Operative outcome of high energy pilon fractures: a retrospective comparison between internal fixation and Ilizarov external fixation

Background: Pilon fractures are serious injuries with many devastating soft-tissue complications associated with them. Deciding a definite treatment plan has always proved a challenge. Comparative studies between the various surgical techniques used for pilon fractures are uncommon and consensus is yet to be reached regarding the best surgical option. Purpose of this study is to retrospectively compare the operative results (complications, functional and radiographic outcomes) of pilon fractures treated either with internal fixation or Ilizarov ring fixators.Methods: Forty-six patients with pilon fractures were retrospectively studied; twenty-one of them had minimal invasive fixation by ankle spanning Ilizarov fixators and 25 patients had internal fixations by either minimal invasive plate osteosynthesis (MIPO) or by open reduction.  The patients were followed-up for a mean of 34 months (range, 24-51 months).Results: The internal fixation group had a higher incidence of soft-tissue complications and deep infections. In comparison the Ilizarov group had only superficial pin-tract infections but no other soft-tissue complications. Although the Ilizarov group had a higher incidence of malreduction and malunion in their series compared to the internal fixation group, there was no significant difference in the AOFAS ankle function score (p-value 0.2922) between the two groups after a follow-up of 2-4 years.Conclusions: The moderately long term functional outcome appears to be similar in both internal fixation and Ilizarov groups. But the Ilizarov technique is less likely to cause any serious peri-operative soft-tissue complications or deep infection. Familiarity of the surgeon with a particular technique should also be considered during surgical decision making.

Management of infected non-unions of long bones using limb reconstruction system (LRS) fixator

Background: Due to increasing number of high-energy traumatic events, the incidence of complex and compound fractures are also in the rise. Such fractures are often exposed to various environmental contaminants, inadequate debridement and sometimes erroneous decision making leading to cases of infected nonunions. Eradication of infection in such cases and achieving union may sometimes pose serious challenge to orthopaedic surgeons. Presence of comminution, bone gap or deformity can seriously complicate the situation. No definite surgical technique has been found to be full proof in dealing with these infected nonunion cases. In this scenario the limb reconstruction system (LRS) fixator is emerging as a useful option for infected nonunions with deformity or gap nonunion.Methods: Twenty seven cases of infected nonunions involving tibia (n=19), femur (n=7) and humerus (n=1) were treated by LRS fixators after debridement of the infected nonunion site. Flap cover procedure was done as per necessity. Bone gaps and limb length discrepancies were dealt with bone transport or limb lengthening by the LRS instrument. Weight-bearing and removal of fixator was decided according to the radiological evidence of healing.Results: All the nonunions and the regeneration sites healed uneventfully, although the union time was varied (range, 21-52 weeks). Commonest complication was pin-tract infection and pain. The mean lower extremity functional score (LEFS) was 60.3 out of 80. Conclusions: LRS fixator is an excellent tool for management of infected nonunions which is easy to apply, comfortable for the patient with minimum complications and predictable as well as reproducible outcomes

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

An Overview of Coronaviruses: In-Silico Approach to Decipher Anti-SARS-CoV-2 Natural Products

In current study, we have focused on the outline of different coronaviruses including COVID-19, along with potential therapeutic targets of SARC-CoV-2. Moreover, experimentally evident anti-coronavirus natural molecules were subjected for in silico screening against Mpro and RdRp of COVID-19, in order to predict effective cure agent for same.Docking analysis have revealed hit molecules namely tetra-O-galloyl-β-D-glucose (2) and juglanin (25) against main protease, in reference of N3 molecule (docking score = -5.95 Kcal/mol), while glycyrrhizin (1) and tetra-O-galloyl-β-D-glucose (2) are good against RdRp in reference of Remdesivir (docking score = -4.23 Kcal/mol). In-silico parameter revealed three lead compounds i.e. glycyrrhizin (1), tetra-O-galloyl-β-D-glucose (2) and juglanin (25) which can be seen as hopeful molecule for COVID-19 treatment in upcoming time. Overall review lesson is to develop a specific and effective drug molecule against the current crisis i.e. COVID-19 derived from natural source. <br /

Development of a Cost Effective Power Generation System: An Overview

This paper presents an overview on development of cost effective power generation system and motivates for development of a model for hybrid system with wind to investigate the combined operation of wind with different sources to cater to wind’s stochastic nature for imbalance minimization and optimal operation. Development of model for trading power in competitive electricity market and development of strategies for trading in electricity markets (wind energy and reserves markets) to investigate the effects of real time pricing tariffs on electricity market operation has been illustrated in this paper. Dynamic modelling related studies to investigate the wind generator’s kinetic energy for primary frequency support using simulink and simulation studies on doubly fed induction generator to study its capability during small disturbances / fluctuations on power system have been described

Performance and Analysis of Reactive Power Compensation by Unified Power Flow Controller

The Unified Power Flow Controller (UPFC) is the most versatile of the FACTS controllers envisaged so far. The main function of the UPFC is to control the flow of real and reactive power by injection of a voltage in series with the transmission line. Both the magnitude and the phase angle of the voltage can be varied independently. Real and Reactive power flow control can allow for power flow in prescribed routes, loading of transmission lines close to their thermal limits and can be utilized for improving transient and small signal stability of the power system. In this paper UPFC is incorporated in a SMIB (Single Machine Infinite Bus) system and the response of SMIB system has been recorded with and without UPFC, thereafter the comparison of both the output has been done. When no UPFC is installed, real and reactive power through the transmission line cannot be controlled. This paper presents control and performance of UPFC intended for installation on that transmission line to control power flow. Installing the UPFC makes it possible to control amount of active power flowing through the line. Simulations are carried out using MATLAB software to validate the performance of the UPFC

Infra-cardiac TAPVC with an intrahepatic portosystemic shunt: A rare association

Total anomalous pulmonary venous connection (TAPVC) is an uncommonly encountered cyanotic congenital heart disease characterized by anomalous drainage of the pulmonary veins. Concomitant venous anomalies are rarely found in these patients. We present a case of an infra-cardiac TAPVC with an intrahepatic portosystemic shunt, where a vascular channel was seen between the middle hepatic vein and the left branch of the portal vein with fusiform dilatation of the latter, diagnosed on computed tomography angiography

Epidemiology, Trends, Utilization Disparities, and Outcomes of Catheter Ablation and Its Association With Coronary Vasospasm Amongst Patients With Non-valvular Atrial Fibrillation: A Nationwide Burden of Last Decade.

BACKGROUND: Catheter ablation (CA) is an important curative treatment for non-valvular atrial fibrillation (NVAF), however, nationwide data on its utilization and disparities is limited. Coronary vasospasm is a rare, life-threatening, peri-operative complication of CA with limited literature in Caucasians. METHODS: We performed a retrospective study on adult hospitalizations in the USA from 2007 to 2017 by obtaining the data from National Inpatient Sample. The primary endpoints of our study were to identify the utilization rate of CA, disparities in utilization, and study the outcomes associated with CA. The secondary endpoints of the study were to identify the incidence of coronary vasospasm amongst patients who underwent CA, evaluate their association, and identify the predictors of coronary vasospasm. RESULTS: From 35,906,946 patients with NVAF, 343641 (0.96%) underwent CA. Its utilization decreased from 1% in 2007 to 0.71% in 2017. Patients who underwent CA, compared to those without CA, fared better in terms of hospital length of stay, mortality rate, disability rate, and discharge to the non-home facility. Patients in the 50-75 years age group, Native Americans, those with private insurance, and median household income of 76-100th percentile were associated with higher odds of CA utilization. Urban teaching hospitals and large-bedded hospitals performed more ablations, while the Mid-West region fared lower than the South, the West, and the Northeast. The prevalence of coronary vasospasm was higher amongst CA in comparison without CA, however, in regression analysis, no significant association was demonstrated between CA and coronary vasospasm. CONCLUSION: CA is an important treatment modality that is associated with improved clinical outcomes. Identification of factors associated with lower utilization of CA and its disparities will help to mitigate the burden associated with NVAF