Outcome of a Simple Novel Technique to Reduce Soft Tissue Complications in Open Tendoachilles Injury: A Series of 20 Patients

@#Introduction: Open tendoachilles injuries are rare and associated with significant soft tissues complications. The objective of the present study was to assess the clinical outcome and safety of a simple and minimally invasive technique, with a goal to assess if it may help minimise flap and wound related complications in open tendoachilles injuries. Materials and methods: This prospective study of four years duration included 20 patients with open tendoachilles injuries managed with a simple minimally invasive tunnel technique. The primary outcome variable was occurrence of a major soft tissue complication. The secondary outcome variables included functional outcome measured using AOFAS Ankle hind foot score, re-rupture of tendoachilles and need for revision surgery. Results: None of the patients in the present series developed a serious soft tissue complication. Based upon the AOFAS hind foot scoring system, good to excellent outcome was achieved in 19 (95%) patients. All the patients were able to perform tip toe walking at six months post-surgery. None of the patients had a re-rupture of the tendoachilles and no patient needed a revision surgery. The complications encountered include thickening of the tendon at the repair site (15%), superficial wound infection (5%), stitch granuloma (5%) and hypertrophic scar (5%). Conclusion: This technique seems to be promising in reducing the soft tissue complications associated with the surgical management of open tendoachilles injuries. Most patients had a good final clinical outcome. The technique is safe, simple and reproducible. However, further randomised control studies with a larger sample size assessing the technique are recommended.

cross sectional study on the acceptance of pre-hospital continuous positive airway pressure ventilation among ambulance paramedic in an urban emergency medical service system in a developing country

To assess the acceptance among the developing country urban paramedics towards pre-hospital continuous positive airway pressure [CPAP] ventilation. A cross-sectional prospective study was conducted among the ambulance paramedics working at the pre-hospital care unit of the Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia from March 2012 to August 2012 on ambulance paramedics. Questionnaires were used to assess their experience, knowledge, and perception, while their competencies were assessed using an Objective Structured Clinical Examination by 2 independent-calibrated raters on the use of the Boussignac CPAP system. Twenty-six ambulance paramedics qualified for this study with an average work experience of 5.59 +/- 3.53 years. A total of 76.9% had no formal training for CPAP during their study years. Knowledge of CPAP apparatus-arrangement sequence scored as 88.5% correct, while 96.2% scored `Good` to `Very-good` in the ability to diagnose conditions that warrant its use. A total of 76.9% were confident to monitor patients on CPAP, and 61.5% in applying the device. However, only 53.8% were confident to start the CPAP, and 38.5% to troubleshoot if any problem arose. For perceptions, 96.2% felt it was easy to learn CPAP, while 88.5% felt that paramedics could use it without supervision, and 80.8% felt that it should not be confined to the Emergency Department setting. A total of 96.1% were competent in CPAP application. Developing country urban ambulance paramedics possessed adequate knowledge, positive attitudes, and demonstrated good CPAP application skills. However, lack of confidence towards decision to initiate and troubleshoot of potential complications were the main obstacles hindering its use

Improving door-to-doctor and door-to-analgesia time in a tertiary teaching hospital emergency department through a novel 'Red Box' system

To evaluate the effectiveness of a new patient flow system, 'The Red Box' on the quality of patient care in respect of the time taken for the care to be delivered to the patient. A pre-post study was conducted looking at the door-to-doctor [DTD] and door-to-analgesia [DTA] times for cases presenting to the Emergency Department [ED] of a tertiary teaching hospital 'The National University of Malaysia Medical Center' between the periods of July and September 2005 against July and September 2008. Demographic data, ED presentation time, time seen by first doctor, and time first analgesia given were collected in both periods and analyzed. A total of 1,000 cases were enrolled. Group A [pre-Red Box] and group B [post-Red Box] comprised 500 cases each. The mean DTD time for group A was 29 minutes [SD +/- 3 minutes] and for group B was 3 minutes [SD +/- 1 minute], with a 98.8% reduction [p<0.001]. For DTA time, group A recorded a mean of 46 minutes [SD +/- 3 minutes], and group B recorded a mean of 9 minutes [SD +/- 2 minutes], an 80.4% reduction [p<0.001]. The implementation of a red box system improved the quality of emergency patient care in the ED of a tertiary teaching hospital as evidenced by significant reductions in DTD and DTA time

Prevalence of rheumatic heart disease in school-going children of Eastern Uttar Pradesh.

BACKGROUND: Rheumatic heart disease is a major health problem in our country. There is evidence from South India that its prevalence is declining. This study attempts to confirm whether this is so in North India as well. METHODS AND RESULTS: A total of 118,212 (68,357 males, 49,855 females) schoolchildren in the age group of 4-18 years were examined for the presence of heart disease. Evaluation, including echocardiography, confirmed that of a total of 389 suspected to have heart disease, 61 had rheumatic heart disease. Thus, the prevalence of rheumatic heart disease was found to be approximately 0.5 per 1000 children. CONCLUSION: In a fairly large school survey conducted by us, the prevalence of rheumatic heart disease turned out to be approximately 0.5 per 1000 children. This is the lowest figure reported from our country so far and confirms the decline of this disease in our country.