A study on management of tennis elbow by local platelet rich plasma injection

Background: Lateral epicondylitis (tennis elbow), a familiar term used to describe myriad symptoms around the lateral aspect of the elbow can occur during activities that require repetitive supination and pronation of the forearm with the elbow in near full extension. This condition can cause severe discomfort to the patient resulting in debilitation and impairment of routine activities. The purpose of this study was to evaluate the effectiveness of local autologous platelet rich plasma injection in the treatment of tennis elbow.Methods: This was a prospective observational study conducted on 50 patients of either sex with an average age of 45.92 years, presenting to the Orthopaedic OPD of SHKM Government Medical College Hospital, Nalhar, NUH, Haryana between November 2016 and February 2018, with a diagnosis of lateral epicondylitis. All the patients were treated with local platelet rich plasma injection and the results were analysed through the assessment of visual analog score (VAS) and disability of arm shoulder and hand (DASH) score. The patients were followed up for a period of 6 months after the local injection of platelet rich plasma.Results: Majority of the patients had significant relief with this method. The VAS and DASH score improved from the pre-treatment values of 8.7 and 74.6 to 2.6 and 29.8 respectively, which was found to be statistically significant (p<0.001).Conclusions: Thus results of our study demonstrate that the local injection of platelet rich plasma is a safe and effective method of treatment of lateral epicondylitis

Compartment syndrome of the forearm following moderately displaced fracture of the radial head in a 10-year-old child

Compartment syndrome of the forearm is a rare complication of radial head fractures. We report the unsual case of a 10-year-old child who developed acute volar compartment syndrome of the forearm following a moderately displaced fracture of the radial head. The patient underwent volar fasciotomy of the forearm and open reduction of the radial head fracture with Krishner wire. Due to timely intervention the patient had a good postoperative outcome and is expected to have a good functional recovery.

A study on management of congenital clubfoot by Ponsetti technique in a rural medical college in India

Background: Congenital clubfoot also known as CTEV (congenital talipus equinovarus) is a common and debilitating congenital musculoskeletal anamoly affecting the children across the world with a slight preponderence in third world countries. The Ponseti technique of casting has now become the mainstay of treatment of this condition. This method is especially effective in rural and underdeveloped areas with limited health care facilities. The purpose of this study was to evaluate the effectiveness of the Ponsetti technique in the correction of this deformity, thorough the assessment of modified Pirani score.Methods: This was a prospective observational study conducted on 75 patients of either sex with 100 feet, with an average age of 3.6 months presenting to the Orthopaedic OPD of SHKM Government Medical College Hospital, Nalhar, Nuh, Haryana between September 2015 and September 2017, with a diagnosis of congenital clubfoot. All the patients were treated with Ponsetti technique and the results were analysed through the assessment of modified Pirani score. The patients were followed up for a peroid of 1 year after attainment of correction.Results: Majority of the patients obtained full correction with this method. The mean value of the modified Pirani score improved from the pre-treatment value of 5.30 to 0.36 at the final follow up. The average number of casts required for full correction was 7.32.Conclusions: Thus results of our study demonstrate that the Ponsetti method is a safe and effective method of treatment for congenital clubfoot, especially in rural and underdeveloped regions.

A study on management of neglected shaft femur fractures by open intramedullary nailing

Background: Fracture shaft of femur is a common and major musculoskeletal injury and in most of the cases the patients are immediately brought to hospitals for specialist orthopaedic management. However, it is not uncommon in developing countries especially in rural India for these injuries to be neglected initially due to the wide spred practice of quackery. The purpose of this study was to evaluate the effectiveness of open intramedullary nailing in the management of neglected fracture shaft femur patients in relation to achievement of union and functional results.Methods: This was a prospective observational study conducted on 20 patients presenting to the Orthopaedic OPD of SHKM Government Medical College Hospital, Nalhar, Nuh, Haryana between August 2013 and December 2016, with a diagnosis of neglected fracture shaft of femur. All the patients underwent single stage open reduction and internal fixation with interlocking intramedullary nails. The patients were followed up for a period of 1 year. The patients were analysed for union and functional results.Results: All the fractures united and the average time of union was 22.6 weeks. The average range of motion of the knees improved from 34 degrees in the preoperative period to 114.5 degrees in the postoperative period.  Two patients developed superficial infections at the incision site which resolved with local drainage and oral antibiotics. All the patients were able to return to their preinjury occupation.Conclusions: Thus results of our study demonstrate that single stage open intramedullary nailing is a safe and effective surgical procedure for the treatment of neglected fractures of shaft of femur.

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

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

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Retracted: Observations on radiological correction of acetabular dysplasia by Dega transiliac osteotomy

The article titled, "Observations on radiological correction of acetabular dysplasia by Dega transiliac osteotomy", published in the International Journal of Research in Medical Sciences, Volume 5, Issue 5, 2017, Pages 1991-1997, DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20171831 is being retracted on authors request. The authors of this article want to redo the calculations with a follow up of more than 4 years so that the results are more conclusive of the effectiveness of the procedures. Since majority of patients are of developmental dysplasia of hip (DDH) the results are not representative of the effectiveness of the procedure in other disorders associated with acetabular dysplasia. Either the study has to be restricted to the patients of DDH or need to add more patients from other pathologies to make it a more conclusive study regarding other causes of acetabular dysplasia. The authors want to add some more criteria for assessment of acetabular dysplasia so that the effectiveness of the procedure can be gauged in a better way