CT scan-based 3D fracture mapping in civilian gunshot intracapsular fractures of the femur neck.

INTRODUCTION: Displaced intracapsular neck of femur (NOF) fractures secondary to civilian gunshots are rare injuries with universally poor outcomes following surgical fixation. No studies have been published on fracture mapping in NOF fractures secondary to civilian gunshots. OBJECTIVES: We performed CT scan-based fracture mapping to identify the most common fracture patterns in these injuries. METHODS: Design: Retrospective search of prospectively collected data. SETTING: Single Level 1 Trauma hospital. Patient selection criteria: All patients presenting with gunshot fractures to the femur neck between 01 January 2009 and 31 December 2022 were identified. Once identified from Picture Archiving and Communication System (PACS), computed tomography (CT) scans in Digital Imaging and Communication in Medicine (DICOM) format were imported into Mimics 16 software and fracture fragments were segmented and three-dimensional (3D) reconstruction was generated. The reduced fractures were exported to 3-Matic software to merge the fragments and adjust the orientation in three planes. An uninjured femur model was used as a template for reduction. Fracture lines and heat maps were then generated. Our outcome measures were successful mapping of the identified fracture lines. RESULTS: A total of 25 intracapsular femur neck fractures were identified and suitable for CT scan mapping. All patients were male with an average age of 22 (range 18-32). Once generated, fracture maps were used to show the location, distribution and frequency of the fracture lines. In all but two cases the fracture line propagation remained within the confines of the hip joint capsule. In three cases there was fracture extension into the superior aspect of the femur head, and in one case extension into the inferior aspect. CONCLUSION: This is the first study to perform 3D fracture mapping for intracapsular femur neck fractures secondary to civilian gunshot injuries. The exercise has helped us better understand the commonest fracture patterns and assisted us with surgical planning and execution.

Role of pinch in Argon impurity transport in ohmic discharges of Aditya-U Tokamak.

We present experimental results of the trace argon impurity puffing in the ohmic plasmas of Aditya-U tokamak performed to study the argon transport behaviour. Argon line emissions in visible and Vacuum Ultra Violet (VUV) spectral ranges arising from the plasma edge and core respectively are measured simultaneously. During the experiments, space resolved brightness profile of Ar1+ line emissions at 472.69 nm (3p44s 2P3/2-3p44p 2D3/2), 473.59 nm (3p44s 4P5/2-3p44p 4P3/2), 476.49 nm (3p44s 2P1/2-3p44p 2P3/2), 480.60 nm (3p44s 4P5/2-3p44p 4P5/2) are recorded using a high resolution visible spectrometer. Also, a VUV spectrometer has been used to simultaneously observe Ar13+ line emission at 18.79 nm (2s22p 2P3/2-2s2p2 2P3/2) and Ar14+ line emission at 22.11 nm (2s2 1S0-2s2p 1P1). The diffusivity and convective velocity of Ar are obtained by comparing the measured radial emissivity profile of Ar1+ emission and the line intensity ratio of Ar13+ and Ar14+ ions, with those simulated using the impurity transport code, STRAHL. Argon diffusivities ~ 12 m2/s and ~ 0.3 m2/s have been observed in the edge (ρ > 0.85) and core region of the Aditya-U, respectively. The diffusivity values both in the edge and core region are found to be higher than the neo-classical values suggesting that the argon impurity transport is mainly anomalous in the Aditya-U tokamak. Also, an inward pinch of ~ 10 m/s mainly driven by Ware pinch is required to match the measured and simulated data. The measured peaked profile of Ar density suggests impurity accumulation in these discharges.

Initial results from near-infrared spectroscopy on ADITYA-U tokamak.

Spectroscopy in vacuum ultraviolet (VUV) and visible ranges plays an important role in the investigation and diagnosis of tokamak plasmas. However, under harsh environmental conditions of fusion grade devices, such as ITER, VUV-visible systems encounter many issues due to the degradation of optical components used in such systems. Here, near-infrared (NIR) spectroscopy has become an effective tool in understanding the edge plasma dynamics. Considering its importance, a NIR spectroscopic diagnostic has been developed and installed on the ADITYA-U tokamak. The system consists of a 0.5 m spectrometer having three gratings with different groove densities, and it is coupled with a linear InGaAs photodiode array. Radiation from the ADITYA-U edge plasma has been collected using a collimating lens and optical fiber combination and transported to the spectrometer. The spectrum in the NIR range from the ADITYA-U plasma has been recorded using this system, in which Paß and Paγ along with many spectral lines from neutral and singly ionized impurities have been observed. The influxes of H and C have been estimated from measurements. The H influx value is found to be 2.8 × 1016 and 1.9 × 1016 particles cm-2 s-1 from neutral hydrogen lines Hα and Paß, respectively, and the C influx value is found to be 3.5 × 1015 and 2.9 × 1015 particles cm-2 s-1 from the neutral carbon and singly ionized carbon, respectively. A good agreement is seen between these results and the results obtained by using a routine photomultiplier tube based diagnostic.

Usability study of a sleeve attachment device for enhancing ease of use of metered dose inhalers in children.

BACKGROUND: Children with asthma often lack the strength to activate their pressurised metered dose inhaler (pMDI). A recently developed sleeve device that attaches to a pMDI reduces the activation force of pMDIs from 36 - 39 Newtons (N) to 12.6 N and monitors the remaining doses with a built-in counter. OBJECTIVES: To examine the usability and patient experience of the Easy Squeezy (ES) sleeve attachment device in the paediatric patient population. METHODS: This cross-over study included 40 participants aged 5 - 10 years, half of whom had previous experience in using a pMDI. The experienced participants had used a pMDI for at least 1 year, and the inexperienced participants had no experience of using a pMDI. Participants and their parents recorded their responses on the ease of use, perceptions and satisfaction with using the pMDI alone and the pMDI with the ES. RESULTS: The participants felt that it was easier for them to activate the pMDI using the ES. They liked the ES device more than the pMDI and felt happier using the ES device. The parents reported that their children would be happier using the ES and would find it easier to activate the pMDI using the ES, that the built-in counter in the ES would make it easier to keep track of the doses, and that their children would be more likely to take the ES to school and use it there compared with the pMDI. They would recommend the ES to other parents and were willing to buy the device with their own money. CONCLUSION: The paediatric participants and their parents reported that the ES made it easier for children to activate the pMDI, that the counter made it easier to keep count of the doses, and that the aesthetics of the ES could potentially remove the stigma attached to use of a pMDI.

Usability study of a sleeve attachment device for enhancing ease of use of metered dose inhalers in children

Children with asthma often lack the strength to activate their pressurised metered dose inhaler (pMDI). A recently developed sleeve device that attaches to a pMDI reduces the activation force of pMDIs from 36 - 39 Newtons (N) to 12.6 N and monitors the remaining doses with a built-in counter. Objectives. To examine the usability and patient experience of the Easy Squeezy (ES) sleeve attachment device in the paediatric patient population. Methods. This cross-over study included 40 participants aged 5 - 10 years, half of whom had previous experience in using a pMDI. The experienced participants had used a pMDI for at least 1 year, and the inexperienced participants had no experience of using a pMDI. Participants and their parents recorded their responses on the ease of use, perceptions and satisfaction with using the pMDI alone and the pMDI with the ES. Results. The participants felt that it was easier for them to activate the pMDI using the ES. They liked the ES device more than the pMDI and felt happier using the ES device. The parents reported that their children would be happier using the ES and would find it easier to activate the pMDI using the ES, that the built-in counter in the ES would make it easier to keep track of the doses, and that their children would be more likely to take the ES to school and use it there compared with the pMDI. They would recommend the ES to other parents and were willing to buy the device with their own money. Conclusion. The paediatric participants and their parents reported that the ES made it easier for children to activate the pMDI, that the counter made it easier to keep count of the doses, and that the aesthetics of the ES could potentially remove the stigma attached to use of a pMDI

The impact of COVID-19 national lockdown on orthopaedic trauma admissions in the northern part of South Africa: A multicentre review of tertiary- and secondary-level hospital admissions.

BACKGROUND: COVID-19 national lockdown measures in South Africa (SA) have been under scrutiny since they were implemented in March 2020. Currently there are no studies showing the effect of the first lockdown on hospital admissions in the northern provinces of SA. OBJECTIVES: To evaluate the impact of national lockdown restrictions on musculoskeletal injury admissions in three hospitals across three provinces (Gauteng, Limpopo and North West). METHODS: In a retrospective review, we compared orthopaedic trauma admissions from 1 April 2020 to 30 June 2020 (during alert level 5 of the national lockdown) with cases admitted during the same period in 2019 (non-lockdown). We reviewed the number of admissions, demographic data and mechanisms of injury in the adult and paediatric population groups. RESULTS: A total of 449 patients were admitted with musculoskeletal injuries during the lockdown period compared with 664 patients in 2019, equating to a 32% reduction in total admissions. While there was an 8% increase in paediatric admissions during lockdown at Dr George Mukhari Academic Hospital, adult admissions decreased in all centres. More young males were admitted during both lockdown (mean age 39.8 years) and non-lockdown (mean age 41.2 years) periods than females (p=0.004). There were significant reductions in the number of injuries due to motor vehicle accidents (59%) and in the number of gunshot wounds (36%) during lockdown. However, we observed an 11% rise in injuries related to suicide attempts among adult admissions during the lockdown period. CONCLUSIONS: Lockdown restrictions resulted in a significant reduction in orthopaedic trauma admissions, and were effective in terms of allowing institutions to direct resources to the management of COVID-19 patients. In the light of the increased suicide attempts observed during lockdown, future lockdown regulations should include comprehensive measures to relieve socioeconomic stress.

Active microrheology using pulsed optical tweezers to probe viscoelasticity of lamin A.

Lamins are nucleoskeletal proteins of mammalian cells that stabilize the structure and maintain the rigidity of the nucleus. These type V intermediate filament proteins which are predominantly of A and B types provide necessary tensile strength to the nucleus. Single amino acid missense mutations occurring all over the lamin A protein form a cluster of human diseases termed as laminopathies, most of which principally affect the muscle and cardiac tissues responsible for load bearing functionalities of the body. One such mutation is A350P which causes dilated cardiomyopathy in patients. It is postulated that a change from alanine to proline in the α-helical coiled-coil forming 2B rod domain of the protein might severely disrupt the propensity of the filaments to polymerise into functional higher order structures required to form a fully functional lamina with its characteristic elasticity. In this study, we have elucidated for the very first time, the application of active microrheology employing oscillating optical tweezers to investigate any alterations in the viscoelastic parameters of the mutant protein meshwork in vitro, which might translate into possible changes in nuclear plasticity. We confirmed our findings from this robust yet fast method by imaging both the wild type and mutant lamin A networks using a super resolution microscope, and observed changes in the mesh size which corroborate our measured changes in the viscoelastic parameters of the lamins. This method could thus be extended to conduct microrheological measurements on any intermediate filament protein thus bearing significant implications in laminopathies and other diseases associated with intermediate filaments.

Drastic reduction of orthopaedic services at an urban tertiary hospital in South Africa during COVID-19: Lessons for the future response to the pandemic.

BACKGROUND: The COVID-19 pandemic has impacted on the global surgery landscape. OBJECTIVES: To analyse and describe the initial impact of the COVID-19 pandemic on orthopaedic surgery at Groote Schuur Hospital, a tertiary academic hospital in South Africa. METHODS: The number of orthopaedic surgical cases, emergency theatre patient waiting times, and numbers of outpatient clinic visits, ward admissions, bed occupancies and total inpatient days for January - April 2019 (pre-COVID-19) were compared with the same time frame in 2020 (COVID-19). The COVID-19 timeframe included initiation of a national 'hard lockdown' from 26 March 2020, in preparation for an increasing volume of COVID-19 cases. RESULTS: April 2020, the time of the imposed hard lockdown, was the most affected month, although the number of surgical cases had started to decrease slowly during the 3 preceding months. The total number of surgeries, outpatient visits and ward admissions decreased significantly during April 2020 (55.2%, 69.1% and 60.6%, respectively) compared with April 2019 (p<0.05). Trauma cases were reduced by 40% in April 2020. Overall emergency theatre patient waiting time was 30% lower for April 2020 compared with 2019. CONCLUSIONS: COVID-19 and the associated lockdown has heavily impacted on both orthopaedic inpatient and outpatient services. Lockdown led to a larger reduction in the orthopaedic trauma burden than in international centres, but the overall reduction in surgeries, outpatient visits and hospital admissions was less. This lesser reduction was probably due to local factors, but also to a conscious decision to avoid total collapse of our surgical services.

Low 30-day mortality in South African orthopaedic patients undergoing surgery at an academic hospital during the first wave of the COVID-19 pandemic: It was safe to perform orthopaedic procedures at our hospital during the first COVID-19 peak.

BACKGROUND:  Initial local and global evidence suggests that SARS-CoV-2-infected patients who undergo surgery, and those who become infected perioperatively, have an increased mortality risk post surgery. OBJECTIVES: To analyse and describe the 30-day mortality, presurgical COVID-19 status and hospital-acquired SARS-CoV-2 infection rates of patients, both SARS-CoV-2-positive and negative, undergoing orthopaedic surgery at a tertiary academic hospital in South Africa (SA) during the first COVID-19 peak. METHODS: This single-centre, observational, prospective study included patients who underwent orthopaedic procedures from 1 April 2020 (beginning of the COVID-19 case increase in SA) to 31 July 2020 (first COVID-19 peak in SA). All patients were screened for COVID-19 and were confirmed positive if they had a positive laboratory quantitative polymerase chain reaction test for SARS-CoV-2 RNA on a nasopharyngeal or oral swab. Thirty-day mortality, presurgical COVID-19 status and hospital-acquired SARS-CoV-2 infection were assessed. RESULTS:  Overall, a total of 433 operations were performed on 346 patients during the timeframe. Of these patients, 65.9% (n=228) were male and 34.1% (n=118) were female. The mean (standard deviation) age was 42.5 (16.8) years (range 9 - 89). Of the patients, 5 (1.4%) were identified as COVID-19 patients under investigation (PUI) on admission and tested positive for SARS-CoV-2 before surgery, and 1 (0.3%) contracted SARS-CoV-2 perioperatively; all survived 30 days post surgery. Twenty-nine patients were lost to follow-up, and data were missing for 6 patients. The final analysis was performed excluding these 35 patients. Of the 311 patients included in the final 30-day mortality analysis, 303 (97%) had a follow-up observation ≥30 days after the operation. The overall 30-day mortality for these patients was 2.5% (n=8 deaths). None of the recorded deaths were of screened COVID-19 PUI. CONCLUSIONS: We report a low 30-day mortality rate of 2.5% (n=8) for patients undergoing orthopaedic surgery at our hospital during the first COVID-19 peak. None of the deaths were COVID-19 related, and all patients who tested SARS-CoV-2-positive, before or after surgery, survived. Our overall 30-day mortality rate correlates with several other reports of orthopaedic centres analysing over similar timeframes during the first peak of the COVID-19 pandemic. Regarding mortality and SARS-CoV-2 infection risk, we can conclude that with the appropriate measures taken, it was safe to undergo orthopaedic procedures at our hospital during the first peak of the COVID-19 pandemic in SA.

Dermotropic Leishmania donovani in Sri Lanka: visceralizing potential in clinical and preclinical studies.

The visceralizing potential of apparently dermotropic Leishmania donovani in Sri Lanka (L. donovani-SL) was investigated through long-term follow-up of cutaneous leishmaniasis (CL) patients and in vivo and in vitro experimental infection models. CL patients (n = 250) treated effectively with intra-lesional antimony therapy were followed-up six monthly for 4 years. There was no clinical evidence of visceralization of infection (VL) during this period. Infection of BALB/c mice with L. donovani-SL (test) through intra-dermal route led to the development of cutaneous lesions at the site of inoculation with no signs of systemic dissemination, in contrast to the observations made in animals similarly infected with a visceralizing strain of L. donovani-1S (control). Cytokine (IL-10, IFN-γ) release patterns of splenocytes and lymph node cell cultures derived from mice primed with experimental infections (with either test or control parasites) revealed significantly high IFN-γ response associated with test mice with CL, while prominent IL-10 levels were observed in association with control mice with VL. Furthermore, diminished infection efficiency, intracellular growth and survival of L. donovani-SL parasites compared with L. donovani-1S were evident through in vitro macrophage infection experiments. These studies confirm, for the first time, the essential dermotropic nature of L. donovani-SL suggesting natural attenuation of virulence of local parasite strains.

Ilioprofunda Endobypass Can Successfully Treat a Post-Operative Femoral Pseudo-Aneurysm.

INTRODUCTION: A 75-year-old male patient with significant cardiopulmonary comorbidity presented with a 70-mm left femoral pseudoaneurysm 6 years after aortobifemoral bypass (and prior femoral endarterectomy). REPORT: As the left superficial femoral artery was occluded, an ilioprofunda endobypass was undertaken following extraperitoneal exposure of the left limb of the bypass graft with subsequent deployment of four Viabahn endoprostheses via the left limb into the proximal left deep femoral artery with successful exclusion of the pseudoaneurysm. The endografts remain patent at 6 months with regression noted in the pseudoaneurysm itself. DISCUSSION: Post-operative femoral pseudoaneurysm following anastomotic dehiscence has traditionally been treated by open surgical repair. Re-re-do open femoral vascular surgery has a high complication rate. Scarring and potential graft infection may necessitate ligation of involved arteries and extra-anatomic bypasses with an attendant risk of limb loss. Although the common femoral artery is conventionally contraindicated for endograft deployment because of the perceived high risk of stent fracture in a highly mobile zone, an endobypass can avoid the potential complications of open revision groin surgery in an unfit, high-risk patient.

Gallbladder Volume in Sikkimese Population.

Background Gall bladder volume can have clinical and therapeutic implications and possibly affect certain pathophysiological mechanisms of many diseases affecting the gallbladder including gall stones. Objective The objective of the study was to establish baseline indices of gallbladder volume for the Sikkimese population and determine its correlation with age, sex and Body Mass Index. Method A prospective epidemiologic study on selected 100 patients (equal male to female ratio) over the age of 36 years, undergoing ultrasound scan of abdomen, was undertaken. Age, Sex, Body Mass Index and gall bladder volume for each subject were collected and analysed statistically. Spearman's correlation test was performed to look for significant variables. Result The overall mean gallbladder volume in the present study was 15.47±7.9 ml with 17.2±8.9 ml and 13.74±6.4 ml being average volumes in males and females respectively, which gives the baseline indices for the Sikkimese population. Gall bladder volume was strikingly increased in obese subjects. There was a positive correlation between gall bladder volume and age (r=0.114), gender (r=0.182) and BMI (r= 0.175) but the strength of correlation was weak and not statistically significant (p <0.001). Conclusion Ultrasonography is an easy and effective method for evaluation of gall bladder volume. Sikkimese males have a larger fasting gall bladder volume which is directly correlated with higher body mass index. Fasting gall bladder volume has a weak correlation with advancing age.

Side-stream tobacco smoke-induced airway hyperresponsiveness in early postnatal period is involved nerve growth factor.

Epidemiological studies have shown that children are more susceptible to adverse respiratory effects of passive smoking than adults. The goal of this study is to elucidate the possible neural mechanism induced by exposure to passive smoking during early life. Postnatal day (PD) 2 and PD 21 mice were exposed to side-stream tobacco smoke (SS), a surrogate to secondhand smoke, or filtered air (FA) for 10 consecutive days. Pulmonary function, substance P (SP) airway innervation, neurotrophin gene expression in lung and nerve growth factor (NGF) release in bronchoalveolar lavage (BAL) fluid were measured at different times after the last SS or FA exposure. Exposure to SS significantly altered pulmonary function in PD2, accompanied with an enhanced SP innervation in airway. However, exposure to SS during the later developmental period (PD21) did not appear to affect pulmonary function and SP innervation of the airways. Interestingly, SS exposure in PD2 group significantly induced an increased gene expression on NGF, and decreased NGF receptor P75 in lung; parallel with high levels of NGF protein in BAL. Furthermore, pretreatment with NGF antibody significantly diminished SS-induced airway hyperresponsivenss and the increased SP airway innervation in the PD2 group. These findings suggest that enhanced NGF released in the lung contributes to SS-enhanced SP tracheal innervation and airway responsiveness in early life.