Primary fusion versus open reduction internal fixation for purely ligamentous lisfranc injuries: A Prospective comparative study and analysis of factors affecting the outcomes.

BACKGROUND: The studies evaluating the outcomes of treatment of purely ligamentous unstable Lisfranc injuries are scarce. This study aimed at comparing outcomes of primary tarso-metatarsal joints fusion versus open reduction and internal fixation in treatment of such condition and determining the possible factors that may alter the outcomes. METHODS: This study comprised 30 patients; 16 in fusion group and 14 in ORIF group. One column was operated on in 2 patients, two columns in 21, and three columns in 7. The mean follow-up period was 36 months. RESULTS: There was no statistically significant difference between both groups regarding patients or injury characteristics. The mean AOFAS and FFI-Rs scores were 88.9 and 22.7 in the fusion group, compared to 61.7 and 34.5 in the ORIF group (P = .03,.04 respectively). At final follow-up all patients in the primary arthrodesis group were maintaining an anatomical reduction versus 71.5% in the ORIF group. Sixteen patients (53%) reported prominent hardware troubles that required removal. Five patients in ORIF group developed osteoarthritis, and four of them underwent secondary fusion. There was significantly higher incidence of posttraumatic osteoarthritis in patients with non-anatomical reduction and complete injuries. Better mean AOFAS and FFI-Rs scores occurred with non-smokers and with anatomical reduction. CONCLUSION: Based on this limited case series, purely ligamentous Lisfranc injuries were found to have better outcomes when managed with a primary fusion as compared to ORIF. Achieving and maintaining anatomical reduction was the most important factor that is significantly attributed to improved outcomes. Possible arthritic changes and additional surgeries apart from implant removal could be avoided by primary fusion. LEVEL OF EVIDENCE: level I- prospective comparative case study.

Combination of Procalcitonin, CRP and CD11b Biomarkers in Early Detection of Neonatal Sepsis.

The study aimed at comparing the diagnostic performances of CRP, PCT and CD11b in neonatal sepsis and evaluating the effectiveness of the sepsis score system when using a combination of various biomarkers. The study was conducted on 90 neonates divided into 3 equal groups; a group with proven sepsis, suspected sepsis and healthy newborns. All were subjected to measurement of CPR by Latex agglutination, serum Procalcitonin by ELISA and CD11b by flow cytometry. On comparing the three biomarkers; PCT (Serum procalcitonin) was associated with the highest (AUC) area under the curve followed by CD11b and CRP recording the smallest value. However, the AUC of the combined sepsis score was much higher than individual biomarkers. Although the sensitivity of individual biomarkers from procalcitonin to CD11b and lastly CRP but the sensitivity and specificity of the sepsis score showed higher values compared to those of individual biomarkers. In conclusion, the study demonstrate that combination of CRP, CD11b and, procalcitonin can enhance diagnostic discriminative power over traditional tests and overcome the drawbacks of each test alone with greater diagnostic accuracy.

Perceptions and reasons of E-cigarette use among medical students: an internet-based survey.

BACKGROUND: Nowadays, E-cigarette use shows a significant increase among adults and youth in many countries, although there is still a public health debate about its relative effects compared to the traditional cigarettes. OBJECTIVES: To assess the prevalence, perceptions, possible reasons of use, and factors associated with E-cigarettes use among medical students at Taibah University, Kingdom of Saudi Arabia. METHODS: An internet-based online survey study was conducted between September and November 2019 which contains socio-demographic data, data related to smoking and E-cigarette use, and data related to reasons of E-cigarette use. RESULTS: A total of 527 out of 720 students completed an online questionnaire, 15.9% of the surveyed students used E-cigarettes, older age, male, higher college class, those who have ≥ 1 close friend who smokes, family history of smoking, and housemates who smoked E-cigarettes show a significantly higher percentage of E-cigarettes use. The first reason for E-cigarettes use namely that, E-cigarette helps to reduce tobacco consumption with no intention to quit smoking was the highest (89.2%), followed by E-cigarette being less toxic than tobacco (88.4%), and finally E-cigarette helps to avoid having to go outside to smoke (62.05%). Logistic regression analysis showed that sex, more than one close friend who smokes, family history of smoking, and housemates who smoked E-cigarettes were significant factors associate with its use. CONCLUSION: E-cigarette use appears to be relatively common than conventional cigarette among the participants. Our study participants perceived that it can help people quit, less harmful, and less addictive. The most common reason for its use among the study participants was that E-cigarette helps to reduce tobacco consumption in users with no intention to quit smoking.

Serum Level of Growth Arrest-Specific 6 (Gas6) Protein and Genetic Variations in the Gas6 Gene in Patients with Type 2 Diabetes Mellitus.

Growth arrest-specific protein 6 (Gas6) belongs to a family of vitamin K-dependent coagulation proteins. Plasma levels of Gas6 are associated to altered glucose tolerance. This study aimed at determining whether c.843+7G>A Gas6 polymorphism is associated with the development of type 2 diabetes mellitus. The study included 50 patients with type 2 diabetes and 40 matched controls. The Gas6 protein was measured in serum using ELISA and Gas6 gene polymorphism by polymerase chain reaction-Restriction Fragment Length Polymorphism. The GG genotype was the most prevalent in the diabetic patient. The frequency of A allele in the diabetic group was lower than the control group (P < 0.05). Serum concentrations of Gas6 were lower among type 2 diabetes patients than controls (P < 0.001). Since the AA genotype was expressed at a lower frequency in type2 diabetes patients compared to controls, a protective role for this Gas6 variant in type 2 diabetic patients may be concluded.