellulose obtained from sugarcane scrapings and bagasse. The mechanical and release properties of paracetamol tablets containing the extracted celluloses and two standard disintegrants- corn starch B.P and microcrystalline cellulose – were determined using crushing strength, friability, disintegration time, the time taken for 50% (T50) and 90% (T90) drug dissolution as assessment parameter. α – cellulose obtained from sugarcane scrapings and bagasse possess better flow properties than cornstarch and microcrystalline cellulose and are capable of absorbing up to five times their own weight in water and swell considerably. α – cellulose obtained from sugarcane scrapings and bagasse have high moisture sorption capacity and they formed relatively softer tablets which became increasingly harder as their concentration increased. All the tablets formulated with cellulose derived from sugarcane scrapings and bagasse passed the official disintegration test for uncoated tablets. Cellulose obtained from sugarcane bagasse had superior disintegrant property to cornstarch and microcrystalline cellulose while cellulose obtained from sugarcane scrapings showed comparable disintegrant property to microcrystalline cellulose. Tablets containing 2.5% w/w cellulose derived from sugarcane scrapings and 5.0% w/w cellulose derived from sugarcane bagasse gave more optimum result as tablet disintegrant. Formulations containing cellulose derived from sugarcane scrapings and bagasse show faster drug release (lower T50 and T90) than tablets containing corn starch and microcrystalline cellulose. There was a linear correlation between T90 and disintegration time (r = 0.976, p< 0.05) for tablets formulated with cellulose derived from sugarcane scrapings. Results show that α – cellulose obtained from sugarcane bagasse and scrapings are potentially useful as disintegrants in tablet formulations

Interventions delivered in secondary or tertiary medical care settings to improve routine vaccination uptake in children and young people:a scoping review

Objective To identify and analyse the interventions delivered opportunistically in secondary or tertiary medical settings, focused on improving routine vaccination uptake in children and young people. Design Scoping review. Search strategy We searched CINAHL, Web of Science, Medline, Embase and Cochrane Database of Systematic Reviews for studies in English published between 1989 and 2021 detailing interventions delivered in secondary or tertiary care that aimed to improve childhood vaccination coverage. Title, abstract and full-text screening were performed by two independent reviewers. Results After deduplication, the search returned 3456 titles. Following screening and discussion between reviewers, 53 studies were included in the review. Most papers were single-centre studies from high-income countries and varied considerably in terms of their study design, population, target vaccination, clinical setting and intervention delivered. To present and analyse the study findings, and to depict the complexity of vaccination interventions in hospital settings, findings were presented and described as a sequential pathway to opportunistic vaccination in secondary and tertiary care comprising the following stages: (1) identify patients eligible for vaccination; (2) take consent and offer immunisations; (3) order/prescribe vaccine; (4) dispense vaccine; (5) administer vaccine; (6) communicate with primary care; and (7) ongoing benefits of vaccination. Conclusions Most published studies report improved vaccination coverage associated with opportunistic vaccination interventions in secondary and tertiary care. Children attending hospital appear to have lower baseline vaccination coverage and are likely to benefit from vaccination interventions in these settings. Checking immunisation status is challenging, however, and electronic immunisation registers are required to enable this to be done quickly and accurately in hospital settings. Further research is required in this area, particularly multicentre studies and cost-effectiveness analysis of interventions