A Sole Thromboprophylactic in Prescription of Postoperative Orthopedic Patients – A Review

Background: Venous thromboembolism (VTE) is one of the most well-known and feared sequelae of orthopaedic surgery. VTE is relatively common after arthroplasty, prophylaxis has been prescribed. The frequency of postoperative thromboembolic events increased in the absence of primary prevention. Following operations, immobilisation of a lower limb that restricts calf muscle contraction has been shown to be a key risk factor for VTE. VTE is the most frequent source of readmission in orthopaedic patients who have undergone major procedures. It should be emphasized that the best mechanical method for preventing VTE is early walking. Medication for VTE prophylaxis is prescribed more often than mechanical prophylaxis. After major orthopaedic surgery, anticoagulant treatment is essential for reducing morbidity and death. Following hospital discharge, prophylactic drug therapy aims to reduce the morbidity and mortality episodes associated with DVT and PE occurrences. Aspirin use for prevention of VTE following THA and TKA has gained popularity, especially among orthopaedic surgeons due to a minimal risk of postoperative haemorrhage, it also reduces the incidence of recurrent DVTs. Conclusion: Due to its low cost and easy administration without the requirement for regular blood testing, aspirin thromboprophylaxis following knee surgery appears promising. Aspirin saved more QALYs and was cost-effective. Aspirin was demonstrated to have a higher VTE prophylaxis profile than other medications with a time-related association to early mobilisation, healthier patients and medication compliance.

Comparison of above elbow and below elbow immobilisation for conservative treatment of distal end radius fracture in adults: A systematic review and meta-analysis of randomized clinical trials / 中华创伤杂志(英文版)

PURPOSE@#The aim of this study was to analyze if any difference exists on the type of immobilisation (above elbow vs. below elbow) in the conservative treatment of distal end radius fractures in adults.@*METHODS@#The study was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses. An electronic literature search was performed up to 1st October 2021 in Medline, Embase, Ovid and Cochrane database using the search terms, "distal end radius fractures OR fracture of distal radius", "conservative treatment OR non-surgical treatment", "above elbow immobilisation" and "below elbow immobilisation". Randomized clinical trials written in English, describing outcome of distal end radius fractures in adults by conservative or non-surgical means using above elbow immobilisation or below elbow immobilisation were included and assessed according to the risk of bias assessment (RoB2) tool by Cochrane collaboration. Non-randomized clinical trials, observational studies, retrospective studies, review articles, commentaries, editorials, conference presentations, operative techniques and articles without availability of full text were excluded from this review. The meta-analysis was performed using Review Manager version 5.4.1 (The Cochrane Collaboration, Copenhagen, Denmark).@*RESULTS@#Six randomized clinical trials were included for quantitative review. High heterogeneity (I2 > 75%) was noted among all the studies. The standard mean difference (MD) between the disability of the arm, shoulder and hand scores in both the groups was 0.52 (95% CI: -0.28 to 1.32) which was statistically non-significant. There was no statistical difference in the radial height (MD = 0.10, 95% CI: -0.91 to 1.12), radial inclination (MD = 0.5, 95% CI: -1.88 to 2.87, palmar tilt (MD =1.06, 95% CI: -0.31 to 2.43) and ulnar variance (MD = 0.05, 95% CI: -0.74 to 0.64). It was observed that shoulder pain occurred more commonly as a complication in above elbow immobilisation and the values were statistically significant (above elbow: 38/92, 41.3%; below elbow: 19/94, 20.2%).@*CONCLUSION@#This two-armed systematic review on the above elbow or below elbow immobilisation to be used for conservative treatment of the distal end radius fracture in adults resulted in non-significant differences in terms of functional and radiological scores among the 2 groups but significant increase in the complication rates in the above elbow group.

Knowledge, attitude, and practices regarding cervical collars in adult trauma patients amongst practitioners at three hospitals in KwaZulu-Natal, South Africa

Background: The use of cervical collars in adult patients with possible injuries to the cervical spine has been an accepted standard of care for many years, despite the absence of evidence for the efficacy of these devices in preventing unwanted movement and harm. Changes to the terminology and recommendations of major trauma guidelines have been made but are limited by low quality evidence. In this context, little is known about what practitioners know, believe, and do, when managing the cervical spine of trauma patients. Methods: In this quantitative, observational, descriptive, cross-sectional survey a specifically designed questionnaire was used to collect data on the knowledge, attitude, and practices of practitioners managing adult trauma patients regarding cervical collars at three hospitals in KwaZulu-Natal, South Africa. Results: A total of 128 completed questionnaires were collected, captured, and analysed. Participants with the additional qualification of ATLS and DipPEC had a mean knowledge score of 8.1 (SD=1.70), compared to those with no additional qualification of 4.5 (SD=1.9) (p<0.001). Participants in the Emergency Department (ED) attained a mean knowledge score of 7.1 (SD=2.2) followed by Surgery (Mean=6, SD=2.0), Orthopaedics (Mean=5.5, SD=1.7) and ICU/Anaesthetics (Mean=4.4, SD=1.8), p<0.001. Head blocks only were most frequently used by 97.4 % of ED, 55.6 % of Surgery, 3.8 % Orthopaedic and 22.2 % ICU/Anaesthetics participants (p<0.001). Conclusion: The knowledge of management principles of cervical spine injuries was influenced by the department in which practitioners worked, the frequency that they managed patients with suspected injuries and additional courses. Head blocks were the most frequently used spinal protection device in all three hospitals. Most participants would be open to a change in practice if new guidelines were recommended. Further research is needed to determine the optimal management of patients with suspected cervical spine injuries and the role of motion restriction devices in limiting movement of the injured spine.

Immobilisation of solvatochromic dyes on transparent cellulose films; an improved methodology for the study of homeopathic potencies

Highly diluted and succussed solutions (homeopathic potencies) have been shown to interact with a wide range of solvatochromic dyes based on changes in their UV-visible spectra. Studies so far have involved free dyes in solution, but there is a pressing need to find ways to investigate the potency-dye interaction using isolated dye molecules in order to ask more searching physico-chemical questions regarding the fundamental nature of potencies. Aims and Methods:The aims of the present study have been tolook for ways to covalently immobilizesolvatochromic dyes onto transparent cellulose films and hence be in a position to investigate dye-potency interactions without the complication of dye-dye interactions, including dye aggregation, which can occur with free dyes in solution. Results: to date a total of nine different dyes have been immobilised on cellulose films using epoxide activation of hydroxyl groups on the cellulose surface. Using this methodology studies have begun looking at the time course of potency action on one of these immobilised dyes, Brooker's merocyanine. Results show that the interaction ofArsenicum10M with this dye consists of three phases ­an initial growth phase, a sustained plateau of interaction and a final decline phase lasting several days.Conclusions: amethodology has been developed that successfully immobilises solvatochromic dyes onto transparent cellulose film. These films can then be used in a spectrophotometer to study at a much more detailed level how potencies interact with dyes compared with using free dyes in solution. Results indicate that the information gained in this way provides new insights regarding the fundamental nature of potencies. Specifically, studies using immobilised Brooker's merocyanine with Arsenicum10M reveal that the lifetime of the potency is much longer than expected and that its action consists of three distinct phases, suggesting a resonant interaction with the dye.

Effects of the Hydroalcoholic Extract of Passiflora edulis on Anxiety Induced by Sub-acute Immobilization Stress

Aims:This study was carried out to assess the anxiolytic effects of the hydroalcoholic extract of P. edulis.Place and Duration of Study:Animal Physiology Laboratory of the Higher Teachers’ Training College, Animal Physiology Laboratory of the Faculty of Sciences , University of Yaoundé I, from November 2017 toAugust 2018.Methodology: Anxiety was induced to mice by thesub-acute immobilization stress. After 11 days treatment, behavioural parameters were assessed using Elevated Plus Maze (EPM) and Open Field (OF), then biochemical parameters (MDA, GSH, SOD, catalase, GABA, GABA-T and 5-HT) were estimated.Results:The results show that treatment with P. edulisat doses 100 and 200 mg/kg significantly increased open arms entries and time, while reducing closed arms entries and time in the EPM test. Lines crossed as well as passages through the centre and the centre time were significantly increased in the OF test. It is suggested that P.edulis would protect against anxiety and this effect probably linked to its ability to fight oxidative stress and counteract hyperexcitability by potentiating the GABA action. The more effective dose, 100 mg/kg significantly (P<0.01) increased to 4.44 ± 0.24 μmol/g the activity of GSH. In mice treated with dose 100 mg/kg, the extract induced a significant decrease of three oxidative stress markers including MDA, catalase and SOD to0.22 ± 0.01 μmol/g, 1.05± 0.15 mmolH2O2/min/g; and 19.46±0.00 unit/min/mg respectively when compared to the negative control. Animals treated with P. edulis100mg/kg presented a significantincrease level (P<0.001) of GABA and 5-HT up to 4.62 ± 0.28 and μg/g and 31.47 ± 1.58 ng/ml respectively. GABA-T activity was also impacted by the treatment with P. edulis, since the value of GABA-T activity of 1.27 ± 0.10 in the negative control significantly (P<0.001) decreased to 0.37± 0.00 in the group treated with dose 100 mg/kg. Conclusion:The beneficial effects of this extract observed in this study justify the empirical use of P. edulisin the treatment of head ache and insomnia

A Prospective Study of Clinical Profile, Predisposing Factors and Management of Deep Venous Thrombosis

Introduction: Deep venous thrombosis (DVT) of lower limbsis one of the most common cause for the majority of deathscaused by pulmonary embolism. Deep vein thrombosis is theformation of blood clots in the deep veins which commonlyaffects the leg veins such as the calf veins, femoral vein, orpopliteal vein or veins of the pelvis. The aim of the studywas to evaluate clinical profile of patients in form of age,sex, etiological factors of deep venous thrombosis in ourinstitute. Also study risk the factors in patients of deep venousthrombosis.Material and Methods: Study was a prospective studywhich was conducted on 108 symptomatic patients of deepvein thrombosis which were proved by colour dopplerultrasonography. All patients who were more than 18 years ofage and either sex were taken into study.Results: In our study 37.03% of the patients were malesand 62,97% were females with majority belonging to 21-30 years of age group (33.82%). In this study the youngestpatient was 20 years old female and the oldest patient was96 years old female. Male: Female ratio was 1:1.7. The leastcommon age group affected is extreme of age i.e. ≥ 20 yearsand > 60 years of age in both sexes. The most common limbaffected is left lower limb 62 patients (57.40) and right limbinvolvement is seen in 39.81% of patients. Bilateral lowerlimb DVT is present in two patients and one patient was upperlimb DVT. Predisposing factors associated with thrombosisin deep veins maximally seen in 46 patients in 42.59% due tounknown cause. Pregnancy and post-partum was the secondmost common predisposing factor associated with DVTwhich is seen in 33 patients in 30.55%. Thrombosis due toorthopaedic trauma is seen eight patients only. Chronic illnessand malignancy was present in 19.44% of patients.Conclusion: It is very important for accurate diagnosis ofDVT to prevent potentially fatal complications like pulmonaryembolism (PE) and pulmonary hypertension. Also it is veryimportant to avoid anticoagulants therapy with associated riskof bleeding in patients of misdiagnosed and negative colourdoppler findings. Because clinical features are nonspecific;hence new strategies were evolved for diagnosing thiscondition.

Immobilised Phytase Production from Aspergillus foetidus MTCC 11682 Using an Optimized Media

Aim: Immobilised fungal phytase production from the novel strain Aspergillus foetidus MTTC 11682 and optimisation of cultural conditions for a better and continuous economic yield. Study Design: The study was designed based on the classical method of changing one independent variable while fixing all other at a certain level- one factor at a time, a close ended system for the optimisation of fermentation process. Methodology: Physical and nutritional parameters were optimised for phytase production and subjected to statistical analysis. Adsorption and Entrapment techniques were employed to immobilise the production strain. Results: The optimum physical conditions for augmenting the yield up to 6 days incubation period were as follows: pH of 3.5, 30ºC temperatures and 5% inoculum size. Amongst the nutritional parameters, lactose and sodium nitrate were found to be the best carbon and nitrogen sources. K++, Mg++, Mn++ and Fe++ ions supported the phytase production. TritonX 100 and tween 80 showed an inducing effect on the secretion of phytase enzyme. Immobilised fungal phytase production resulted in an increased yield of 32.5% with poly urethane foam (PUF) as the matrix. A scale up fermentation resulted in an activity of 52.7 FTU/mL for immobilised cells as compared to 25.5 FTU/mL by its free counterpart. Conclusion: Phytase produced in an optimised media employing immobilised Aspergillus foetidus 11682 on poly urethane foam cubes exhibited better phytase activity, improved stability and long shelf life.

Knowledge regarding snake bite in rural Bengal – Are they still lingering on myths and misconceptions.

Introduction: Snake bite is a very common problem in rural India which even today leads to a large number of deaths. This is because the uninformed community members take recourse to harmful traditional healing measures which cause loss of vital time which is very important for the survival of the patient. Objectives: To assess the knowledge of the study population on snake bite and to elicit any association of this knowledge with their demographic and socioeconomic characteristics. Material and methods: An observational, cross-sectional study was done in a village in the Singur Block of Hooghly district of West Bengal. The head of the family or in his absence the senior most members was interviewed with a pre-designed, pre-tested schedule. Results: Farming was the occupation of the majority (36%) followed by business (20.6%) and service (17.7%). 45% belonged to the social class I and II (modified B.G. Prasad) while 39% were in the social class IV and V. Only 58.85% of the study population were aware that the incidence of snake bite can be reduced. 68% were aware of immobilisation of the affected part was the initial first aid measure and only 4% had the correct knowledge that application of collar was unnecessary and harmful. . Correct knowledge on the availability of specific treatment was present among 85.1% and 77.1% knew where specific treatment is available. Education OR 2.51 (1.26 – 5.00), Occuption OR 4.44 (2.35-8.40), PCI OR 2.05 (1.12-3.76) were significantly associated with good knowledge. Conclusion: There is a paucity of knowledge on different domains of snakebite. Hence dissemination of correct knowledge is necessary to remove their misconceptions.

Soybean β-Glucosidase immobilisated on chitosan beads and its application in soy drink increase the aglycones

The objective of this study was to investigate the immobilisation efficiency of soybean β-glucosidase (181.6 U/mL; 23.8 mg protein/mL) on activated chitosan beads. Central Composite Rotational Design (CCDR) 23 was used and the application of immobilised enzyme in commercial soy drink was evaluated. The activation of chitosan beads was achieved with established 2.5% glutaraldehyde, pH 7.5, 8 h incubation time (6 h with agitation and 2 h without agitation) at 37ºC. The highest immobilisation efficiency (%) of soybean β-glucosidase on chitosan beads obtained was 37.74 U/mL and 18.84 mg protein/4 chitosan beads at pH 7.5 and 20 h coupling time of enzyme-matrix (7 h with agitation and 13 h without agitation) at 4ºC. The immobilised enzyme incubated at 50ºC, pH 5.5 resulted in 24% increase in the aglycones content in commercial soy drink after 60 min.

Influence of the pH of glutaraldehyde and the use of dextran aldehyde on the preparation of cross-linked enzyme aggregates (CLEAs) of lipase from Burkholderia cepacia

The preparation of cross-linked enzyme aggregates (CLEAs) of lipase has been a challenge due the low amount of lysine residues that lipases have on their surface. The results show that CLEAs prepared using dextran aldehyde (100-200KDa) have a higher hydrolysis activity and particle size (activities between 3186 +/- 21 U/g of CLEA and 4800 +/- 30 U/g of CLEA and particle sizes between 52.6 +/- 18.7 um and 126.2 +/- 53.5 um) than CLEAs prepared with glutaraldehyde (0.1 KDa) (activities between 894 +/- 16 U/g of CLEA and 2874 +/- 20 U/g of CLEA and particle sizes between 21.2 +/- 5.1 um and 83.4 +/- 24.9 um); Thermal stability assays of bioctalysts at 60 ºC at pH 7.0 using phosphate buffer 25 mM showed that CLEAs prepared with dextran aldehyde have lower residual activity after 50 hrs (maximum residual activity of 46.8 percent in the CLEA) than CLEAs prepared with glutaraldehyde (maximum residual activity of 70.2 percent in CLEA). When considering hydrolysis activity, thermal stability and residual activity of CLEAs as a criteria for selecting the best preparation conditions, it has been found that the best condition for CLEAs preparation are to use glutaraldehyde as cross-linking reagent at pH 9.5, at a concentration of 3.5 g/l, and an enzyme/albumin ratio of 15.

Use of epoxysepharose for protein immobilisation.

Epoxy Sepharose, an activated affinity matrix which has been used for immobilisation of carbohydrates has been tried for immobilisation of proteins. Under normal conditions of coupling at neutral or alkaline pH proteins do not couple to epoxy Sepharose. However, a very high salt concentration during coupling allows the binding of proteins to epoxy Sepharose at a pH as low as 8·5. Increasing ionic strength and/or pH facilitates the binding. The bioactivity of the proteins is not destroyed by the immobilisation. This matrix, unlike cyanogen bromide-Sepharose, retains its ability to bind albumin by 80–90% even after 60 days of storage in aqueous suspension at 4°C. Its capacity to bind proteins is comparable to that of cyanogen bromide-Sepharose.

The binding requirements of monkey brain lysosomal enzymes tο their immobilised receptor protein.

The lysosomal enzyme binding protein (receptor protein) isolated from monkey brain was immobilised on Sepharose 4B and used to study the binding of brain lysosomal enzymes. The immobilised protein could bind ß-D-glucosaminidase, α-D-mannosidase, α-Lfucosidase and ß-D-glucuronidase. The bound enzymes could be eluted either at an acid pH of 4·5 or by mannose 6-phosphate but not by a number of other sugars tested. Binding could be abolished by prior treatment of the lysosomal enzymes with sodium periodate. Alkaline phosphatase treatment of the enzymes did not prevent the binding of the lysosomal enzymes to the column but decreased their affinity, as seen by a shift in their elution profile, when a gradient elution with mannose 6-phosphate was employed. These results suggested that an 'uncovered' phosphate on the carbohydrate moiety of the enzymes was not essential for binding but can enhance the binding affinity.