Experience on postmortem minimally invasive tissue sampling to ascertain the cause of death determination in South African children: A case for implementing as standard of care.

Determining the death burden for prioritising public health interventions necessitates detailed data on the causal pathways to death. Postmortem minimally invasive tissue sampling (MITS), incorporating histology, molecular and microbial culture diagnostics, enhances cause-of-death attribution, particularly for infectious deaths. MITS proves a valid alternative to full diagnostic autopsies, especially in low- and middle-income countries. In Soweto, South Africa (SA), the Child Health and Mortality Prevention Surveillance (CHAMPS) programme has delineated over 1 000 child and stillbirth deaths since 2017. This SA CHAMPS site supports advocating for the use of postmortem MITS as routine practice, for more granular insights into under-5 mortality causes. This knowledge is crucial for SA's pursuit of Sustainable Development Goal 3.2, targeting reduced neonatal and under-5 mortality rates. This commentary explores the public health advantages and ethicolegal considerations surrounding implementing MITS as standard of care for stillbirths, neonatal and paediatric deaths in SA. Furthermore, based on the data from CHAMPS, we present three pragmatic algorithmic approaches to the wide array of testing options for cost-effectiveness and scalability of postmortem MITS in South African state facilities.

[Minimally Invasive Osteosynthesis of Calcaneal Fractures Using the Anterolateral Locking Plate]. / Miniinvazivní osteosyntéza zlomenin patní kosti anterolaterální úhlove stabilní dlahou.

PURPOSE OF THE STUDY Extended lateral approach to calcaneus fractures is associated with a high risk of infection. Such risk can be reduced by using mini-invasive approaches. The sinus tarsi approach provides a good overview of the posterior joint facet of the calcaneus and can also be done as a mini-invasive procedure. The authors present their fi rst experience with osteosynthesis of joint depression calcaneal fractures using the anterolateral locking plate inserted through the sinus tarsi approach. MATERIAL AND METHODS During the period from 1 February 2020 to 31 January 2022, 18 patients were treated by the anterolateral locking plate in the authors' department (3 women, 15 men). Eleven fractures were classifi ed according to Sanders as IInd grade, fi ve as IIIrd grade and two fractures were classifi ed as tongue-type (as described by Essex-Lopresti). The fractures were treated by open reduction through the sinus tarsi approach and osteosynthesis by the anterolateral locking plate combined with headless screws. The following factors were examined: time from injury, duration of surgery, quality of reduction (post-op control with multiplanar CT scans), wound and technical complications, loss of reduction after treatment, substance abuse and comorbidities. The follow-up was 12-36 months (median 17). At one year after surgery, the functional outcomes were evaluated using the AOFAS Hindfoot score. RESULTS The most common negative predispositions for successful healing were smoking (9 cases), alcohol abuse, drug abuse, mild mental retardation, personality disorder, insulin-dependent diabetes and epilepsy (1 case each), hypothyreodism and bronchial asthma (2 cases each). The time from injury to surgery and duration of surgery surgery were measured. The quality of reduction was excellent in 12 patients (dislocation less than 1 mm), good in 6 patients (dislocation less than 2 mm), dislocation more than 2 mm was not present in the group. In one case, a revision surgery was performed because of screw malposition into the subtalar joint, delayed wound healing was observed in two cases. There was no case of deep surgical site infection or loss of reduction. The mean AOFAS score after one year was 85 points. The most common complaints were scar pain or discomfort. DISCUSSION The current studies on osteosynthesis of calcaneal fractures favor the sinus tarsi approach for its lower risk of wound-related complications compared to the extended lateral approach. The sinus tarsi approach requires the use of different osteosynthetic material than the conventional calcaneal plate. If a conventional locking plate is to be used, the surgical approach has to be modifi ed. In 2021, Wang et al. published an intermediate step leading to the reduction of early complications and the use of conventional locking calcaneal plate inserted through the sinus tarsi approach, with an additional incision. The sinus tarsi approach is used also when intramedullary nailing is performed, which is preferred by biomechanical studies evaluating the rigidity of osteosynthesis. However, when comparing nails and locking plates, the differences are insignifi cant. The use of anterolateral locking plates was presented by Xie et al., with results similar to those of our own group of patients. CONCLUSIONS The results of the followed-up group of patients confi rm low complication rate of the sinus tarsi approach as reported by current literature. At the same time, it provides good options for reduction even in complicated fractures. For successful osteosynthesis, the anterolateral locking plate with headless screws may be used. The incidence of post-operative complications is low even in high-risk patients. Adhesions of peroneal tendons can be treated with material removal and tissue release. They could be prevented by good physiotherapy. Key words: calcaneus, osteosynthesis, anterolateral plate, peroneal tendons, sinus tarsi approach.

Calcaneal fractures - current trends and pitfalls.

Calcaneal fractures, being the most common tarsal fractures, pose a therapeutic challenge. Even today there is no consensus on their ideal treatment. The authors present review of current literature focusing on this topic. Diagnostic techniques and most commonly used classification systems are discussed as well as the algorithm for conservative or surgical treatment based on the current trends. Among surgical procedures and implants, various open and minimally invasive techniques are presented, together with a variety of implants, including screws, nails and plates. Most frequent complications, their prevention and solutions are also scrutinized.

Retrospective analysis of complications after treatment of acute Achilles tendon rupture by Kessler technique.

INTRODUCTION: Open surgical treatment of Achilles tendon rupture comes with high ratio of complications. We have retrospectively evaluated those complications to find patients that would benefit from the mini-invasive technique. METHODS: We analysed all patients after surgical treatment of acute Achilles tendon rupture between the years 2014 and 2020. Information about the surgery, the following complications and patients characteristics were extracted from our documentation. Statistical analysis was concluded to evaluate their significance. We have included 134 patients with the Achilles tendon rupture in our analysis. The majority of patients were men (83.6%) and left-sided injuries were more common (51.5%). The average age was 45 years. RESULTS: Our results show that the most common complications after the treatment of Achilles tendon rupture in our clinic are wound dehiscence, thrombosis and infection. On the other hand, paresthesia and rupture are rare. We have confirmed that most complications occur in smoking patients. Our data show that age is a risk factor as well. Contrary to the previous study, our data did not show the female sex to be a risk factor. CONCLUSION: Open surgical treatment of Achilles tendon rupture in our clinic is accompanied with relatively high complication rate. Mini-invasive techniques could improve the outcomes in the cohort of smoking older patients with acute Achilles tendon rupture. Please kindly refer to the corresponding author to obtain full data in English.

Screening of inbred popcorn lines for tolerance to low phosphorus.

Increasing phosphorus use efficiency in agriculture is essential for sustainable food production. Thus, the aims of this study were: i) to identify phosphorus use efficiency (PUE) in popcorn lines during the early plant stages, ii) to study the relationship between traits correlated with PUE, and iii) to analyze genetic diversity among lines. To accomplish this, 35 popcorn lines from Universidade Estadual de Maringá breeding program were studied. The experiment was conducted in a growth chamber using a nutrient solution containing two concentrations of phosphorus (P): 2.5 µM or low P (LP) and 250 µM or high P (HP). After 13 days in the nutrient solution, root morphology traits, shoot and root dry weight, and P content of the maize seedlings were measured. A deviance analysis showed there was a high level of genetic variability. An unweighted pair group method with arithmetic mean (UPGMA) clustering analysis identified three groups for the LP treatment (efficient, intermediate, and inefficient) and three groups for the HP treatment (responsive, moderately responsive, and unresponsive). The results of a principal component analysis and selection index were consistent with the UPGMA analysis, and lines 1, 2, 13, 17, 26, and 31 were classified as PUE.

Pericallosal aneurysm simulating corpus callosum tumour.

The MRI characteristics of an isolated subacute aneurysmal corpus callosum hematoma, without evidence of blood in cerebrospinal fluid (CSF) spaces or ventricles, have not been previously reported. This report highlights the difficulty of accurate diagnosis and treatment in a patient with an unusual ruptured pericallosal aneurysm simulating a corpus callosum tumour. Additionally we analyse the particular radiological configuration and appearance of blood products in this region.

Job stress and burnout among Canadian managers and nurses: an empirical examination.

This study examined the relationship of job stress with burnout and its three dimensions (emotional exhaustion, lack of accomplishment and depersonalization), job satisfaction, organizational commitment and psychosomatic health problems. Data were collected by means of a structured questionnaire from Canadian managers (N = 67) and nurses (N = 173). Pearson correlation and moderated multiple regression were used to analyze the data. Job stress was significantly correlated with overall burnout and its three dimensions and job satisfaction in both samples. In the nursing sample, job stress was also significantly correlated with psychosomatic health problems and organizational commitment. Moderated multiple regression only marginally supported the role of gender as a moderator of stress-burnout relationship.

Occupational mental health: a study of work-related depression among nurses in the Caribbean.

This study addresses issues of occupational mental health among nurses in the Caribbean. A linear model linking role, work and social factors, stress, burnout, depression, absenteeism and turnover intention guides the research. Data were collected from 119 nurses working for major hospitals located in St. Vincent and Trinidad & Tobago using a field survey. Psychometrically sound instruments with proven cross-cultural validity were utilized in the questionnaire. Descriptive statistics, correlations, and path analysis were used to analyze the data. The results indicated fairly strong support for the proposed model which is tested for the first time among a Caribbean population. Role conflict, role overload and social support predicted stress, which along with social support predicted burnout. Burnout was the sole predictor of depression which in turn predicted both absenteeism and turnover intention. Implications of these findings for research and practice are discussed.