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Knee arthrodesis as a salvage method for septic TKA failure

Abstract

Periprosthetic joint infection is the most common reason for a failed TKA, with a septic TKA reported rate of 1 to 4% of primary TKA patients. Septic TKA has a various number of treatment options which include chronic-suppressive antibiotics, irrigation and debridement, single or staged revision arthroplasty. The goal is to eradicate the periprosthetic joint infection and reimplant a sterile and fully functional total knee prosthesis. In case the infection becomes uncontrollable, there is only one option to eradicate the infection: knee arthrodesis or above-knee amputation.

We report the case of a 63-year-old patient who in 2009 underwent TKA, the 1 year follow-up showed periprosthetic infection. At first stage, the prosthetic implants were removed and a solid cement spacer was shaped to occupy the remaining space. In 2011, after achieving complete clinical and biological remission of the infection, the cement spacer was removed and LCCK revision prosthesis was inserted.

In 2013 reinfection occurred leading to removal of the prosthetic implants and reinsertion of an antibiotic impregnated cement spacer.

Since the patient suffered significant bone loss and the local conditions were unfavorable, being prone to infection, there were 2 options to evaluate: knee arthrodesis or above knee amputation. We chose knee arthrodesis using Ilizarov external fixation technique.

Many surgical techniques are available to achieve knee arthrodesis: internal fixation with plates or intramedullary nails and external fixation. The Ilizarov method is a very effective technique that could be taken into consideration when knee arthrodesis is required.

Open access
Late Cognitive Impairment After Coronary Bypass Graft Surgery: Opportunities in Rehabilitation with the Use of Computer-Based Training

Abstract

In spite of recent significant advances in reduction of mortality and disability, coronary heart disease (CHD) remains widespread both in Russia and around the world. Coronary bypass graft surgery (CABG) has proved to be the most effective method of CHD treatment, providing that conservative therapy is not effective enough. The aim of the present study was to reveal and correct postoperative cognitive dysfunction (POCD), developed under the conditions of cardiopulmonary bypass (CB) in patients with CHD within 12 months after CABG.

A total of 87 patients were examined, all the patients underwent a course of drug therapy, 50 patients underwent a course of rehabilitation using computer-based stimulation programmes (once per day for 20 minutes within 10 days) in addition to medical therapy. A reliable improvement in results of the conducted research suggests that the proposed method provides safety and high performance in cognitive rehabilitation of patients with impairments of the higher brain functions after CABG. A relatively short course of rehabilitation (10 days) corresponded to the length of hospital stay of patients in the cardiac unit. However, even in such a short course we could obtain significant advantage in terms of efficiency of higher cortical functions recovery. Therefore, a course of rehabilitation using computer-based stimulation programmes in patients with coronary heart disease after CABG was proved to be an effective way of correcting cognitive function.

Open access
Management recommendations for body stuffers at emergency units

Abstract

Managing body packers and stuffers is a challenge to emergency physicians, stuffers in particular, as there is no systematic approach to their treatment. The aim of this study was therefore to review all available literature on body stuffing and propose a guide to manage these patients. We searched Medline/PubMed, Google Scholar, and Scopus for published work on body stuffers using key words “body stuffer”, “body stuffing”, “poisoning”, “toxicity”, and “treatment” without a time limit and retrieved 290 articles, of which 61 remained after exclusion of those on “body packers” and repetitive documents. This review article evaluates and summarises the information gathered from them. The main step in body stuffer management is observation to make sure that they have passed all the swallowed packages of drugs of abuse. In some cases, imaging can be quite useful. Diagnostic pitfalls may be avoided with abdominopelvic CT without contrast, which is probably the best diagnostic method to determine the presence and the number of packages in these patients. Treatment should be specific for each group of drugs, whether it is opioids, cocaine, or amphetamine. Surgical interventions are indicated for obstruction of the intestines or package rupture. Legal precautions should be taken because of the legal complexity of body stuffing cases.

Open access
Osseous metastases and ovarian cancer

Abstract

This article analyses a series of 22 confirmed cases of ovarian cancer throughout a period of 14 months (January 2018 - February 2019), in which we assessed the incidence of osseous metastases, in correlation with their histological features. This retrospective study, based on medical imaging techniques, demonstrates that bone metastases are not uncommon in ovarian cancer.

Open access
Poor Knowledge of the Harmful Effects of Shisha Among Shisha Smokers: Findings from a Preliminary Survey in Northwest Nigeria

Abstract

Background: Tobacco smoking is an addictive behavior with heavy risks accompanying its prolonged practice. Unfortunately, more and more people are indulging in tobacco smoking habits despite the public health education programs going on worldwide about the dangers associated with tobacco smoking behavior. This study aims to survey active shisha smokers in Birnin Kebbi Local Government Area (LGA), Kebbi State, Nigeria, on the awareness of the harmful effects associated with shisha smoking.

Methods: This study was a survey of 45 active shisha smokers in Birnin Kebbi LGA. Snowballing technique was adopted in participants’ recruitment. Study instrument was a questionnaire. Data collected was analyzed using SPSS version 20 software.

Results: Majority (32/45) of the participants were males, 16 had secondary school education, and 19 were within age range of 15 to 24 years. The majority (25/45) of them began to smoke shisha at the age of 18 years or more; also, 20 participants smoked shisha in all the 30 days prior to their participation in this study. Less than half of the study participants knew that: shisha is a stimulant (6/45), shisha smoke contains carbon monoxide (10/45), and the liquid in shisha could be replaced with alcohol (15/45). However, more than half of the participants knew that shisha contains nicotine (23/45) and tobacco (25/45). Only 16, 13, 11, 9, 5, 10, and 13 participants knew that shisha smoking could lead to cancer, cardiovascular diseases, increase in the risk of infections, reduced baby weight in pregnancy, gum and mouth disease, eye disease and blindness, and harm to non-smokers, respectively.

Conclusion: Many of the active shisha smokers surveyed in this study began smoking shisha at a young age. Also, a significant proportion of them were unaware of the health hazards associated with shisha use; hence the need to educate them and even the Nigerian public on the dangers associated with shisha use.

Open access
Pyrethroid exposure and neurotoxicity: a mechanistic approach

Abstract

Pyrethroids are a class of synthetic insecticides that are used widely in and around households to control the pest. Concerns about exposure to this group of pesticides are now mainly related to their neurotoxicity and nigrostriatal dopaminergic neurodegeneration seen in Parkinson’s disease. The main neurotoxic mechanisms include oxidative stress, inflammation, neuronal cell loss, and mitochondrial dysfunction. The main neurodegeneration targets are ion channels. However, other receptors, enzymes, and several signalling pathways can also participate in disorders induced by pyrethroids. The aim of this review is to elucidate the main mechanisms involved in neurotoxicity caused by pyrethroids deltamethrin, permethrin, and cypermethrin. We also review common targets and pathways of Parkinson’s disease therapy, including Nrf2, Nurr1, and PPARγ, and how they are affected by exposure to pyrethroids. We conclude with possibilities to be addressed by future research of novel methods of protection against neurological disorders caused by pesticides that may also find their use in the management/treatment of Parkinson’s disease.

Open access
The relationship between antioxidant activity, first electrochemical oxidation potential, and spin population of flavonoid radicals

Abstract

I have shown that by averaging antioxidant activity (AA) values measured by different methods it is possible to obtain an excellent correlation (R2=0.960) between the first electrochemical oxidation potential, Ep1, and AA. Separate correlations using the AA values obtained with each of the four methods [R2 were 0.561 for diphenyl-1-picrylhydrazyl (DPPH), 0.849 for Folin Ciocalteu reagent (FCR), 0.848 for the ferric-reducing ability of plasma (FRAP), and 0.668 for the Trolox equivalent antioxidant capacity (TEAC)] were all worse, and in some cases not useful at all, such as the one for DPPH. Also, the sum of atomic orbital spin populations on the carbon atoms in the skeleton of radicals ( s(C) Σ AOSPRad), calculated with the semi-empirical parameterisation method 6 (PM6) in water, was used to correlate both Ep1 and AA, yielding R2=0.926 and 0.950, respectively. This showed to be a much better variable for the estimation of Ep1 and AA than the bond dissociation energy (BDE), R2=0.854 and 0.901 for Ep1 and AA, respectively, and especially the ionisation potential (IP), R2=0.445 and 0.435 for Ep1 and AA, respectively.

Open access
A Review on Status of Production of Large Cardamom in Nepal and its Marketing in National and Global Scenario

Abstract

The study mainly focuses on the status of production and marketing of large cardamom in Nepal and also compares these dimensions in the context of different countries. For the study mainly secondary data were collected from research articles, reports, publications and news articles. Large cardamom is the third most expensive crop and one of the major cash crops of Nepal. Nepal is the largest producer of large cardamom in the world followed by India and Bhutan. Taplejung, Sankhuwasabha, Panchthar and Illam are the four major districts that contribute more than 80% of the national production. Cardamom produced in Nepal is graded according to tail cutting after drying and packed in jute bag or plastic to export it to foreign countries. Nepal exports almost 90 percentage of its total cardamom production to India. In the global scenario, Guatemala is the largest exporter of cardamom (small and large combined) followed by India, Nepal, Singapore and Indonesia respectievly. It was found that the production of cardamom is declining in Nepal due to price fluctuation and viral diseases such as Chirkey, Furkey. Problem such as absence of unique HS code for large cardamom and ‘duplicate large cardamom’ are also seen in the market.

Open access
Simultaneous Evaluation of Communication Skills by Standardized Patients and Medical Evaluators

Abstract

Introduction: The present study analyzes the evaluation of communication skills by standardized patients (SPs) and medical evaluators (Es) in an OSCE setting.

Methods: The OSCE involved 189 sixth-year medical students, as well as 34 SPs and 63 Es. Communications skills were evaluated in 8 stations, simultaneously by SPs and Es. The SPs were actors who had been trained in the clinical case and who acted in accordance with a standardized script in a simulated clinical situation. The evaluators, also standardized, were Resident Doctors or staff Doctors from the Hospital Services involved.

Results: The global scores awarded to students for communication skills were very similar in both groups, although the score awarded by Es was significantly higher, and a direct relationship was also observed between the mean scores awarded by both groups. Evaluators awarded significantly higher scores than SPs in 7 out of the 10 items on the checklist. Female medical students also scored significantly higher than their male counterparts in many items, including external appearance, listening, cordiality, optimism, interest, expression and empathy.

Discussion: Our data indicate that SPs and Es evaluated communication skills in a similar manner in an OSCE setting, a finding which suggests that health-related professionals can be used as an alternative to SPs, thus helping to lower economic costs. Our study also confirms a gender difference (in favor of women) in the evaluation of communications skills by both groups.

Open access
Simultaneous quadriceps and contralateral patellar tendon ruptures in a patient with chronic renal failure following electric shock; a case report and review of the literature

Abstract

Bilateral extensor tendon ruptures of the knee are not uncommon. However, simultaneous ruptures of the patellar tendon (PT) and contralateral quadriceps tendon (QT) are relatively rare injuries. These ruptures are frequently associated with chronic renal failure and minor trauma. However, they can occur spontaneously in healthy individuals. In this case report, a 43-year-old male with chronic renal failure who sustained bilateral extensor tendon ruptures (right knee: QT rupture, left knee: PT rupture) following an alternating current electrical shock was reported. To our knowledge, simultaneous quadriceps and contralateral patellar tendon rupture following an electric shock have not been reported yet. Etiology, mechanism of injury and treatment options of this rare injury are discussed together with a thorough literature review.

Open access