Cemented versus uncemented stems for revision total hip replacement: A systematic review and meta-analysis.

BACKGROUND: The popularity of uncemented stems in revision total hip arthroplasty (THA) has increased in the last decade. AIM: To assess the outcomes of both cemented and uncemented stems after mid-term follow up. METHODS: This study was performed following both the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement and the Cochrane Handbook for systematic reviews and meta-analysis guidelines. Articles were chosen irrespective of country of origin or language utilized for the article full texts. This paper included studies that reviewed revision THA for both cemented or uncemented long stems. RESULTS: Three eligible studies were included in the meta-analysis. Analysis was conducted by using Review Manager version 5.3. We computed the risk ratio as a measure of the treatment effect, taking into account heterogeneity. We used random-effect models. There were no significant differences found for intraoperative periprosthetic fractures [risk ratio (RR) = 1.25; 95% confidence interval (CI): 0.29-5.32; P = 0.76], aseptic loosening (RR = 2.15, 95%CI: 0.81-5.70; P = 0.13), dislocation rate (RR = 0.50; 95%CI: 0.10-2.47; P = 0.39), or infection rate (RR = 0.99, 95%CI: 0.82-1.19; P = 0.89), between the uncemented and the cemented long stems for revision THA after mid-term follow-up. CONCLUSION: This study has evaluated the mid-term outcomes of both cemented and uncemented stems at first-time revision THA. In summary, there were no significant differences in the dislocation rate, aseptic loosening, intraoperative periprosthetic fracture and infection rate between the two cohorts.

Primary intramuscular thigh hydatid cyst: A case report.

INTRODUCTION AND IMPORTANCE: Hydatid cyst is a parasitic infection caused by Echinococcus granulosis. It mostly involves the liver and lungs; however, muscle involvement is an uncommon event. The diagnosis of such cystic masses is still a challenge due to the presence of more common pathological conditions in soft tissue. Imaging is useful and can identify a definitive diagnosis. CASE PRESENTATION: We present a case of a 32-year-old woman with history of close contact with dogs and cats, who complained of an isolated swelling in the right upper thigh growing gradually over a period of 3 years. Ultrasound reported intramuscular hydatid cyst in the right thigh. Hydatid cyst was completely excised. The outcome was good, with no recurrence in one year. CLINICAL DISCUSSION: Ultrasonography is an excellent and cost-effective imaging modality with a high negative predictive value in the evaluation of palpable superficial soft-tissue masses and hydatid cysts. CONCLUSION: Isolated intramuscular hydatid cyst is rarely reported, even in endemic areas of the disease, so the diagnosis should be considered in any cystic masses of soft tissue, particularly in subjects from high-endemic zones. Although the treatment of choice in such cases is surgical excision but prevention is more favorable to fight against hydatid disease.

Environmental and health impacts of PFAS: Sources, distribution and sustainable management in North Carolina (USA).

Poly- and perfluoroalkyl substances (PFAS) are a class of manufactured chemicals that have recently attracted a great deal of attention from environmental regulators and the general public because of their high prevalence, resistance to degradation, and potential toxicity. This review summarizes the current state of PFAS and its effects on the environment of North Carolina, USA. Specific emphasis has been placed to identify i) the sources of PFAS in North Carolina ii) distribution of PFAS in different environmental segments of North Carolina, including surface water, groundwater, air, and sediment iii) drinking water contamination iv) impact of PFAS on human health v) PFAS accumulation in fish and other biota vi) status of PFAS removal from drinking water and finally vi) socioeconomic impact of PFAS uncertainties. Continuous discharges of PFAS occur in the North Carolina environment from direct and indirect sources, including manufacturing sites, firefighting foam, waste disposal and treatment plants, landfill leachate, and industrial emissions. PFAS are widespread in many environmental segments of North Carolina. They are more likely to be detected in surface and groundwater sediments and can enter aquatic bodies through direct discharge and wet and dry deposition of emissions. Eventually, some adverse effects of PFAS have already been reported in North Carolina residents who could have been exposed to the chemicals through contaminated drinking water. Furthermore, PFAS were also found in blood samples from fish and alligators. PFAS were confirmed to be present in water, sediment, organic compounds, and aquatic species at all levels of the food web. However, there is still a substantial amount of work to be done to understand the actual contamination by PFAS in North Carolina comprehensively.

Selecting suitable seed sludge for anammox enrichment: Role of influent characteristics and reactor operational conditions.

The study investigated the suitability of three different sludge collected from diverse environments for anammox process establishment. Sludge was collected from SBR (S1) treating municipal wastewater, nitrification tank (S2), denitrification tank (S3) treating fertilizer industrial wastewater. The microbial community in the seed sludge was studied. The presence of anammox bacteria was detected only in seed sludge S2 treating high NH4+-N wastewater. Seed sludge S3 showed high abundance of denitrifiers due to NO3--N and organic carbon rich environments in denitrification tank. The anammox start-up performances of sludge were assessed. S2 achieved start-up within 65 days whereas S1 and S3 showed longer start-up period of 79 and 93 days, respectively. S1, S2, S3 achieved nitrogen removal rate of 148.84 gN m-3day-1, 159.70 gNm-3day-1 and 120.90 gNm-3day-1, respectively. Influent NH4+-N, NO3--N and organic carbon concentrations governed the abundance of anammox and denitrifying bacteria in seed sludge thereby impacting the anammox start-up.

Thermal conductivity measurements of sub-surface buried substrates by steady-state thermoreflectance.

Measuring the thermal conductivity of sub-surface buried substrates is of significant practical interests. However, this remains challenging with traditional pump-probe spectroscopies due to their limited thermal penetration depths. Here, we experimentally and numerically investigate the TPD of the recently developed optical pump-probe technique steady-state thermoreflectance (SSTR) and explore its capability for measuring the thermal properties of buried substrates. The conventional definition of the TPD (i.e., the depth at which temperature drops to 1/e value of the maximum surface temperature) does not truly represent the upper limit of how far beneath the surface SSTR can probe. For estimating the uncertainty of SSTR measurements of a buried substrate a priori, sensitivity calculations provide the best means. Thus, detailed sensitivity calculations are provided to guide future measurements. Due to the steady-state nature of SSTR, it can measure the thermal conductivity of buried substrates that are traditionally challenging by transient pump-probe techniques, exemplified by measuring three control samples. We also discuss the required criteria for SSTR to isolate the thermal properties of a buried film. Our study establishes SSTR as a suitable technique for thermal characterizations of sub-surface buried substrates in typical device geometries.

High In-Plane Thermal Conductivity of Aluminum Nitride Thin Films.

High thermal conductivity materials show promise for thermal mitigation and heat removal in devices. However, shrinking the length scales of these materials often leads to significant reductions in thermal conductivities, thus invalidating their applicability to functional devices. In this work, we report on high in-plane thermal conductivities of 3.05, 3.75, and 6 µm thick aluminum nitride (AlN) films measured via steady-state thermoreflectance. At room temperature, the AlN films possess an in-plane thermal conductivity of ∼260 ± 40 W m-1 K-1, one of the highest reported to date for any thin film material of equivalent thickness. At low temperatures, the in-plane thermal conductivities of the AlN films surpass even those of diamond thin films. Phonon-phonon scattering drives the in-plane thermal transport of these AlN thin films, leading to an increase in thermal conductivity as temperature decreases. This is opposite of what is observed in traditional high thermal conductivity thin films, where boundaries and defects that arise from film growth cause a thermal conductivity reduction with decreasing temperature. This study provides insight into the interplay among boundary, defect, and phonon-phonon scattering that drives the high in-plane thermal conductivity of the AlN thin films and demonstrates that these AlN films are promising materials for heat spreaders in electronic devices.

Factors influencing mHealth adoption and its impact on mental well-being during COVID-19 pandemic: A SEM-ANN approach.

The objectives of this study are to examine the factors affecting the intention and actual usage behavior on mHealth adoption, investigate the effect of actual usage behavior of mHealth on mental well-being of the end-users, and investigate the moderating role of self-quarantine on the intention-actual usage of mHealth under the coronavirus disease (COVID-19) pandemic situation. The required primary data were gathered from the end-users of mHealth in Bangladesh. Using the Unified Theory of Acceptance and Use of Technology (UTAUT2), this study has confirmed that performance expectancy, effort expectancy, social influence, hedonic motivation, and facilitating conditions have a positive influence on behavioral intention whereas health consciousness has an impact on both intention and actual usage behavior. mHealth usage behavior has an affirmative and meaningful effect on the mental well-being of the service users. Moreover, self-quarantine has strong influence on actual usage behavior but does not moderate the intention-behavior relationship. In addition, due to the existence of a non-linearity problem in the data set, the Artificial Neural Network (ANN) approach was engaged to sort out relatively significant predictors acquired from Structural Equation Modeling (SEM). However, this study contributes to the emergent mHealth literature by revealing how the use of the mHealth services elevates the quality of patients' mental well-being under this pandemic situation.

Injectable Amoxicillin Versus Injectable Ampicillin Plus Gentamicin in the Treatment of Severe Pneumonia in Children Aged 2 to 59 Months: Protocol for an Open-Label Randomized Controlled Trial.

BACKGROUND: Pneumonia causes about 0.9 million deaths worldwide each year. The World Health Organization (WHO) guidelines for the standard management of severe pneumonia requires parenteral ampicillin every 6 hours and once-daily parenteral gentamicin for 5 to 7 days. Although this treatment has contributed to the reduction of mortality, it requires nursing interventions every 6 hours for 7 days. Further intervention trials should be conducted to search for alternate antibiotics with better adherence, reduced cost, and reduced hospital stay. Parenteral amoxicillin is an effective alternative to ampicillin, as it has a longer half-life and broader coverage. OBJECTIVE: The aim of this clinical trial is to compare the efficacy of a dose of injectable amoxicillin every 12 hours plus a once-daily dose of injectable gentamicin with a dose of injectable ampicillin every 6 hours plus a once-daily dose of injectable gentamicin in children hospitalized for severe pneumonia. METHODS: This randomized, controlled, open-label, noninferiority trial is being conducted in Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh. A sample size of 308 children with severe pneumonia will give adequate power to this study. Children aged 2 to 59 months are randomized to either intravenous ampicillin or intravenous amoxicillin, plus intravenous gentamicin in both study arms. The monitoring of the patients is carried out according to the WHO protocol for the treatment of severe pneumonia. The primary objective is the rate of treatment failure, defined by the persistence of danger signs of severe pneumonia beyond 48 hours or deterioration within 24 hours of initiation of the therapy. The secondary objectives are (1) improvement in or the resolution of danger signs since enrollment, (2) length of hospital stay, (3) death during hospitalization, and (4) rate of nosocomial infections. RESULTS: Enrollment in the study started on January 1, 2018, and ended on October 31, 2019. Data entry and analysis are in progress. Findings from the study are expected to be disseminated in October 2020. CONCLUSIONS: Our study's findings will improve compliance with the use of antibiotics that require less frequent doses for the treatment of severe pneumonia. TRIAL REGISTRATION: ClinicalTrials.gov NCT03369093; https://clinicaltrials.gov/ct2/show/NCT03369093. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/17735.

How does dyslexia impact on the educational experiences of healthcare students? A qualitative study.

AIMS: To explore the impact of dyslexia on the educational experiences of undergraduate students in medicine, dentistry, dental therapy and biomedical sciences. METHODS: It was a qualitative study based on semi-structured interviews. The study was conducted at the Faculty of Medicine and Dentistry at a University in the South West region of the United Kingdom. Purposive sampling was used, and the participants included undergraduate students from the schools of medicine, dentistry and biomedical sciences. RESULTS: The sample consisted of fifteen undergraduate students including five from medicine; four from dentistry; three from dental therapy; and three from biomedical sciences. All students had a formal diagnosis of Dyslexia. The students shared their views and experiences regarding disclosure, transition into the university, learning environments, assessments and challenges after graduation. CONCLUSIONS: This is the first study to explore the impact of dyslexia on the educational experiences of healthcare students from multiple programmes in a variety of educational settings. The findings show that the students were confident regarding disclosure of their dyslexia and had a formal diagnosis of dyslexia established during their school years. Although the participants experienced typical academic difficulties associated with dyslexia, problem-based learning (PBL) was perceived to be enjoyable and less stressful than traditional lectures and no specific challenges were reported in acquisition of clinical, communication and team-working skills.

The First Consensus Statement on One Anastomosis/Mini Gastric Bypass (OAGB/MGB) Using a Modified Delphi Approach.

BACKGROUND: An increasing number of surgeons worldwide are now performing one anastomosis/mini gastric bypass (OAGB/MGB). Lack of a published consensus amongst experts may be hindering progress and affecting outcomes. This paper reports results from the first modified Delphi consensus building exercise on this procedure. METHODS: A committee of 16 recognised opinion-makers in bariatric surgery with special interest in OAGB/MGB was constituted. The committee invited 101 OAGB/MGB experts from 39 countries to vote on 55 statements in areas of controversy or variation associated with this procedure. An agreement amongst ≥ 70.0% of the experts was considered to indicate a consensus. RESULTS: A consensus was achieved for 48 of the 55 proposed statements after two rounds of voting. There was no consensus for seven statements. Remarkably, 100.0% of the experts felt that OAGB/MGB was an "acceptable mainstream surgical option" and 96.0% felt that it could no longer be regarded as a new or experimental procedure. Approximately 96.0 and 91.0% of the experts felt that OAGB/MGB did not increase the risk of gastric and oesophageal cancers, respectively. Approximately 94.0% of the experts felt that the construction of the gastric pouch should start in the horizontal portion of the lesser curvature. There was a consensus of 82, 84, and 85% for routinely supplementing iron, vitamin B12, and vitamin D, respectively. CONCLUSION: OAGB/MGB experts achieved consensus on a number of aspects concerning this procedure but several areas of disagreements persist emphasising the need for more studies in the future.

Comparative Efficacy of Aloe vera and Benzydamine Mouthwashes on Radiation-induced Oral Mucositis: A Triple-blind, Randomised, Controlled Clinical Trial.

PURPOSE: To compare the efficacy of an Aloe vera mouthwash with a benzydamine mouthwash in the alleviation of radiation- induced mucositis in head and neck cancer patients using a triple-blind, randomised controlled trial. MATERIALS AND METHODS: Twenty-six eligible head and neck cancer patients who were to receive conventional radiation therapy at the radiation oncology department were randomised to receive an Aloe vera mouthwash or a benzydamine mouthwash. Mucositis severity was assessed during the course of radiation therapy using the WHO grading system. RESULTS: At baseline, there was no difference in the distribution of mucositis severity between the two groups. The mean interval between radiation therapy and onset of mucositis was similar for both groups (Aloe vera 15.69±7.77 days, benzydamine 15.85±12.96 days). The mean interval between the start of radiation therapy and the maximum severity of mucositis were was also similar in both the Aloe vera and benzydamine groups (Aloe vera 23.38±10.75 days, benzydamine 23.54±15.45 days). Mean changes of mucositis severity over time in both groups were statistically similar and the effect of both treatments did not change signficantly with time (p=0.09). CONCLUSION: Aloe vera mouthwash was as beneficial as benzydamine mouthwash in alleviating the severity of radiation-induced mucositis and showed no side effects. The Aloe vera mouthwash could be an alternative agent in the treatment of radiation-induced mucositis in patients with head and neck cancers.

In vitro/in vivo performance of different complexes of itraconazole used in the treatment of vaginal candidiasis

A large majority of new chemical entities and many existing drug molecules exhibit poor aqueous solubility, which may limit their potential use in developing drug formulations, with optimum bioavailability. One of the approaches to improve the solubility of a poorly water soluble drug and eventually its bioavailability is complexation with agents like humic acid (HA), fulvic acid (FA), β-cyclodextrin (β-CD), 2-hydroxypropyl-β-cyclodextrin (HP-β-CD) and caffeine (Caff). The current work emphasized at employing these agents to prepare different complexes and their in vitro/in vivo assessment. All the complexes evaluated for their complexation efficiency and authenticated by molecular modeling; conformational analysis, differential scanning calorimetry (DSC), X-ray diffraction (XRD), nuclear magnetic resonance (NMR) and mass spectroscopy. Furthermore, the complexes were assessed in an in vivo, rat vaginal model for their efficacy in treatment of vaginal candidiasis. Amongst the five tested complexes, fulvic acid-itraconazole complex yielded better solubility as well as in vivo efficacy and therefore may further be explored for developing a commercial formulation for treating vaginal candidiasis.

A maioria das novas entidades químicas e muitas moléculas de fármacos existentes apresenta fraca solubilidade em água, o que pode limitar seu uso potencial no desenvolvimento de formulações com biodisponibilidade ideal. Uma das abordagens para melhorar a solubilidade de um fármaco pouco solúvel em água e, eventualmente, a sua biodisponibilidade é a complexação com agentes como o ácido húmico (HA), ácido fúlvico (FA), β-ciclodextrina (β-CD), 2-hidroxipropil-β-ciclodextrina (HP-β-CD) e cafeína (Caff). O presente trabalho baseia-se no uso desses agentes para preparar diferentes complexos e suas avaliações in vitro/in vivo. Todos os complexos foram avaliados quanto à eficiência de complexação por modelação molecular, análise conformacional, calorimetria de varredura diferencial (DSC), difração de raios-X (XRD), ressonância magnética nuclear (RMN) e espectroscopia de massas. Além disso, os complexos foram avaliados in vivo, em ratas, no tocante à sua eficácia no tratamento de candidíase vaginal. Entre os cinco complexos testados, o complexo de ácido fúlvico-itraconazol foi o que apresentou melhor solubilidade, bem como melhor eficácia in vivo e, portanto, pode ser explorado para o desenvolvimento de uma formulação comercial para o tratamento de candidíase vaginal.

"Homemade" negative pressure wound therapy: treatment of complex wounds under challenging conditions.

UNLABELLED:   Background. Complex wounds pose a challenge to the surgeons regarding coverage and reconstruction. Negative pressure wound therapy (NPWT) has become a widely accepted technology for managing such wounds. Despite the case reports suggesting excellent outcomes of commercially available NPWT systems, there is paucity of randomized, controlled trials. Homemade alternatives can be of great use in hospitals with limited resources if they are found to be effective for managing complex wounds. OBJECTIVE: To determine the effectiveness of "homemade" NPWT for coverage of challenging and difficult wounds of different regions of the body with limited options for reconstruction. METHODS: Forty-four patients with 51 complex wounds involving different parts of body were included in the study. After initial debridement, the patients were treated with NPWT to obtain a healthy granulating wound bed that could be covered with simple reconstruction (ie, skin graft). RESULTS: The average number of dressing changes was 2.9 and the average duration from start of therapy until the wound was ready for coverage was 13 days. Forty-seven wounds were skin grafted and 3 wounds were covered with local turnover flaps. One post sternotomy wound healed by secondary intention. CONCLUSION: This simple "homemade" NPWT system is an effective technique for treating challenging wounds on various parts of the body. .

Rectal bezoars due to pumpkin seeds.

Rectal bezoars commonly occur due to seeds, especially in children living in countries south of the Mediterranean and in the Middle-East. Dried seeds are considered a delicacy and consumed widely. Inadequate chewing or hastily eating without removing the hull may lead to their impaction as bezoars, which may require manual removal under general anaesthesia.

Theory and design of a simple tunable Sagnac loop filter for multiwavelength fiber lasers.

We present a novel design for a Sagnac loop filter (SLF) whose periodic output spectrum can be fully controlled by cascading a small-birefringence loop (SBL) with a high-birefringence loop (HBL). We develop a detailed theoretical analysis, using the Jones vector method, to calculate the transfer function of the tunable SLF. It has been quantitatively shown that both the transmission coefficient and the phase of the SLF can be controlled by adjusting the orientation angle of the birefringent axes of the SBL in the plane of polarization. The theory has been confirmed by experimental results where a stress-induced SBL was mechanically rotated to tune both the wavelength and the power of a periodic output spectrum. Such a tunable SLF is used in the design of a multiwavelength erbium-doped fiber laser in the C band.

Pre-operative evaluation of ovarian mass: risk of malignancy index.

OBJECTIVE: To evaluate the risk of malignancy index (RMI) for pre-operative diagnosis of ovarian mass. DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Chemical Pathology and Endocrinology at Armed Forces Institute of Pathology (AFIP), Rawalpindi from January 2001 to January 2002. SUBJECTS AND METHODS: The study consisted of 100 female patients consecutively admitted for surgical exploration of ovarian mass. Pre-operatively ultrasonic evaluation of ovarian mass, menopausal status and serum cancer-associated antigen 125 (CA 125) levels were carried out. Postoperatively histopathology of the resected ovarian mass was done to confirm the diagnosis. To increase the sensitivity and specificity of CA 125 for early detection of ovarian cancer, a combination of serum CA 125 with ultrasonography and menopausal status, designated as risk of malignancy index (RMI) for each patient, was calculated. RESULTS: The sensitivity and specificity of CA 125 alone for the diagnosis of ovarian cancer, at cutoff level of 35 U/ml, were 83% and 82% respectively. Using RMI, at cutoff level of 125, the sensitivity was 87%, and specificity was 88%. Receiver operating characteristic (ROC) curves reveal that RMI was a better discriminant than CA 125 alone for differentiating between benign lesions and malignant ovarian tumors. CONCLUSION: The risk of malignancy index (RMI) is a better diagnostic marker as compared to CA 125 alone because of its high specificity and sensitivity in differentiating ovarian cancer from ovarian benign lesions. It is a simple scoring system and, therefore, its application is recommended to evaluate ovarian masses in clinical practice.