Assessing Spectrum of Fractures in Elderly; Perspective on Tertiary Care Hospital of Nepal.

Background There is an increasing life expectancy and a surging elderly population in the last few decades, leading to a higher incidence of fractures in the elderly. The health care of the elderly in Nepal is below par and there are no studies done to evaluate the spectrum of fractures in the elderly. Objective To evaluate the demographical and epidemiological aspects of fractures in the elderly (≥ 65 years) presenting to a tertiary care hospital in Nepal in a 15 years' timeline. Method This study was a retrospective epidemiological study conducted in the Department of Orthopedics, Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH), Nepal. The patients of age ≥ 65 years having traumatic injuries, admitted in the orthopedics ward from 2006 January to 2020 December were included. Patient demographics, site of injury, fracture incidence, mechanism of injury, hospital stay duration, and mode of treatment (surgical/ conservative) were evaluated. Result Of the 787 patients with an average age of 73.65 ± 7.5 years, 54% were females. Peritrochanteric fracture was the most common fracture (29.4%) followed by spine (18.3%). The most common mechanism of injury was fall on the labeled ground (38.6%). The incidence of fragility fractures (peri-trochanteric, proximal humerus, spine, and distal radius) was increasing with age. Conclusion Females, peritrochantric fractures, and trivial trauma are the most common occurrences for fractures in elderly. The incidence of fragility fractures is increasing with age but the overall incidence of fractures compared to other studies is low. Higher incidences of road traffic accidents (RTA) and compound fractures among the elderly are serious public health concerns that highlight the importance of primary preventive measures.

Myocardial Infarction in Non-obstructive Coronary Arteries (MINOCA) in the Perioperative Period can Epinephrine be Responsible?

Ephedrine, metaraminol, epinephrine and maneuvers like carotid sinus stimulation used during intraoperative period have been postulated to cause temporary spasm of the coronary vessels leading to decrease supply to the myocardium and precipitating myocardial infraction in non-obstructive coronary arteries (MINOCA). As an anaesthesiologists, we should be aware that even a dose as small as 25 mcg epinephrine infiltrated along with local anaesthetic in the subcutaneous plane may be responsible for coronary vessel spasm and thus myocardial infraction in nonobstructive coronary arteries. We report a case of 45 years old female with papillary carcinoma of thyroid who developed features of non-ST elevation myocardial infarction 5 minutes after the subcutaneous infiltration of 5 ml of 2% Xylocaine with 1:200000 Epinephrine. Patient was managed for acute Myocardial Infarction. Coronary angiogram done the next day revealed normal coronary arteries, hence the diagnosis Myocardial infraction in non-obstructive coronary arteries was made.

Functional Outcome of Pediatric Monteggia Fracture Dislocation Treated Surgically in a Tertiary Care Centre of Nepal.

Background Monteggia fracture dislocation may need operative management. The fracture of ulna is reduced by closed or open reduction followed by stabilization of ulna with Rush pin, K-wires or Dynamic compression plate. Objective To evaluate the Mayo Elbow Performance Score of patients with Monteggia fracture dislocation treated operatively. Method It is a retrospective study conducted at Dhulikhel Hospital, Kathmandu University Hospital. All the pediatric patients with Monteggia fracture dislocation managed operatively from January 2011- December 2019 were included in the study. The functional outcome scoring of the effected elbow using Mayo Elbow Performance Score was done in the last follow up. Result Forty eight surgically managed Monteggia patients had a mean age of 7.23 ± 2.9 years with male predominance. Left side was the dominant side of involvement with 29 patients. Bado type 1 was the most common type (81.3%). Most of the patient underwent closed reduction and fixation with Rush pin (n=40). All of the patient has excellent (89.6%) to good (10.4%) functional outcome. Conclusion Operative management of Monteggia fracture dislocation with complete ulna fracture has excellent to good outcome.

Orthopaedic Services during Nationwide COVID-19 Lockdown: Dhulikhel Hospital, Kathmandu University Hospital Experience and Review of Literature.

Background The Nepal government issued a nationwide lockdown due to COVID-19 from 24 March to 21 July 2020. This halted elective medical services in our hospital. A number of modifications in the orthopaedic practices at our department were made. Objective This article discusses the impact on orthopaedic load at the Department of Orthopaedics and Trauma, Dhulikhel Hospital, Kathmandu University Hospital during the lockdown. Method This is a longitudinal observational study done during the nation-wide lockdown including all the patients who presented to the hospital requiring orthopaedic consultation. For comparison purposes, the patient numbers from the same date in previous year (2019) were retrieved. Result We received no COVID-19 cases requiring orthopaedics consultation. A total of 1828 patients were seen in the Orthopaedic Outpatient Department, 1077 trauma patients in the Emergency Department, 216 patients were admitted and 210 orthopaedics procedures were performed at the operation theatre. There was 82.21% decrease in OPD patients and 56% less surgeries in OT compared to the same duration of last year. Conclusion There was a great reduction in the patient numbers visiting the hospital, which reflected in decreased number of admission and surgery. A greater part of our work during the lockdown was trauma.

Oligomeric amyloid ß induces IL-1ß processing via production of ROS: implication in Alzheimer's disease.

Alzheimer's disease (AD) is a chronic neurodegenerative disease characterized by progressive neuronal loss and cognitive decline. Oligomeric amyloid ß (oAß) is involved in the pathogenesis of AD by affecting synaptic plasticity and inhibiting long-term potentiation. Although several lines of evidence suggests that microglia, the resident immune cells in the central nervous system (CNS), are neurotoxic in the development of AD, the mechanism whether or how oAß induces microglial neurotoxicity remains unknown. Here, we show that oAß promotes the processing of pro-interleukin (IL)-1ß into mature IL-1ß in microglia, which then enhances microglial neurotoxicity. The processing is induced by an increase in activity of caspase-1 and NOD-like receptor family, pyrin domain containing 3 (NLRP3) via mitochondrial reactive oxygen species (ROS) and partially via NADPH oxidase-induced ROS. The caspase-1 inhibitor Z-YVAD-FMK inhibits the processing of IL-1ß, and attenuates microglial neurotoxicity. Our results indicate that microglia can be activated by oAß to induce neuroinflammation through processing of IL-1ß, a pro-inflammatory cytokine, in AD.

A comparison of the efficacy of footbaths containing formalin or zinc sulphate in treating ovine foot-rot under field conditions.

A comparison was made of the efficacy of zinc sulphate and formalin footbaths in treating foot-rot of a wide range of severity in a British lowland sheep flock. Solutions of 10% zinc sulphate and 10% formalin in a walk-through trough were used at weekly intervals on three occasions following initial foot trimming. Paring allowed accurate scoring of foot lesions. Ninety affected sheep were randomly divided between three groups: two groups having footbaths and a control group. Both agents were effective in reducing the total lesion score and the number of feet affected.

Interim evaluation by WFP/FAO/WHO/UNICEF mission of project Malawi 525 expansion III supplementary feeding of vulnerable groups and appraisal of the expansion request: conclusions and recommendations of the mission

The mission concludes that further support for the supplementary feeding programme is fully warranted in view of the high levels of malnutrition