Assessment of the functional outcomes of isolated fifth metacarpal fractures treated by antegrade intramedullary K-wiring

Background: Fractures of the neck of the fifth metacarpal is known as Boxer's fractures; they are among the most common fractures of the hand. Despite the variety of conservative and surgical options available, no one technique has been established as the reference

Objective: To evaluate functional outcomes of isolated fifth metacarpal fractures treated by antegrade intramedullary K-wiring

Design: A Retrospective Review

Setting: Bahrain Defence Force Hospital, Kingdom of Bahrain

Method: A retrospective review of patients who underwent surgical fixation of fractures of the neck of the fifth metacarpal using intramedullary K-wires inserted in an antegrade fashion treated from July 2007 to February 2013

Result: Twelve patients met inclusion criteria. Mean follow-up was 34.5 months, a range of 23 to 56 months. The patients had a mean of 97.8% range of motion in the injured hand compared to the non-injured. They had a mean of 90.2% strength on the injured hand compared to the non-injured. Complex regional pain syndrome was documented in one patient. Radiographically, all patients showed full union on follow-up. Subjectively, Visual Analogue Scale [VAS] scores had a mean of 1.08. Disabilities of the Arm, Shoulder and Hand [DASH] scores had a mean of 6.9 and Steele scores had a mean of 378.5

Conclusion: Surgical fixation of Boxer's fractures using intramedullary K-wires inserted in an antegrade fashion is an effective method of fixation

Cervical cord compression secondary to mycetoma infection

Mycetoma is a chronic granulomatous subcutaneous infection caused by actinomycetes [actinomycetoma] or by true fungi [eumycetoma]. Clinically the disease is characterized by swelling, and sinuses in the affected part. Another characteristic feature of mycetoma is the formation of aggregates of the organism [grains] in the tissues, which are visible to the naked eye and are discharged through sinuses in the skin. The grains vary in colour, size and consistency depending on the causative agent [1, 2]. These features are helpful in making a tentative diagnosis of the causative organism. We report a 75 year's Sudanese female with spastic paraplegia of gradual onset, she has discharging sinuses in her neck. Cervical X-RAY and cervical MRI showed destruction of cervical vertebrae. Identification of the agent was established by the histological examination of the grains, by culture and serologic techniques. Mycetoma is a local chronic and progressive infection of the skin, subcutaneous tissues and bone. It is characterized by swelling that is often grotesque and disfiguring and by multiple sinus tracts that drain granule-containing pus [3]

Chronotherapeutic effect of fluvastatin on lipid profile in rats

Dyslipidemia is a major risk factor for coronary heart disease [CHD], and its management is important in preventing the occurrence of cardiovascular events. Lipid-altering drug treatment, targeted to patients at high risk for cardiovascular disease, has been shown [in clinical trials] to reduce the incidence of first and recurrent CHD events. Statins are used widely for the treatment of dyslipidemia. They act through reversible competitive inhibition of the hepatic 3-hydroxy-3-methylglutaryl coenzyme A [HMG-CoA] reductase, the enzyme that catalyzes the rate-limiting step in cholesterol biosynthesis. The early use of statin in management of dyslipidemia recommended their morning administration. However, this strategy should be re-evaluated in light of reports showing that the biosynthesis of cholesterol exhibits diurnal periodicity with nocturnal increase in the level of cholesterol precursors. The experiments were performed on forty male albino rats divided after estimation of basic lipid profile into four equal groups, each composed of 10 animals: control normocholesterolemic, hypercholesterolemic non-treated, hypercholesterolemic treated with morning fluvastatin [8mg/kg, for 12[th] weeks] and hypercholesterolemic treated with evening fluvastatin [8mg/kg for 12[th] weeks]. Lipid profile was estimated at the end of the 4[th], 8[th], 12[th] and 16[th] weeks for all animals using spectrophotometeric assay kits and the results were expressed in mg/dl. Both morning and evening treatment with fluvastatin significantly reduced blood cholesterol level and low-density lipoprotein. Significant increase of plasma high density lipoprotein level was observed in evening treated group in comparison with non-treated hypercholesterolemic animals. Interestingly, all these beneficial effects of fluvastatin treatment were more significant when administered in the evening rather than in the morning pattern of treatment. On the other hand, fluvastatin treatment whether given in the morning or in the evening for hypercholesterolemic animals, produced no significant effect on plasma triglyceride level and total lipid level in comparison with non-treated hypercholesterolemic animals. It is concluded that therapeutic efficiency of fluvastatin is best obtained when the drug was administered in the evening rather than in the morning. This most likely occurred due to the circadian rhythm of cholesterol biosynthesis. This chronotherapeutic pattern of fluvastatin recommends its night administration to ensure introduction of the drug at the proper timing thus achieving the best therapeutic effect