Optimising Wound Closure Following a Fasciotomy: A narrative review

Compartment syndrome is a surgical emergency that could be resolved by a fasciotomy. However, performing substantial skin incisions may lead to life-threatening complications. This narrative review aimed to present the available methods of wound closure and preferential factors for using each technique. Viable and noninfected wounds were most often treated by gradual approximation techniques, such as the simple or modified shoelace technique, the prepositioned intracutaneous suture or several commercially-available mechanical devices. In addition, applying negative pressure therapy was found to be feasible, particularly when combined with approximation techniques. Skin grafting was reserved for severely-dehiscent wounds while other non-invasive approaches were considered for other subsets of patients with inadvisable surgical interventions. Treatment decision should be made in view of the patient’s condition, ease of application, availability of resources, cost of treatment and aesthetic outcomes.Keywords: Compartment Syndrome; Fasciotomy; Wound Closure Techniques; Negative-Pressure Wound Therapy

A pilot study on the use of autofluorescence spectroscopy for diagnosis of the cancer of human oral cavity

The results of a pilot study to evaluate the potential of autofluorescence spectroscopy for the diagnosis of the cancer of oral cavity are presented. The study was carried out using a N2 laser-based system developed in-house and involved 25 patients with histopathologically confirmed squamous cell carcinoma of oral cavity. A general multivariate statistical algorithm was developed to analyse and extract clinically useful information from the oral tissue spectra acquired in vivo. The algorithm could differentiate, over the sample size investigated, the squamous cell carcinoma of the oral cavity from normal squamous tissue with a sensitivity and specificity of 86% and 63%, respectively towards cancer. The relatively poor specificity is presumably because most of the patients investigated had advanced cancers, due to which some of the visually uninvolved sites treated as normal may not be truly normal

Hookworm infestation as a cause of melena and severe anaemia in farmer

Abstract Hookworm infections remain a major cause of morbidity in the developing world. Prevalence is highest in agricultural areas, where use of waste water for irrigation and poor hygiene increases infection rates among farmers. Infections present with gastrointestinal symptoms and chronic anaemia, and there are usually no signs of overt blood loss.The following report describes a case of melena in a middle-aged farmer, where the diagnosis of hookworm infestation was delayed due to the unusual presentation. The patient underwent multiple blood transfusions before referral to the Aga Khan University Hospital (AKUH), Karachi and was managed conservatively with mebendazole at our hospital after exclusion of other possible causes of gastrointestinal bleeding. This case highlights the importance of considering hookworm infestations as a cause of melena in the older age group, where other critical differentials such as peptic ulcer disease and occult malignancy may result in delay in initiation of treatment and a significant financial burden on the patient

DETERMINATION OF DIVERSE ENVIRONMENTAL POLLUTION LEVEL FROM SELECTED AREAS OF RAWALPINDI, PAKISTAN

Anthropogenic contaminants arising from both stationary (power plants, industries and residential heating) and mobile sources (road traffic) can harm ambient air quality in urban areas. Depending upon their physical state, these pollutants are classified as liquid and vapor phases and are subsequently transported to the Earth’s surface through dry and wet deposition. After the deposition of these pollutants onto the surface of earth various health effects caused by these pollutants occurred like cardiovascular diseases and hypertension. In this study four different locations/sites were selected from the Rawalpindi city depending upon the population, traffic rush and industries to examine the noise level, concentration of carbon dioxide and heavy metals. Air sampler was used for the collection of air sample to analyze the heavy metal concentration, Quest electronic sound meter for measuring sound level and SIBATA for CO2 measurement. The study findings revealed that noise level was higher at all selected locations as described by WHO limit (70 dB) being highest at Industrial area due to heavy machinery and lowest at green area. Concentration of all four heavy metals were high as compared with the prescribed limits. CO2 level reaches up to 300 ppm because of coal consumption during the winter season. The threshold values of all these selected parameters well above the prescribed limits defined by the authorities so to combat with this situation we should move towards more energy efficient fuels, proper maintenance of vehicles and machineries, traffic management and installation of noise barriers in industries as well as installation of catalytic convertors in vehicles to stop further air pollution

The Effects of Vitamins on Micropropagation of Desiree and Mozart Potatoes (Solanum Tuberosum L.)

An attempt was done to achieve a micropropagation protocol by determining the most optimal types and concentrations of vitamins including thiamine (B1), nicotinic acid (B3), pyridoxine (B6) and folic acid to induce shoot formation and rooting in vitro, as replacement vitamins in the culture medium. The four vitamins were included in the medium at two concentrations and the control treatment without vitamins. The highest number of shoots per explant (2.50 shoots/ explant) was achieved from the addition of 0.3 mgl-1thiamin to Desiree cultivar grown on MS medium. Whereas, the highest mean length of shoots was recorded in the case of adding nicotinic acid at 3.0 mgl-1 to Mozart cultivar grown on MS medium. The highest number of leaves 10.50 leaves/ explant) was obtained from Mozart cultivar grown on a medium enriched with 0.6 mgl-1 pyridoxine. The highest number of roots (7.00 roots/ explant) was achieved from the control treatment from Desiree potato cultivar. The longest roots (12.50 cm) were produced by Desiree potato cultivar grown on MS medium supplemented with 0.5 mgl-1 thiamin. Mozart potato cultivar performed better than Desiree cultivar in concern to mean length of shoots, number of leaves, number of roots and mean length of roots. No significant differences were found between the both cultivars in concern to the number of shoots and roots

Hematoma Enlargement Among Patients with Traumatic Brain Injury: Analysis of a Prospective Multicenter Clinical Trial

Observational studies suggest that hematomas continue to enlarge during hospitalization in patients with traumatic brain injury (TBI). There is limited data regarding factors associated with hematoma enlargement and on whether hematoma enlargement contributes directly to death and disability in patients with TBI. We analyzed data collected as part of the Resuscitation Outcomes Consortium Hypertonic Saline and TBI Study. Hematoma enlargement was ascertained and collected as a predefined safety endpoint. We evaluated the effect of hematoma enlargement on the risk of death and disability at 6 months based on the Extended Glasgow Outcome Scale (GOSE) (dichotomized as \u3e4 or ≤4) using stepwise logistic regression analysis. We adjusted for age (continuous variable), admission GCS score (dichotomized at \u3e5 and ≤5), and computed tomography (CT) scan classification (Marshall grades entered as a categorical variable). Of the 1200 patients with severe TBI analyzed, 238 (19.8%) patients were reported to have hematoma enlargement as an adverse event. The proportion of patients who reached favorable outcome at 6 months was significantly lower (defined by GOSE of \u3e4) among patients with hematoma enlargement (29.0% vs. 40.1%, p\u3c.0001). The proportion of patients who died within 6 months was significantly higher among patients with hematoma enlargement (31.9% vs. 20.7%, p\u3c.0001). After adjusting for age, admission GCS score, and initial injury score, the odds of favorable outcome was lower in patients with hematoma enlargement (odds ratio 0.7, 95% confidence interval [CI]; 0.5–0.97). Our results suggest that hematoma enlargement may be a direct contributor to death and disability in patients with TBI at 6 months. Future clinical trials must continue to evaluate new therapeutic interventions aimed at reducing hematoma enlargement with a favorable risk benefit ratio in patients with TBI

Reduced Cost and Decreased Length of Stay Associated with Acute Ischemic Stroke Care Provided by Nurse Practitioners: A Single Primary Stroke Center Experience

Nurse practitioner (NP) have a wider role in modern stroke centers providing quality evidence based care to patients with both in and outpatient settings for acute ischemic stroke (AIS) and transient ischemic attack (TIA) patients. We studies the outcome measures, length of stay (LOS) and cost before and after implementation of nurse practitioners as the primary medical provider in a community based stroke center.https://digitalcommons.centracare.com/nursing_posters/1075/thumbnail.jp

Microangiopathic Occlusion of a Perforating Prepontine Long Circumferential Artery Presenting with Lower Motor Neuron Facial Weakness: Clinical and Radiological Correlation

Case Description: A 79-year old male patient with myelodysplastic syndrome associated with severe neutropenia, thrombocytopenia, anemia, hypertension, and hyperlipidemia was admitted for pneumonia secondary to influenza A. Two weeks later he presented with new symptoms of acute dysarthria, and left facial weakness involving his upper and lower face; the following day he developed left arm weakness. Admission computed tomography (CT) and MRI scans revealed an acute ischemic stroke (AIS) in the right posterior frontal cortex. The initial MRI was reported negative for pontine lesions. Anatomically, the cortical infarct could not explain his left lower motor neuron cranial nerve VII (LMN CN VII) facial weakness distribution because in a cortical lesion the upper half of the face would be expected spared due to contralateral cortical innervation. Upon review of the MRI, the initial hyperintensity seen on Fluid-Attenuated Inversion Recovery (FLAIR) was overlooked and later identified as an acute stroke in the vicinity of the perforating prepontine long circumferential artery affecting the CN VII nucleus. Conclusion: In the absence of earache, active infection, and/or inflammation, a sudden onset facial palsy, lower motor neuron distribution, must poin

Outcome of the ‘Drip-and-Ship’ Paradigm among Patients with Acute Ischemic Stroke: Results of a Statewide Study

www.karger.com/cee This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License (www.karger.com/OA-license), applicable to the online version of the article only. Distribution for non-commercial purposes only.