Management of Hand Avulsion Injury: A Case Report of a 39-Year-Old With Partial Soft Tissue Avulsion.

Hand injuries occur distal to the wrist crease in the upper limb. Infrequently life-threatening, but with the potential for severe disabilities and far-reaching effects. Hand injuries are common among productive adults. The initial stage in managing hand injuries is identifying the affected structures, followed by determining the urgent procedures required to restore full function. For example, suppose the mechanism of injury, the composition of the avulsed tissue, the extent of damage to the underlying tissues, and the dimension, pattern, and orientation of the avulsed tissue are favorable. In that case, successful reattachment of the avulsed tissue can be achieved. In this article, we describe a 39-year-old woman who underwent immediate repair of a partial avulsion of the radial aspect of her right hand with an almost satisfactory outcome.

Molecular Markers of Pancreatic Cancer: A 10-Year Retrospective Review of Molecular Advances.

Pancreatic cancer remains the third leading cause of death amongst men and women in the United States. Pancreatic ductal adenocarcinoma (PDAC), the most common type of pancreatic cancer maintains its reputation of being the most aggressive with a poor prognosis. One of the contributing factors to the high mortality of PDAC is the absence of biomarkers for early detection of disease and the complexity of tumor biology and genomics. In this review, we explored the current understanding of epigenetics and diagnostic biomarkers in PDAC and summarized recent advances in molecular biology. We discussed current guidelines on diagnosis, prognosis, and treatment, especially in high-risk individuals. We also reviewed studies that have touched on identifying biomarkers and the role they play in making early diagnosis although there are currently no screening tools for PDAC. We explored the recent understanding of epigenetic alterations of PDAC and the future implications for early detection and prognosis. In conclusion, the new and emerging advances in the detection and treatment of PDAC can lead to an improvement in the current outcome of PDAC.

Antibiogram at a Rural Hospital Against the Background of COVID-19: A Five-Year Retrospective Review.

Background and objective The role of the antibiogram in reducing hospital length of stay (LOS), mortality rate, health care costs, and, by extension, patients' social, physical, and emotional wellness has a significant impact on the medical community. Hospitals in large cities serve a dynamic population of diverse ethnic groups. Many scholarly works and publications have shown that the antimicrobial pattern in rural settings has significant variability annually. Over the last two years, the spread of coronavirus disease 2019 (COVID-19) has brought about many unknowns in the sphere of healthcare. The pattern of pathology accompanying COVID-19 has affected hospital policies and direct patient management, leading to a paradigm shift in approaches, policies, and resource utilization. The years 2019 to 2021 were marked by many admissions due to COVID-19, and the effects of COVID-19 are still being studied. In light of this, this study examined the changes in sensitivity patterns, new trends, and nature of bacteria isolates, antimicrobial rates, and susceptibility based on a rural hospital's annual antibiogram pertaining to its central departments: the intensive care unit (ICU), patient care unit (PCU), the outpatient unit, and emergency department (ED). Methods This five-year retrospective antibiogram review compared antibiogram patterns two years before the first case of COVID-19 was reported in the hospital and those two years after the initial outbreak. Results The organism comparative susceptibility tests for Escherichia coli (E. coli) were not significant except for increased susceptibility toward nitrofurantoin (p=0.003); Klebsiella pneumoniae (K. pneumoniae) was also not significant except for the increased susceptibility to ciprofloxacin (p=0.003). Pseudomonas aeruginosa (P. aeruginosa) had no changes in susceptibility patterns, while Proteus mirabilis (P. mirabilis) had increased susceptibility to imipenem (p=0.05), aztreonam (p=0.00), and meropenem (p=0.004), with reduced susceptibility to gentamicin (97.47% vs. 88.24%, p=0.006). There was a whopping decrease in the sensitivity of methicillin-resistant Staphylococcus aureus (MRSA) to clindamycin (75.93% vs. 50.7%, p=0.000), linezolid (99.54% vs. 88.73, p=0.004), trimethoprim/sulfamethoxazole (92.59% vs. 74.65%, p=0.001), and vancomycin (99.54% vs. 88.73%, p=0.004). Staphylococcus aureus (S. aureus) had no significant variation except an increase in susceptibility to nitrofurantoin (p=0.023), and perhaps ironically, Streptococcus pneumoniae (S. pneumoniae) had no significant changes in susceptibility pattern. Conclusion Our data demonstrate that the susceptibility of different drugs against different bacterial pathogens varied. However, some antibiotic drugs were found to have high susceptibility against different isolated organisms, and these drugs include amikacin, levofloxacin, vancomycin, cefotaxime, nitrofurantoin, and ceftriaxone. Some organisms showed a significantly declined antibiotic susceptibility, while others showed a significant improvement. The role of COVID-19 regarding these changes is unknown. COVID-19 may not be the cause of the observed differences. We believe that further research on antibiotic legislation and prescribing trends is required. Other non-significant study findings may be attributed to the limited data available to us.