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@#Introduction: A dilemma arises when a bone graft or fracture fragment is accidentally dropped on the operation theatre floor and becomes contaminated. This study aimed to determine the efficacy of simple and readily available antiseptic solutions in disinfecting contaminated bones. Materials and methods: This experimental study involved 225 bone specimens prepared from discarded bone fragments during a series of 45 knee and hip arthroplasty surgeries. The bone fragments were cut into five identical cubes and were randomly assigned to either control (positive or negative), or experimental groups (0.5% chlorhexidine, 10% povidone-iodine or 70% alcohol). The control negative was to determine pre-contamination culture. All bone specimens, except the control negative group were uniformly contaminated by dropping on the operation theatre floor. Subsequently, the dropped bone specimens except for the control positive group, were disinfected by immersing in a respective antiseptic solution for 10 minutes, before transported to the microbiology laboratory for incubation. Results: The incidence of a positive culture from a dropped bone fragment was 86.5%. From the 37 specimens sent for each group, the incidence of positive culture was 5.4% (2 specimens) after being disinfected using chlorhexidine, 67.6% (25 specimens) using povidone-iodine and 81.1% (30 specimens) using alcohol. Simple logistic regression analysis demonstrated that chlorhexidine was significantly effective in disinfecting contaminated bones (p-value <0.001, odd ratio 0.009). Povidone-iodine and alcohol were not statistically significant (p-value 0.059 and 0.53, respectively). Organisms identified were Bacillus species and coagulase negative Staphylococcus. No gram-negative bacteria were isolated. Conclusion: A total of 0.5% chlorhexidine is effective and superior in disinfecting contaminated bones.
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@#Introduction: The vertical diameter of the foramen isdependent upon the vertical diameter of the correspondingintervertebral disc. A decrease in disc vertical diameter hasdirect anatomic consequences to the foraminal diameter andarea available for the nerve root passing through it. Thisstudy is to establish the relationship amongst theintervertebral disc vertical diameter, lateral foramendiameters and nerve root compression in the lumbarvertebra.Materials and Methods: Measurements of the studyparameters were performed using sagittal MRI images. Theparameters studied were: intervertebral disc verticaldiameter (DVD), foraminal vertical diameter (FVD),foraminal transverse diameter (FTD) and nerve root diameter(NRD) of both sides. The relationship between the measuredparameters were then analyzed.Results: A total of 62 MRI images were available for thisstudy. Statistical analysis showed moderate to strongcorrelation between DVD and FVD at all the lumbar levelsexcept at left L23 and L5S1 and right L3L4 and L4L5.Correlation between DVD and FTD were not significant atall lumbar levels. Regression analysis showed that a decreaseof 1mm of DVD was associated with 1.3, 1.7, 3.3, 3.3 and1.3mm reduction of FVD at L1L2, L2L3, L3L4, L4L5 andL5S1 respectively.Conclusion: Reduction of DVD was associated withreduction of FVD. However, FVD was relatively wide forthe nerve root even with complete loss of DVD. FTD wasmuch narrower than the FVD making it more likely to causenerve root compression at the exit foramina. Theseanatomical details should be given consideration in treatingpatients with lateral canal stenosis.
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Vibrio cholerae infection is mainly caused acute diarrhoea disease. Bacteraemia due to non-O1 V. cholerae is rare and mainly reported in liver cirrhotic patients. We report one case of non-O1 V. cholerae bacteraemia in splenectomised thalassaemic patient who presented with septic shock secondary to abdominal sepsis. She had undergone emergency laporatomy and was managed in the intensive care unit for nine days. She was treated with meropenem and doxycyline and discharged well after fourteen days of admission. The V. cholerae was identified by API 20NE, serotype and polymerase chain reaction showed as non-O1, non-O139 strain. Besides known cholera-like toxin and El Tor hemolysin, with increasing reported cases of V. cholerae bacteraemia, there is possibility of other virulence factors that allow this organism to invade the bloodstream.