Association between Facial Types and Handedness among Students of Faculty of Basic Medical Sciences Bayero University, Kano

Background: Generally, a person's dominant hand is a simple and precise determinant of his preference for hand use in fine manual tasks. The main tools used in forensics are derived from the relationships between anthropometric features with important physical and /or biological traits. Objective: This study was to determine the association between facial types and handedness among students of the Faculty of Basic Medical Sciences of Bayero University, Kano. Methodology: Cross-sectional study design with a consecutive sampling of 400 (180 males and 220 females) students (aged 18 and above) of the Faculty of Basic Medical Sciences Bayero University, Kano was carried out. Facial height (FH) and facial width (FW) were measured using established landmarks and the facial index (FI) was calculated from them. The dominant handedness of each participant was determined using the writing component of the Edinburgh Handedness Inventory. This procedure involved asking the participants to mention which of their hands was dominant. The participant was then asked to write a sentence regarding the activitieshe/she was carrying out at the point of recruitment to ascertain the claim made by the participants. The sentence was written separately using each hand. All the data obtained were analyzed using statistical software (SPSS version 20.0). Results: The study population was relatively young (21.76 ± 2.77 years). Right-handedness was the commonest hand dominance observed in both males (90.7%) and females (91.7%). The commonest types of face were the hypereuriproscopic 2 (0.5%), Euriproscopic 41 (10.3%), Mesoproscopic 78 (19.5%), Leptoproscopic 127 (31.8%) and Hyperleptoproscopic 152 (37%) facial types. The majority of the participants were right-handed and this was regardless of gender. The prediction of handedness based on facial types (ꭕ2 = 1.39, Df =3, P = 0.85) or facial index (P = 0.92, OR=0.99, CI = 0.82 ­ 1.19) was not statistically significant. Conclusion: The facial types identified among the study population were not associated with their handedness and thus it was not a good predictor of handedness

Assessment of Post-mortem Processing Methods on Quality and Shelf Life of Mutton

This study was carried out to assess the influence of post-mortem processing methods on quality and shelf life of two breeds of sheep meat. A total of twelve sheep, six each from Balami and Ouda (two prominent breed of Sheep in Nigeria) were weighed, slaughtered and allotted to three processing methods which are scalding, singeing and skinning in a completely randomized experimental design in a 2 × 3 factorial arrangement (2 breeds and 3 post-mortem processing methods). The carcass characteristics, primal cuts, physico-chemical properties, sensory and microbial counts were assessed. The results showed that Ouda breed gave the highest (p<0.05) dressing % (36.43%), preferred (p<0.05) primal cuts in rounds (15.13%), Marbling score, lipid profile (Total cholesterol, LDL), and Lipid peroxidation, Balami sheep was however rated higher (p<0.05) in juiciness, tenderness and overall acceptability. The Scalded sheep had the highest dressing % (35.45%), with preferred marbling score (5.80), and microbial counts. The scalded samples were also the lowest (p<0.05) for crude Fiber, CF, total cholesterol (276.40 mg/dL) and LDL (183.89 mg/dL). Minimal exudate loses (cooking loss and drip loss) were recorded in singeing samples and was rated highest (p<0.05) with organoleptic properties. The microbial and fungi loads increased with the storage days. Conclusively, Ouda breed and Scalding method of post-mortem dressing gave the preferred values for optimum nutrients and shelf-life of sheep meat.

Response of three wheat varieties to nitrogen levels, seeding rates and their combination; 2: Spike characters

To achieve larger production per unit area, sciences and farmers face a great defiance in improving cropping practices and elicitation new top yielding wheat varieties and also to establish the effects of these factors on the spike characters. Two years experiment were conducted to evaluate the effect of three nitrogen fertilizer levels (recommend rate 80 kg N/fed and 25% lower and higher than the recommended, i.e. 60 and 100 kg N/ fed, three seeding rates (40, 60 and 80 kg grains/fed) and there varieties (Giza-171, Gemmiza-12 and Shandawil-1), on spike characters of wheat at the Agricultural and experimental Research Station, Faculty of Agriculture, Cairo University, Giza, Egypt during 2018/2019 and 2019/2020 seasons. The experimental design was a split- split plot in randomized complete block arrangement with three replications. Nitrogen levels were allocated to the main plots, while the sub plots were assigned for seeding rates. Wheat varieties were distributed at random in the sub-sub plots. Each sub-sub plots area 4 m (2 x 2m). Generally, results indicated that significant effect on spike length and number of grains/ spike in both seasons and on weight of grains/ spike and 1000-grain weight in one season, where the tallest and heaviest spike as well as the heaviest 1000-grain weight were produced at the 100 kg N/fed in both seasons but the highest number of grains/spike was obtained at 80 kg N/fed in one season. It could be concluded that application nitrogen at the rate of 100 kg/fed proceed the favorable effect on spike characters under the environmental conditions of the experimental site and the similar conditions. Seeding rates caused a significant effect on all studied traits in one season, so the highest values were at 80 kg grains/fed, but this effect on 1000-grain weight was true in both seasons, where the highest value was at 60 kg grains/fed. Moreover, varieties were significantly differed in all spike character in both seasons except number and weight of grains/spike in one season where Giza-12 variety surpassed others. Al studied interactions had significant effect on all studied traits either in one or two season. Planting Giza-171 with 80 kg grains/fed and application of 100 kg N/fed was the pest treatment.

Glomerular filtration rate in homozygous sickle cell disease children in steady state and healthy Nigerian children: a comparative study in north-eastern Nigeria

Background: Homozygous sickle cell disease (HSCD) is the most common inherited blood disorder of public health importance worldwide, with Sub-Saharan Africa accounting for a third of the global burden. The effect of HbS on the kidneys results in sickle cell nephropathy, which contributes to increased mortality among HbSS patients beyond third decade of life. Glomerular filtration rate (GFR) is an important renal function test for evaluating progress of sickle cell nephropathy, however, this is seldom done to HbSS patients especially in the insurgency that devastated the North-eastern part of Nigeria, where displacement of people has led to increase in diarrhoeal diseases with its complications which also contributes to renal diseases, hence the need for this study. Objective: To determine the baseline glomerular filtration rate of homozygous SCD in steady state and compare same with normal controls. Methods: This is a prospective comparative study conducted at the University of Maiduguri Teaching Hospital (UMTH). The study population consisted of age and sex matched HbSS subjects in steady state and children with haemoglobin AA genotypeaged 3-14 years. The study was conducted over a period of 6 months. Anthropometry and serum creatinine of the subjects were determined and GFR calculated using Schwartz formula. Results: Two hundred and twenty children consisting 110 HbSS and 110 controls were enrolled. This consist of 106 males and 114 females with M:F ratio of 0.9:1. Mean ages of HbSS patients and HbAA subjects were 8.2years and 7.9 years respectively. The mean GFR (SD) was 125.9 (31.9) ml/min/1.73m2 and 93.0 (16.1) ml/min/1.73m2 for the HbSS and HbAA controls, the difference between the means was significant (P<0.001). The normal GFR range for the controls was 77 to 109 ml/min/1.73m2. Sixty-seven (61%) casesand 86 (78%) controls had GFRs within normal range. There was statistically significant difference for GFRs above and below the normal range (Z-score=6.2 & -2.9, p<0.001 & p<0.004). Conclusion: About a third of HbSS children in steady state have elevated GFR, this suggests the presence of moderate renal pathology. Regular monitoring of these children will lead to improvements in management of sickle cell nephropathy and their quality of life

Acute Toxicity Studies and Evaluation of Analgesic Property of the Methanol Stem Bark Extract of Neocarya macrophylla.

The methanol stem bark extract of Neocarya macrophylla was screened for its analgesic activity using acetic acid-induced writhing in mice and formalin-induced pain in rats. The results of the study showed that the extract (60mg/kg, i.p.) decreased writhing response with 63.9% inhibition. The methanol extract also exhibited significant analgesic effect (P<0.05) in the formalin test which is in the same order of magnitude as that observed after administration of pentazocine (10mg/kg, i.p.) the standard drug. The intraperitoneal median lethal dose (LD50) of the methanol extract of N. macrophylla was found to be 283mg/kg in mice suggesting the plant is fairly toxic. The results of the study have shown that the methanol extract of N. macrophylla possesses analgesic activity which rationalizes the traditional use of the plant in the management of pain.

Cure of post Kala-azar dermal leishmaniasis with paromomycin/sodium stibogluconate combination: a proof of concept.

Background: Post kala-azar dermal leishmaniasis (PKDL) is a recognized dermatologic complication of successfully treated visceral leishmaniasis (VL). PKDL lesions are suspected to be important reservoirs for VL transmission in Sudan. Prolonged treatment schedules, feeling of general well-being and the social stigmata of PKDL prevent most patients seeking treatment. The mainstay of treatment is cardiotoxic sodium stibogluconate (SSG) for 60-120 days. Recently, liposomal amphotericin B (Ambisome®) and immunochemotherapy gave promising results. Ambisome® is expensive and difficult to prepare under field conditions. Paromomycin/SSG combination has been shown to be safe, efficacious and can save time in VL treatment. This study aims to prove that Paromomycin/SSG combination can cure and reduce PKDL treatment duration. Methods: We are reporting nine cases of patients with PKDL lesions of ≥6 months duration who were diagnosed by clinical signs, histopathological/immunohistochemical and PCR. Results: Patients’ mean age was 11.7 ± 4.3 years. A third of the patients (3/9; 33.3%) who failed previous SSG treatment of 2-3 months duration responded completely to 40 days of paromomycin/SSG combination. The majority of patients (5/9; 55.6%) responded completely to 30 days of the combination. One patient (1/9; 11.1%) relapsed following 30 days paromomycin/SSG combination. Conclusion: It was concluded that paromomycin/SSG combination for 30 days is time-saving, safe and efficacious for PKDL treatment.

Short Sleep Duration and Correlates among Sero-positive HIV Patients in Nigeria, West Africa.

Introduction: Short sleep duration is a salient issue because it is a major public health concern and has more wide-reaching problems among HIV/AIDS patients. Short sleep duration was said to be associated with lower CD4 count, higher viral load values, depression, high blood pressure, high body mass index and disease progression. It was also documented that patients receiving efavirenz had shorter duration of deep sleep. Incidentally there is paucity of data in Nigeria to support these claims hence the need to investigate. Methods: Four hundred HIV zero-positive patients were recruited at the HIV clinic of Kwara State Specialist Hospital, Sobi, Ilorin, after institutional ethical approval and informed consent was obtained. Blood pressure was measured. Classification of hypertension was made according to the seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure (JNC-7). Body Mass Index was calculated as (kg/m2). The Patient Health Questionnaire (PHQ-9) was administered to the respondents to screen for depressive symptoms. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep duration. The respondents were categorized into four groups viz, sleeping more than 7 hours, 6-7 hours, 5-6 hours and less than 5 hours. Subjects with <5hrs are poor sleepers while those with >7hrs were good sleepers. Results: Four hundred HIV-infected patients were recruited with a mean age of 39yrs (SD 9). Eighty four (21%) were male, while 316 (79%) were female. The mean body mass index was 22.0 (SD 4.6), mean present CD4 count was 339.0 (SD 180.6). One hundred and eighty three respondents (45.8%) slept less than 5 hours, while 58 (14.5%) sleep more than 7hours. Short sleep was commoner in the age group 31-40 73(39.9%), among the female 145(79.2%) and those that were married 103(56.7%), and those with non-formal education 84(45.9%). Traders 80(43.7%) had highest number than other occupation. Short sleepers of less than 5 hours were prone to high blood pressure; higher body mass index and depression. This was statistically significant. The lower the CD4 count, the more the short sleep duration observed among the respondents. Patients receiving HAART containing efavirenz had shorter duration of deep sleep. Conclusion: Almost half of the respondents were poor sleepers with associated high blood pressure and increased body mass index (BMI). Both effects of the virus and antiretroviral drugs may cause short sleep duration. Health providers managing HIV positive patients, need to take complaints of short sleep duration seriously, because they can indicate an increased risk for low CD4 counts, high viral load, depression, high blood pressure and increase body mass index. There is the need for targeting efforts to improve short sleep duration for the majority of adults living with HIV/AIDS and tailoring appropriate interventions.

Dietary Pattern and Antioxidants Levels in Patients with Simple Goiter and Thyroid Cancer.

Background /Aims: Oxidative stress has been implicated in the pathogenesis of thyroid cancer and simple goiter among other diseases however; there has not been a direct comparison of the severity of the stress factor in these two conditions in relation to their dietary pattern in our environment. Objective: This study assessed oxidative stress indices, antioxidant status and dietary pattern in thyroid cancer and simple goiter compared with the controls. Study Design: This is a case-control study. Place and Duration of Study: Study groups were recruited from the Departments of Surgery and Nuclear medicine of University of Ilorin teaching hospital, Ilorin, Kwara State and University College Hospital, Ibadan, Oyo State respectively between March 2013 and September 2013. Materials and Methodology: A total number of one hundred and five (105) age matched participants consisting of 88 females and 17 males were recruited for this study. They were divided into 3 groups; Group one 35 participants with thyroid cancer and group two, 35 participants with simple goiter and group three, 35 control participants. Plasma levels malondialdehyde (MDA), hydrogen peroxide (H2O2) and total plasma peroxide (TPP) were determined by colorimetric methods. Antioxidant status was determined by measuring total antioxidant potential (TAP), glutathione peroxidase (GPx), Superoxide dismutase (SOD), reduced glutathione (GSH), glutathione-s-transferase (GST) by colorimetric methods. Selenium (Se) was determined by atomic absorption spectrophotometry (AAS).Oxidative stress index (OSI) was measured and all values expressed as mean ± SD, while frequency of intake of various dietary sources of the participants were collated. Results: TAP, SOD, GPx, GSH and GST (antioxidants) levels in group 1 (552.17±74.67; 1.30±0.32; 1.91±0.23; 4.47±0.59; 0.92±0.25; 1.28±0.04 respectively) were significantly lower than group 3 (933.51±80.15; 2.85±0.39; 5.40±0.76; 8.34±1.12; 2.11±0.31). While the mean plasma levels of antioxidants in group 2 (704.74±62.22; 2.01±0.27; 4.62±0.89; 6.19± 0.56; 1.47± 0.14 and 1.40±0.04) were significantly higher than that of group 1. However, significant increase was observed in mean levels of oxidative stress markers; TPP, MDA, H2O2 and OSI, in group 1 (16.24±2.52, 13.88±2.95, 13.52±6.91 and 2.93±1.40 respectively) compared to group 3 (4.57±1.32, 3.22±1.20, 3.01±0.86 and 0.48±0.14). Oxidative stress markers in group 2 (9.79±1.40, 5.90±1.13, 3.81±1.40 and 1.62±0.23) were significantly lower than group 1. A p - value <0.05 was considered significant. Majority of the control participants consumed fruits and vegetables (sources of exogenous antioxidants) regularly more than the test groups Conclusion: The study reported higher oxidative stress markers; oxidative stress index and lower antioxidant status in study subjects compared to controls .Oxidative stress appeared more marked in thyroid malignancy than the benign thyroid disease state. Adequate intake of fresh fruits and vegetables could be beneficial for thyroid cancer patients.

Flavonol Glycosides from the Aerial Parts of Indigofera hirsuta and Anti-inflammatory Activity of n-butanol Fraction.

Aims: The study aimed to phytochemically investigate the n-butanol soluble fraction of Indigofera hirsuta aerial parts and to evaluate the anti-inflammatory activity of the fraction using laboratory animal models. Study Design: Isolation and elucidation of the bioactive compounds and antiinflammatory activity investigation on n-butanol soluble fraction. Place and Duration of Study: Department of Pharmaceutical and Medicinal Chemistry, Ahmadu Bello University, Zaria - Nigeria. The study was completed between January-October, 2011. Methodology: The compounds isolated were identified using different spectroscopic techniques. The n-butanol fraction was investigated for its effect on carrageenan-induced oedema in rat’s experimental model. Results: Two Flavonol glycosides were isolated; Kaempferol-3-O-β-D-glucopyranoside (T2) and Kaempferol-7-O-β-D-glucopyranoside (Q3).The fraction significantly (P = .05) inhibited the carrageenan-induced paw oedema at doses of 150 and 300 mg/kg tested. The percentage anti-inflammatory effect of the highest dose tested (300 mg/kg) at the peak hour was higher than that of ketoprofen (10 mg/kg), the standard anti-inflammatory agent. Conclusion: The result of this research suggests that the n-butanol soluble fraction of Indigofera hirsuta aerial parts contains bioactive compounds with anti-inflammatory activity.

Extadigits: an unusual presentation.

Extra digit is a common congenital anomaly in our environment which usually affect the hands and occasionally the feet but very rarely both. A five months old male infant presented with accessory digits of the both hands and feet, with two extra digits on the left hand and one on the right hand, right foot and left foot. The extra digits were well developed, with normal range of motion, good capillary refill and intact sensation. General examination revealed an otherwise healthy child with no associated congenital malformations. The treatment modality used was surgical removal of the extra digits and reconstruction of any associated anomalies in the remaining ray such as longitudinal epiphyseal bracket. After the surgery the patients is no longer experience difficulty with fitting gloves and shoes as well as discrimination among peer groups in his future life.

Worsening cholestasis after endoscopic retrograde cholangiopancreatography

Prolonged cholestasis is a rare complication of endoscopic retrograde cholangiopancreatography [ERCP] with few cases reported in literature. A case of a 39-year-old Jordanian woman who presented with abdominal pain and jaundice was reported. Clinical investigations revealed cholestasis with dilatation of the intrahepatic biliary system. A cholecystectomy had been performed 15 years earlier. ERCP findings were consistent with a mild biliary obstruction. The symptoms were thought to be due to a biliary stone that had passed spontaneously. Her abdominal pain subsided and she was discharged. A few days later the patient's jaundice worsened and she developed severe pruritus. A viral and autoimmune screen were negative and a repeat abdominal ultrasound was normal. She was treated with ursodeoxycholic acid for 10 days, but with no improvement. The patient declined to undergo a liver biopsy. A dramatic improvement was achieved following a short course of oral corticosteroids

High Performance Liquid Chromatography (HPLC) Method Development and Validation Indicating Assay for Ciprofloxacin Hydrochloride.

A new simple, rapid, selective, precise and accurate isocratic reverse phase high performance liquid chromatography assay has been developed for the estimation of Ciprofloxacin Hydrochloride in tablet formulation. The separation was achieved by using C-18 column (LichroCART® 125x4mm, 5μm) coupled with a guard column of silica in mobile phase methanol: buffer (0.025M Orthophosphoric acid with the pH adjusted to 3.0±0.1 with triethylamine) (40:60v/v). The flow rate was 2.0ml/min and the drug was detected using UV detector at the wavelength of 278nm. The retention time was within 1.753 – 1.757 minutes. The method was validated as per ICH guidelines. The proposed method was found to be accurate, repeatability and consistent. It was successfully applied for the analysis of the drug in marketed formulation and could be effectively used for the routine analysis of formulation containing the drug without any alteration in the chromatography conditions.

Comparison between DOT EIA IgM and Widal Test as early Diagnosis of Typhoid Fever.

A recently developed DOT enzyme immunoassay known as "Typhidot" for detecting IgM antibody against 50 KDa OMP antigen of Salmonella typhi, was evaluated on 100 clinically suspected typhoid fever cases and 40 age-sex matched controls, in the Department of Microbiology, Mymensingh Medical College during, the period from June 2006 to July 2007. Blood culture, Widal test, and DOT EIA for IgM test were performed in all patients. Among 100 clinically suspected typhoid fever cases, 35 were subsequently confirmed on the basis of positive blood culture for S. typhi and/or significant rising titre of Widal test. The DOT EIA IgM test could produce results within 1 hour. The result of the DOT EIA IgM test showed a good diagnostic value for typhoid fever. The sensitivity, specificity, positive and negative predictive value of the test was found as 91.42%, 90.00%, 88.88% and 92.30% respectively. On the other hand corresponding values for Widal test were of 42.85%, 85.00%, 71.42% and 62.96% respectively. Thus, The DOT EIA IgM seems to be a practical alternative to Widal test for early diagnosis of typhoid fever.

Anti H.pylori IgM in Symptomatic and Asymptomatic Population.

To evaluate the usefulness of specific IgM in the diagnosis of Helicobacter pylori infection, a cross sectional study was carried out in the Department of Microbiology, Mymensingh Medical College between July 2006 to June 2007. A total of 45 patients having upper gastrointestinal symptoms underwent endoscopy and were subsequently diagnosed as patients with gastritis, peptic ulcer (PU) and non-ulcer dyspepsia (NUD) and another 45 asymptomatic individuals aged 18-65 years, were included in the study. The serum samples of participants were tested for presence of anti-H pylori IgM by using ELISA method. The ELISA for anti H. pylori IgM provided sensitivity and specificity of 73.33%, 93.33% respectively.

PCR for mecA Gene of Methicillin Resistant Staphylococcus Aureus.

The study was under taken to detect mecA gene of methicillin resistant Staphylococcus aureus (MRSA) by PCR. It was carried out in the department of Microbiology, Mymensingh Medical College in collaboration with the Department of Medicine under the Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh between the periods from July 2006 to June 2007. A total of 40 S. aureus strains were used in this study. Isolates of S. aureus were identified by standard microbiology technique and their antimicrobial susceptibility test was done by disk diffusion method according to NCCLS. Minimum inhibitory concentration (MIC) of oxacillin was determined for all isolates by standard agar plate dilution method. All strains were tested for mecA gene by PCR. Out of 40 S. aureus strains 15(37.5%) were detected as MRSA by disk diffusion and agar dilution method but 10(25%) yielded mecA gene by PCR. Detection rate of MRSA by disk diffusion and agar dilution test showed significant difference to that by PCR (p<0.001).

Knowledge on HIV/AIDS and Sexual Behaviour among Youths in Kibaha District; Tanzania

Sub-Saharan Africa is more heavily affected by HIV/AIDS than any other region in the World. Half of all new HIV infections occur in young people. Identifcation of the associated factors is likely to be useful in designing effective interventions. This cross-sectional study aimed to investigate the determinants of high-risk sexual behaviours among youths in Kibaha District; Tanzania. Data was collected using a structured questionnaire. The survey gathered data pertaining to the sexual healthy behaviours among youths; including condom use; number of sexual partners; age at first sexual involvement and knowledge on sexually transmitted diseases and HIV/AIDS. A total of 322 individuals aged 15-24 years were involved in the study. More than 69had sex at least once in their life time. Only about one-third (32.3) of the youths reported to have used condom during the first sexual intercourse and 37during the last sex. About 21.7of the respondents acknowledged having more than one sexual partner in the last 12 months. The majority (98.4) of the respondents have heard of HIV/AIDS. About three quarters (74.8) of the respondents knew where to get HIV testing services but only a small proportion (28.9) had tested for HIV infection. Of those not yet tested; 38.2admitted that they were ready to do so. Although 317 (98.4) respondents were aware of HIV/AIDS; and majority; 65.2mentioned condom as the method used to prevent its transmission; only 117 (36.3) acknowledged using them. In conclusion; despite good knowledge on transmission of HIV among youths in Kibaha district; only a small proportion of them practices safe sex. Education programmes on safe sex practices should be strengthened to provide skills that could be effective in changing and maintaining safe sex behaviours among youths in Tanzania

Is Z Division of The Achilles Tendon Always Necessary in Wide Exposure of The Back of The Distal Tibia and Ankle Joint? Report of a Preliminary Investigation

Background: In posterior approach to the back of tibia and ankle; mere retraction of the Achilles tendon can expose the operation site but when this exposure is not enough; Z division of the Achilles tendon is recommended in literature. The main objective of the study is to find out if Z division of the Achilles tendon is always necessary in posterior approach to the back of tibia and ankle for direct vision of the back of distal tibia; exploration of bones and joints of the posterior aspect of the ankle joint.Method: From 15/12/1997 to 30/12/2006 sixteen patients required surgical management of distal tibia fractures involving articular surfaces. Posterior approach with Achilles tendon division was indicated for satisfactory access to the back of tibia and ankle. In equal number of these patients division of the Achilles tendon was either by Z or longitudinal divisions. Intra and post operative assessment of both types of Achilles tendon division was done.Results: Longitudinal division of the Achilles tendon had advantages and should be preferred. Operation time; period of post- operative pain and cast immobilization were brief. There was full range of motion of the ankle joint after removal of cast.Conclusion: When division of the Achilles tendon is indicated for direct vision of the posterior aspect of the distal of tibia and ankle joint; Z division is not necessary. A good knowledge of anatomy and experience makes the procedure easier and quicker

Is Z Division of The Achilles Tendon Always Necessary in Wide Exposure of The Back of The Distal Tibia and Ankle Joint? Report of a Preliminary Investigation

Background: In posterior approach to the back of tibia and ankle; mere retraction of the Achilles tendon can expose the operation site but when this exposure is not enough; Z division of the Achilles tendon is recommended in literature. The main objective of the study is to find out if Z division of the Achilles tendon is always necessary in posterior approach to the back of tibia and ankle for direct vision of the back of distal tibia; exploration of bones and joints of the posterior aspect of the ankle joint.Method: From 15/12/1997 to 30/12/2006 sixteen patients required surgical management of distal tibia fractures involving articular surfaces. Posterior approach with Achilles tendon division was indicated for satisfactory access to the back of tibia and ankle. In equal number of these patients division of the Achilles tendon was either by Z or longitudinal divisions. Intra and post operative assessment of both types of Achilles tendon division was done.Results: Longitudinal division of the Achilles tendon had advantages and should be preferred. Operation time; period of post- operative pain and cast immobilization were brief. There was full range of motion of the ankle joint after removal of cast.Conclusion: When division of the Achilles tendon is indicated for direct vision of the posterior aspect of the distal of tibia and ankle joint; Z division is not necessary. A good knowledge of anatomy and experience makes the procedure easier and quicker

Clinical evaluation of EM-2 Electroscope Electroshield system to protect against electrosurgical stray currents during laparoscopy

Monopolar electrosurgery is the most commonly used method of dissection and haemostasis in laparoscopic surgery. The problems of active electrode insulation failure, capacitive coupling and direct coupling associated with monopolar electrosurgery can lead to inadvertent and unrecognised energy transfer to tissues outside laparoscopic view and produce serious internal organ damage. The objective of this study was to identify and measure the depth of skin burn around the laparoscopic cannula entry sites, and to determine if the Electroscope Electroshield system can protect against such burns. A prospective randomised study comparing the use of EM-2 Electroscope Electroshield system and conventional electrosurgical instruments in 24 patients who underwent laparoscopic cholecystectomy. The Electroshield system was used in the study group [n = 10] to shield the active electrosurgical electrode throughout the operation. At the end of the operation adequate skin biopsies were taken from the edge of cannula entry wounds at the epigastric and umbilical sites of all patients. The skin biopsies were examined by two independent blinded Pathologists for evidence of coagulative necrosis and the burn depth was measured in mm. Thermal damage of varying depth was identified adjacent to plastic laparoscopic cannulas at both epigastric and umbilical sites in both study groups. There was no significant difference in the burn depth at the epigastric ports [P=0.5896] and at the umbilical ports [P=0.7468] between the two groups [Electroshield used and Electroshield not used]. Within each group there was no statistically significant differences in burn depth between the epigastric and umbilical ports [P=0.2207] for the Electroshield used group, and [P=0.4896] for the Electroshield not used group. The difference in burn depth measurements between the two Pathologists was significant [P=0.0239]. Unrecognised electrosurgical energy transfer can cause skin burns adjacent to plastic cannulas during laparoscopic abdominal surgery at both epigastric and umbilical entry wounds, regardless of whether the EM-2 Electroscope Electrofield system is used or not