Fracture healing in Human Immunodeficiency Virus positive patients: the HIV in Orthopaedic Skeletal Trauma (HOST) study

Background: Human immunodeficiency virus (HIV) has been shown to reduce bone mineral density (BMD), mineralisation and bone turnover. In the HIV-negative population, reduced BMD is associated with delayed bone union and this may also be true in HIV infection. Previous clinical and basic science research has suggested an association between HIV infection and impaired fracture healing. However, the effect of HIV on bone healing is very poorly understood. The aim of this study was to establish whether HIV is a risk factor for the development of delayed bone union or non-union following a fracture. Methodology: The project aims were addressed with two related clinical studies undertaken at two tertiary referral hospitals in Cape Town, South Africa. 1. HIV in Orthopaedic Skeletal Trauma (HOST) 1 Study: Case-cohort study of participants undergoing fracture surgery: All adult participants with fresh tibia and femur fractures who underwent IM nailing for fracture fixation were eligible for inclusion over a 14-months period. Participants were evaluated at six weeks, and three, six, nine and 12 months post-operatively. The primary outcome was delayed bone union at six months (Radiological Union Score for the Tibia [RUST] score < 9) and the secondary outcome was non-union at months 9 (RUST score < 9). 2. HIV in Orthopaedic Skeletal Trauma (HOST) 2 Study: Matched case-control study of participants presenting with non-unions (RUST 9) within six months of injury. All study participants underwent HIV testing, with measurement of CD4 cell count and viral load and a history of anti-retroviral (ART) therapy if appropriate. Bone healing was assessed by two blinded independent reviewers, using the RUST scoring system. The odds of delayed and non-union by HIV group were estimated and compared using univariate and multivariable logistic regression. Results: 1. HOST 1 study: A final study population of 358/400 (89.5%) participants, who underwent 395/442 (89.4%) IM nailings were recruited over a 14-month period. All participants were followed up for a minimum of 12 months. 71 participants (71/358, 19.8%) were HIV-positive (83 IM nailings [83/395], 21.0%). HIV was not statistically significantly associated with the development of delayed bone healing following an IM nailing of the tibia or femur in this study population (univariate OR 0.76, [CI 0.37-1.44], p-value=0.417, multivariable OR 1.06 [CI 0.50-2.22], p-value=0.869). However, the HIVpositive participants had a statistically significant lower risk of non-union compared to HIV-negative (univariate OR 0.16 [CI 0.01-0.78], p-value = 0.076, multivariable OR 0.17 [CI 0.01-0.92], p-value = 0.100). 2. HOST 2 study: A total of 57 cases were matched with 57 controls, over a 14month period. The prevalence of HIV among cases was 7% (4/57) and was 15.8% (9/57) among controls, with an overall prevalence of 11.4% (13/114) in the study population. HIV status was not associated with the development of non-union following the management of tibia and femur fractures, on either univariate (OR 0.40 [CI 0.10-1.32], p-value = 0.151) or multivariable (OR 0.86 [CI 0.18-3.73], p-value = 0.831) logistic regression analysis. Conclusion: The HOST 1 and 2 studies demonstrate that HIV is not associated with the development of delayed union following fracture of the tibia or femur. Additionally, HIV-positive status appears to be associated with a lower risk of developing a non-union. Therefore, fractures sustained in HIV-positive individuals can be managed in the same way as those who are HIV-negative, with no increased risk of delayed or non-union. Future areas of research are indicated to assess the role of ART and CD4 cell count on fracture healing

Synthesis and reactivity of N-allenyl cyanamides

N-Allenyl cyanamides have been accessed via a one-pot deoxycyanamidation–isomerization approach using propargyl alcohol and N-cyano-N-phenyl-p-methylbenzenesulfonamide. The utility of this novel class of allenamide was explored through derivatization, with hydroarylation, hydroamination, and cycloaddition protocols employed to access an array of cyanamide products that would be challenging to access using existing methods

A micro-optical module for multi-wavelength addressing of trapped ions

The control of large-scale quantum information processors based on arrays of trapped ions requires a means to route and focus multiple laser beams to each of many trapping sites in parallel. Here, we combine arrays of fibres, 3D laser-written waveguides and diffractive microlenses to demonstrate the principle of a micro-optic interconnect suited to this task. The module is intended for use with an ion microtrap of 3D electrode geometry. It guides ten independent laser beams with unique trajectories to illuminate a pair of spatially separated target points. Three blue and two infrared beams converge to overlap precisely at each desired position. Typical relative crosstalk intensities in the blue are $3.6 \times 10^{-3}$ and the average insertion loss across all channels is $8~$dB. The module occupies $\sim 10^4$ times less volume than a conventional bulk-optic equivalent and is suited to different ion species

Clinical outcomes of ankle fractures in sub-Saharan Africa:a systematic review

Purpose Ankle fractures may cause disability and socioeconomic challenges, even when managed in a high-resource setting. The outcomes of ankle fractures in sub-Saharan Africa are not widely reported. We present a systematic review of the patient-reported outcomes and complications of patients treated for ankle fractures in sub-Saharan Africa. Methods Medline, Embase, Google Scholar and the Cochrane Central Register of Controlled Trials were searched, utilising MeSH headings and Boolean search strategies. Ten papers were included. Data included patient demographics, surgical and non-surgical management, patient-reported outcome measures and evidence of complications. Results A total of 555 patients with ankle fractures were included, 471 of whom were followed up (range 6 weeks–73 months). A heterogenous mix of low-quality observational studies and two methodologically poor-quality randomised trials demonstrated mixed outcomes. A preference for surgical management was found within the published studies with 87% of closed fractures being treated operatively. A total of five different outcome scoring systems were used. Most studies included in this review were published by well-resourced organisations and as such are not representative of the actual clinical practice taking place. Conclusion The literature surrounding the clinical outcomes of ankle fractures in sub-Saharan Africa is sparse. There appears to be a preference for surgical fixation in the published literature and considering the limitations in surgical resources across sub-Saharan Africa this may not be representative of real-life care in the region

Principles for the post-GWAS functional characterisation of risk loci

Several challenges lie ahead in assigning functionality to susceptibility SNPs. For example, most effect sizes are small relative to effects seen in monogenic diseases, with per allele odds ratios usually ranging from 1.15 to 1.3. It is unclear whether current molecular biology methods have enough resolution to differentiate such small effects. Our objective here is therefore to provide a set of recommendations to optimize the allocation of effort and resources in order maximize the chances of elucidating the functional contribution of specific loci to the disease phenotype. It has been estimated that 88% of currently identified disease-associated SNP are intronic or intergenic. Thus, in this paper we will focus our attention on the analysis of non-coding variants and outline a hierarchical approach for post-GWAS functional studies

Survey of ophthalmologists-in-training in Eastern, Central and Southern Africa: A regional focus on ophthalmic surgical education.

Background: There are 2.7 ophthalmologists per million population in sub-Saharan Africa, and a need to train more. We sought to analyse current surgical training practice and experience of ophthalmologists to inform planning of training in Eastern, Central and Southern Africa. Methods: This was a cross-sectional survey. Potential participants included all current trainee and recent graduate ophthalmologists in the Eastern, Central and Southern African region. A link to a web-based questionnaire was sent to all heads of eye departments and training programme directors of ophthalmology training institutions in Eastern, Central and Southern Africa, who forwarded to all their trainees and recent graduates. Main outcome measures were quantitative and qualitative survey responses. Results: Responses were obtained from 124 (52%) trainees in the region. Overall level of satisfaction with ophthalmology training programmes was rated as 'somewhat satisfied' or 'very satisfied' by 72%. Most frequent intended career choice was general ophthalmology, with >75% planning to work in their home country post-graduation. A quarter stated a desire to mainly work in private practice. Only 28% of junior (first and second year) trainees felt surgically confident in manual small incision cataract surgery (SICS); this increased to 84% among senior trainees and recent graduates. The median number of cataract surgeries performed by junior trainees was zero. 57% of senior trainees were confident in performing an anterior vitrectomy. Only 29% of senior trainees and 64% of recent graduates were confident in trabeculectomy. The mean number of cataract procedures performed by senior trainees was 84 SICS (median 58) and 101 phacoemulsification (median 0). Conclusion: Satisfaction with post-graduate ophthalmology training in the region was fair. Most junior trainees experience limited cataract surgical training in the first two years. Focused efforts on certain aspects of surgical education should be made to ensure adequate opportunities are offered earlier on in ophthalmology training

Civilian gunshot injuries in orthopaedics : a narrative review of ballistics, current concepts, and the South African experience

The incidence of civilian gunshot injuries is on the rise worldwide.Unfortunately, there is a lack of high-level evidence guiding management. The treatment of orthopaedic injuries from gunshots is complex and requires consideration of multiple aspects, including energy transfer to the tissue, severity of the wound, possible contamination, presence of fractures and associated injuries. With this narrative review we aim to discuss some of the relevant ballistics, current concepts, and controversies in the general management of civilian gunshot-related orthopaedic injuries based on the available evidence and personal experience. Important points which will be highlighted are the initial management in the emergency room, the assessment and management of soft tissue injuries, associated injuries, use of antibiotics, indication and techniques for fracture fixation, and gunshot injuries to joints.https://link.springer.com/journal/5902022-03-24hj2022Orthopaedic Surger