Outcomes in Thoracolumbar Burst Fractures With a Thoracolumbar Injury Classification Score (TLICS) of 4 Treated With Surgery Versus Initial Conservative Management.

STUDY DESIGN: This is a single-center, retrospective, observational cohort study. OBJECTIVE: To determine whether surgery or nonoperative treatment has better clinical outcomes in neurologically intact patients with an intermediate severity thoracolumbar burst fracture. SUMMARY OF BACKGROUND DATA: Optimal management, whether initial operative or nonoperative treatment, for thoracolumbar injury classification score (TLICS) 4 burst fractures remains controversial. Better insight into the treatment which affords patients a better clinical outcome could significantly affect patient care. MATERIALS AND METHODS: This retrospective study included consecutive cases of TLICS 4 burst fracture patients from 2007 to 2013 and minimum 6-month follow-up. Potential confounders examined included age, sex, injury severity score, initial kyphotic angle, injured facets, and interspinous widening. Outcomes were determined by standardized questionnaires [Oswestry Disability Index (ODI), 12-item Short Form Physical Component Score (SF-12 PCS), and back pain Visual Analog Scale (VAS)] and analyzed using regression analysis. RESULTS: A total of 230 patients with burst fractures were identified, of which 67/230 (29%) were TLICS 4 and 47/67 (70%) had completed follow-up. No difference on univariate analysis was found between nonsurgical and surgical groups in mean ODI scores (P=0.27, t test), nor mean time to return to work (P=0.10, t test).Regarding outcomes, linear regression analysis revealed no association between having surgery and ODI (P=0.29), SF-12 PCS (P=0.59), or VAS (P=0.33). Furthermore, no difference was found between groups for employed patients working versus not working (P=0.09, the Fisher test), nor in mean time to return to work (P=0.30, Cox regression). CONCLUSIONS: This is one of the largest studies examining TLICS 4 burst fracture patients, adjusting for both clinical and radiologic confounders and reporting patient outcomes with minimum 6-month follow-up. No differences were found in outcomes between patients treated either surgically or nonsurgically. Studies focusing on early postoperative differences or cost-effectiveness might help in decision making. LEVEL OF EVIDENCE: Level III.

Evaluation of toxicological risk of foodstuffs contaminated with heavy metals in Swat, Pakistan.

This study aimed to assess the concentrations of heavy metals such as cadmium (Cd), chromium (Cr), copper (Cu), manganese (Mn), nickel (Ni), lead (Pb) and zinc (Zn) in the available foodstuffs (crops, milk and water), their bioaccumulation in human body and potential human health risks in Swat valley, northern Pakistan. Heavy metal concentrations in foodstuffs and human blood (adults (18-above) and children (1-12 years)) were analyzed using atomic absorption spectrometer. The results revealed high level of Mn in foodstuffs followed by Cr>Cu>Zn>Ni>Cd>Pb, which significantly increased the levels of heavy metals in the adult׳s blood as compared to that of children in the order of Cr>Zn>Mn>Ni>Pb>Cu>Cd. Principal component analysis showed that selected foodstuffs were the possible sources of metal contamination in human blood, while correlation analysis revealed that the concentrations of Cr, Cu, Mn, Ni, Pb and Zn in foodstuffs significantly correlated with that in human blood. Moreover, risk assessments for individual metals via foodstuffs were found within safe limits, except for Cd (HQ>1); Whereas, for aggregate multiple metals the risk was calculated as 3.97E+00 (HI>1), in which water and milk were perceived as the greater contributors (81 percent) to HI; while fruits, grains and vegetables contributed 5 percent each, and pulses 4 percent.