The Relationship Between Serum 25[OH]D Concentration and Orthopaedic Infection: A Case-Control Study

Background: An estimated one in two healthy adults in the United Kingdom suffer from low levels of 25[OH]D. Vitamin D is involved in modulating immune response, but there is less clarity over its role in orthopaedic infection. This study assesses the relationship between serum 25[OH]D concentration and orthopaedic infection. Methods: A total of 205 patients in a tertiary referral centre for orthopaedic infection were included in the study. They were divided into groups based on their infection status, matched by age and gender. Data were statistically analysed to determine presence and direction of relationship. Results: A total of 114 patients had an infection. There was no statistically significant difference in age or gender between the two groups. Mean serum 25[OH]D concentration was 39 nmol/L in the group with infection and 59 nmol/L in the group without an infection (p< 0.01). Overall mean serum 25[OH]D concentration was 48 nmol/L. There was a correlation between low serum 25[OH]D concentration and rate of infection (odds ratio, 5.94; 95% confidence interval [CI], 3.24 to 10.92) with a bivariate correlation of − 0.338 (p< 0.01). Conclusion: This study demonstrates an association between low levels of serum 25[OH]D and increased orthopaedic infection. Orthopaedic inpatients suffered from vitamin D insufficiency, and there was a correlation between higher levels of serum 25[OH]D and lower rates of infection. This suggests that prophylactic supplementation of 25[OH]D may improve outcomes, and provides a foundation for randomized controlled trials to assess its effectiveness in practice

WALANT Protocol: Stop before you block

The use of Wide Awake Local Anaesthetic No Tourniquet (WALANT) amongst Plastic and Orthopaedic Hand Surgeons has been accelerated by the impact of the COVID-19 pandemic and associated risks of general anaesthesia. Benefits of WALANT include a bloodless field, improved recovery, on-table testing, as well as cost and time savings. Whilst more clinical trials are underway to fully elucidate safety-profile and outcomes, there is a lack of consensus and clarity over contraindications to WALANT. A survey of trainees identified that only one-in-five were aware of the appropriate reversal agent in the event of inadequate perfusion. We feel that a WALANT checklist should be developed and implemented for use immediately prior to administration of local anaesthetic with adrenaline to an extremity, building on the successes of the World Health Organisation (WHO) and the Royal College of Anaesthetists checklists. Such a checklist should include contraindications to WALANT and make the operator aware of the availability, dose and location of Phentolamine as a reversal agent. Introducing this checklist will help to facilitate safer and more effective use of WALANT within Hand Surgery

Cosmetic business mechanics in London: A cross-sectional analysis and audit of ASA compliance

INTRODUCTION: The proliferation of providers and practitioners of cosmetic botulinum toxin and dermal filler has profound public health implications. The Advertising Standards Authority (ASA) regulates the use of advertising materials in the United Kingdom and prohibits the promotion of prescription-only medicines. AIMS: We aim to perform a cross-sectional analysis of the practitioners in London, UK to evaluate the distribution of clinics within Greater London, prices advertised for interventions, and compliance with the ASA code. We also aim to identify whether there are any differences in cost of botulinum toxin or dermal filler between the boroughs. METHODS: Between December 2021 and January 2022, we performed a systematic search using the internet search engine Google. Five searches were performed (1) [london] botox, (2) [london] botulinum toxin, (3) [london] anti wrinkle injection, (4) [london] filler, (5) [london] dermal filler. One hundred websites per search string were systematically reviewed and those which met the inclusion/exclusion criteria of each search string were included and analyzed. Each clinic's product/service range compliance with the ASA/CAP code was assessed. Any reference to Botulinum Toxin or anti-wrinkle injections was noted and analyzed. Further analysis would look to calculate price per milliliter (mL) of botulinum toxin and dermal filler per borough and to calculate whether there were any statistical differences between the 32 different London boroughs. RESULTS: A total of 500 websites were visited and evaluated. After removal of duplicates, a total of 233 independent clinics was identified. A total of 206 out of the 233 clinics sampled (88%) were in direct infringement of the enforcement notice through advertising a prescription medicine. The overall average cost per mL of dermal filler was £330.89 and there was a statistically significant variance across London boroughs (p < 0.05). The overall average cost per mL of Botulinum Toxin was £284.45 and the variance across London boroughs was close to significant (p = 0.058). CONCLUSION: This paper demonstrates poor compliance with the ASA/CAP guidelines and further provides an insight into the industry mechanics associated with aesthetic injectables in a major UK city, identifying regional variance in price and clinic density. The advertising of prescription-only medication may pose a potential risk to patients and will be an important consideration in proposed legislation to introduce licensing to the industry

Profiling UK injectable aesthetic practitioners: a national cohort analysis

Introduction: The United Kingdom (UK) injectables market has been growing rapidly with a lack of robust regulation and to date, no information regarding the profile of practitioners has been published. Aim: We aim to provide a descriptive and qualitative analysis of the advertised practitioners in the United Kingdom. Methods: We performed a systematic search using the internet search engine Google to perform a qualitative descriptive analysis of aesthetic practitioners in the UK. For each contiguous country in the UK: England, Scotland, and Wales, five searches were performed. The list of practitioners was then cross-referenced with professional regulatory bodies, with extraction of registration number, date of registration and presence or absence from the Specialist Register or General Practitioner register. Results: 3,000 websites were visited and evaluated. 1,224 independent clinics with 4,405 practitioners were identified. 738 were identified as those in business support functions and the remaining 3,667 practitioners were undertaking injectable practice. The profile of professions were doctors 32%, nurses 13%, dentists 24% and dental nurses 8%. Of the 1,163 doctors identified 481 were on the specialist register (41%) and 219 were on the GP register (19%). 27 specialties were represented in this cohort analysis. Plastic Surgery formed the majority of those who were on the specialist register at 37%, followed by Dermatology at 18%. Conclusion: This paper is the first to describe the range of practitioners, their professional backgrounds and experience who perform non-surgical aesthetic interventions. The range of backgrounds may have an impact on the potential risks to patients and will be an important consideration in proposed legislation to introduce licensing to the industry

Identification of medicinal plants of Urmia for treatment of gastrointestinal disorders

The gastrointestinal tract is one of the most important organs of the human body and is vulnerable to different diseases. Available drugs often have low efficacy or are associated with many adverse effects. Therefore, alternative drugs are necessary to treat gastrointestinal complications. This study intended to identify medicinal plants in Urmia, Iran, that can affect common gastrointestinal disorders and diseases. Data was collected from public resources via interviews and questionnaires applied from April to June 2013. Herbarium specimens were collected from the region and authenticated by a botanist. A total of 41 indigenous medicinal plants from the Urmia region, belonging to twenty families, have a traditional medicinal role in the treatment of parasitic and infectious diseases, diarrhea, reflux, gastroenteritis, peptic ulcer, constipation, bloating, among other gastrointestinal tract disorders. Analysis showed that most plants affecting the gastrointestinal tract belonged in the Asteraceae family (24%). The most used part of the plants was the seed at 17%. Decoction at 65% was the most popular form of treatment used. Some of the medicinal plants discussed in this article have new implications presented for the first time. Pharmacological studies on the therapeutic effects of the indigenous plants mentioned in this study are necessary in order to investigate their claimed clinical effects and the use of their effective compounds to produce natural and useful drugs. Currently, there is no data on the herbal plants used to treat gastrointestinal disorders in northwestern Iran. Therefore, these findings are important for the management of gastrointestinal disorders and to conduct future studies on traditional medicine for drug development. (C) 2014 Sociedade Brasileira de Farmacognosia. Published by Elsevier Editora Ltda. All rights reserved

Fabrication of Perovskite-type Oxide BaPbO3 Nanoparticles and their Efficiency in Photodegradation of Methylene Blue

BaPbO3 perovskite was prepared by the sol-gel method. The physical and chemical properties of catalyst were characterized by XRD, TEM, SEM, EDX and IR techniques. The photocatalytic activity of the sample was evaluated by photocatalytic decomposition of methylene blue (MB) dye under UV irradiation. The results of XRD indicate that the perovskite-type oxide (BaPbO3) is crystal at 700 °C. The XRD, TEM and SEM revealed that BaPbO3 particles are prepared in the nano-size regime. The results show that the degradation efficiency of methylene blue (MB) by BaPbO3 is higher than rutile under similar conditions.Keywords: Perovskite-type oxide, nanopowder, dye removal, methylene blue