An interesting case of external type of coxa saltans treated by z plasty of iliotibial band-a case report

Coxa saltans commonly known as snapping hip is a nagging illness which can physically and mentally hinder patients life. A snapping hip (coxa saltans) secondary to a tight iliotibial band rarely needs surgical release since most cases respond well to conservative management. The purpose of this study is to present the surgical results of refractory external-type snapping hip by Z-plasty of the iliotibial band. We present a case report of 47-year-old lady who was diagnosed to have snapping hip of external type who was treated with Brignall and stainsby technique of Z plasty. The surgical results of Z-plasty are excellent and predictable. Careful examination is necessary to rule out other causes. Z-plasty is recommended as an effective surgical treatment of the refractory snapping hip

Management of Extra Articular Distal Tibial Metaphyseal Fractures by Intramedullary Interlocking Nailing: A Short Term Analysis

INTRODUCTION: Fractures of tibia remain a controversial subject despite advances in both non-operative and operative care. The goal in expert care is to realign the fracture, realign limb length and early functional recovery. Treatment of distal tibial metaphyseal fractures can be challenging. Fractures in this region have not been clearly distinguished from pilon fractures, and the literature contains relatively little information on their treatment 28.31.32. The mechanism of injury, treatment principles and prognosis for these fractures is different from and must be distinguished from those for both proximal diaphyseal fractures and distal intra-articular pilon fractures 5. Treatment selection is influenced by the proximity of the fracture to the plafond, fracture displacement, comminution, and injury to the soft-tissue envelope. AIM: To analyse the short term results of intramedullary interlocking nailing in the management of extra articular distal tibial metaphyseal fractures done in our institution during the period February 2005 to August 2007. MATERIALS AND METHODS: This study was designed to review the outcomes of the treatment of extraarticular distal tibial metaphyseal fractures by intramedullary interlocking nailing. From Feb 2005 to Aug 2007, 28 consecutive extraarticular distal tibial metaphyseal fractures in skeletally matured patients managed by primary locked intramedullary nailing. Inclusion criteria were, fracture sustained within the past 1 week, skeletal maturity, fracture centre in the distal metaphysis of tibia involving the distal 5 cm , associated fibular fracture and treatment with an intramedullary nail of the fracture pattern that allowed placement of atleast 2 distal interlocking screws through the nail. Patients with neglected fractures (more than 3 weeks), non union, and patient with multiple injuries or a history of previous knee or ankle pathology were not included as were patients who sustained high energy axial load injury causing disruption or impaction of the ankle plafond. Patients suffering from open fractures underwent debridement and primary closure followed by stabilisation. Closed fractures were initially managed by reduction and application of splint followed by operative treatment to decrease the soft tissue swelling. All patients were given I.V third generation cephalosporin during induction wich was continued for 3-5 days post operatively. The average time from the moment of injury to the operative fixation of fracture was 12 days (range 6 hrs to 20 days). RESULTS: The mean follow up was 14 months (range 3m to 26 m).The average distance from the distal extent of the tibial fracture to the plafond was 4.8 cm (range, 4.2 cm to 5.8 cm). The average distance between the distal tip of the nail and the articular surface of the plafond was 12 mm (range, 4 to 15 mm). The decision for adjunctive fibular stabilisation as well as the number and orientation of the distal locking bolts were made at the surgeon’s discretion. Fibular plating was done in 10 patients. Two distal locking bolts were used in 26 patients; 2 patients had three distal locking bolts. CONCLUSION: Intramedullary nailing is a safe and effective technique for the treatment of extra articular distal metaphyseal tibial fractures if careful preoperative planning is allied with meticulous surgical technique. Acceptable alignment of the short distal fragment during surgery is necessary for good functional outcome. Knowledge and recognition of inherent instability of the short distal fragment is necessary to enable stable fixation and avoid loss of reduction on follow up. We propose a new classification to aid stable fixation of the distal fragment by fibular plating. Prospective, randomized, clinical trials are needed to determine the outcomes of metohods of internal fixation in the management of extra articular distal metaphyseal tibial fractures

Method Development and Validation of Related Substances for the Simultaneous Estimation of Atorvastatin and Ezetimibe in Tablet Dosage Form by RP-HPLC

In this study, RP-HPLC based Related substances method was developed for the simultaneous estimation of Atorvastatin calcium and Ezetimibe in tablet dosage form and validated according to ICH guidelines. There was no compendial methods available for the determination of Atorvastatin and Ezetimibe in pharmaceutical dosage form. From the literature review, it was evident that very few simultaneous estimation of Related substances methods were reported in articles for determining Atorvastatin and Ezetimibe. The reported simultaneous estimation of Related substances methods make use of C18 and C8 column of different dimension for the separation of analyte and the impurity. Most reversed phase separation are carried out using a polar solvents such as methanol or acetonitrile as mobile phase with peak shape modifiers. Comparatively in our study C18 column with Buffer and organic modifier Acetonitrile alone are utilised for the efficient separation of analyte and the impurity in a single run. In order to obtain the complete separation of Impurity peaks from the significant main peaks the retention time values of both the analytes should be well separated so that there may not be overlapping of peaks. The developed method is superior over other reported methods in terms of resolution between analyte and impurity peak, retention time and sensitivity. The related substances estimation of this In-house formulation was performed and the percentage purity of Atorvastatin and Ezetimibe was found to be 100.09%. Hence the developed method was reported and was validated as per ICH guidelines. CONCLUSION: A simple, rapid, novel and precise method using RP-HPLC technique was developed for the determination and simultaneous estimation of Related Substances in Atorvastatin calcium and Ezetimibe in tablet dosage form. The proposed method was validated according to ICH guidelines with the validation parameters such as accuracy, precision, robustness, precision, specificity. The percentage Impurities was within the limit for commercial tablets and the Impurity peaks do not interfere with significant main peaks. The proposed method was used for routine analysis and quality control analysis of pharmaceutical preparations. The identification of unknown impurity peaks may be taken up as further research in this study

A flap graft technique for the reconstruction of extensor mechanism of the knee in a case of peri-articular synovial sarcoma managed by limb salvage

Synovial sarcoma is a malignant soft tissue tumour arising from the primitive mesenchymal cells which has a delayed progression has a slow progression and often mis-diagnosed. A fifty-two years old female presented with complaint of swelling, pain and inability to move her left knee for three years duration. Presented with recurrence for which Wide excision of the tumour, with reconstruction of knee using custom mega-prosthesis and extensor mechanism reconstruction was done. Patient had a good functional outcome and no recurrence

Antecedents of psychological capital: The role of work design

Aim/purpose – Though psychological capital has become a hot topic in the recent years, scholars have given little attention to its antecedents. This study used the job characteristics model (Hackman & Oldham, 1975) as a framework to examine the relationship between the five job characteristics and the four components of psychological capital. Moreover, task performance is examined as an outcome of psychological capital. Design/methodology/approach – Using structural equation modelling, data were ob-tained from Egyptian professionals (N = 251). The survey included measures of psychological capital and job characteristics as well as task performance, which was rated by employees’ supervisors. Findings – Results indicate that the five job characteristics of skill variety, task significance, job feedback, job identity and job autonomy are positively related to the four components of psychological capital. Moreover, hope, self-efficacy and resilience were positively related to task performance. However, Egyptian employees’ optimism was not found to be related to task performance. Research implications/limitations – Results contribute to a better understanding of what enhances psychological capital in the workplace. Originality/value/contribution – The current study is the first to integrate the theory of work design with the psychological capacities of hope, optimism, resilience and self-efficacy. Research on the development of psychological capital has been limited to interventions with little or no attention given to macro or organisational factors that could contribute to its enhancement. Moreover, it is the first to link psychological capital to job performance in an Arab country

Chemosensetizing and cardioprotective effects of resveratrol in doxorubicin- treated animals

BACKGROUND: Doxorubicin (DOX), an anthracycline antibiotic is one of the most effective anticancer drug used in the treatment of variety of cancers .Its use is limited by its cardiotoxicity. The present study was designed to assess the role of a natural product resveratrol (RSVL) on sensitization of mammary carcinoma (Ehrlich ascites carcinoma) to the action of DOX and at the same time its protective effect against DOX-induced cardiotoxicity in rats. METHODS: Ehrlich ascites carcinoma bearing mice were used in this study. Percent survival of tumor bearing mice was used for determination of the Cytotoxic activity of DOX in presence and absence of RSVL. Uptake and cell cycle effect of DOX in tumor cells in the presence of RSVL was also determined. Histopatholgical examination of heart tissues after DOX and/or RSVL therapy was also investigated. RESULTS: DOX at a dose level of 15 mg/kg increased the mean survival time of tumor bearing mice to 21 days compared with 15 days for non tumor-bearing control mice. Administration of RSVL at a dose level of 10 mg/kg simultaneously with DOX increased the mean survival time to 30 days with 70% survival of the tumor-bearing animals. RSVL increased the intracellular level of DOX and there was a strong correlation between the high cellular level of DOX and its cytotoxic activity. Moreover, RSVL treatment showed 4.8 fold inhibition in proliferation index of cells treated with DOX. Histopathological analysis of rat heart tissue after a single dose of DOX (20 mg/kg) showed myocytolysis with congestion of blood vessels, cytoplasmic vacuolization and fragmentation. Concomitant treatment with RSVL, fragmentation of the muscle fiber revealed normal muscle fiber. CONCLUSION: This study suggests that RSVL could increase the cytotoxic activity of DOX and at the same time protect against its cardiotoxicity

Clinicopathological and prognostic significance of mitogen-activated protein kinases (MAPK) in breast cancers

Background Mitogen-activated protein kinases (MAPKs) are signalling transduction molecules that have different functions and diverse behaviour in cancer. In breast cancer, MAPK is related to oestrogen receptor (ER) and HER2. Methods Protein expression of a large panel of MAPKs (JNK1/2, ERK, p38, C-JUN and ATF2 including phosphorylated forms) were assessed immunohistochemically in a large (n = 1400) and well-characterised breast cancer series prepared as tissue microarray. Moreover, reverse phase protein array was applied to quantify protein expression of MAPKs in six breast cancer cell lines with different phenotypes including HER2-transfected cells. Results MAPKs expression was associated with clinicopathological variables characteristic of good prognosis. These associations were most significant in the whole series and in the ER? subgroup compared to other BC classes. Most of MAPKs showed a positive association with ER, BCL2 and better outcome and were negatively associated with the proliferation marker Ki67 and p53. Association of MAPK with HER2 was mainly seen in the ER- subgroup. Reverse phase protein array confirmed immunohistochemistry results and revealed differential expression of MAPK proteins in ER? and ER- cell lines. Conclusions MAPKs are associated with good prognosis and their expression is mainly related to ER. Studying a large panel rather than individual biomarkers may provide improved understanding of the pathwa

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Left Main Coronary Artery Revascularization in Patients with Impaired Renal Function: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting

Introduction: The evidence about the optimal revascularization strategy in patients with left main coronary artery (LMCA) disease and impaired renal function is limited. Thus, we aimed to compare the outcomes of LMCA disease revascularization (percutaneous coronary intervention [PCI] vs. coronary artery bypass grafting [CABG]) in patients with and without impaired renal function. Methods: This retrospective cohort study included 2,138 patients recruited from 14 centers between 2015 and 2,019. We compared patients with impaired renal function who had PCI (n= 316) to those who had CABG (n = 121) and compared patients with normal renal function who had PCI (n = 906) to those who had CABG (n = 795). The study outcomes were in-hospital and follow-up major adverse cardiovascular and cerebrovascular events (MACCE). Results: Multivariable logistic regression analysis showed that the risk of in-hospital MACCE was significantly higher in CABG compared to PCI in patients with impaired renal function (odds ratio [OR]: 8.13 [95% CI: 4.19–15.76], p < 0.001) and normal renal function (OR: 2.59 [95% CI: 1.79–3.73]; p < 0.001). There were no differences in follow-up MACCE between CABG and PCI in patients with impaired renal function (HR: 1.14 [95% CI: 0.71–1.81], p = 0.585) and normal renal function (HR: 1.12 [0.90–1.39], p = 0.312). Conclusions: PCI could have an advantage over CABG in revascularization of LMCA disease in patients with impaired renal function regarding in-hospital MACCE. The follow-up MACCE was comparable between PCI and CABG in patients with impaired and normal renal function

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication