A Retrospective Two-Year Review of the Outcomes of Surgical Rib Fixation Following Chest Wall Injury by the Multidisciplinary Chest Wall Injury Group in a Major Trauma Centre and the Change in Outcomes as the Service Has Developed.

Aims All English major trauma centres (MTCs) offer rib fixation, which the National Institute for Health and Care Excellence (NICE) guidance indicates in patients with multiple rib fractures or a flail segment; however, the data does not identify the appropriate patients. Our aims were to establish improvements in outcomes following rib fixation at our trust and then determine if the rib fixation service has improved. Methods We performed a matched cohort study whereby 32 patients who underwent rib fixation were independently matched with conservatively managed patients. We then performed a retrospective re-audit to compare outcomes with the matched cohort study. The outcomes analysed were mortality, critical care length of stay (LOS) and total hospital LOS. Results Our initial study revealed a 33.4% reduction in mortality in patients over 55 years. There was also a reduction in average total hospital LOS by 4.5 days in patients under 55 years when comparing rib fixation to conservative management. The results also revealed an average of 4.1 days from admission to operation, 12.7 days of critical care LOS and 29.1 days of total hospital LOS. The re-audit showed improvements in all outcomes. Time from admission to fixation was reduced to 2.1 days, critical care LOS was reduced to 7.5 days and total hospital LOS was reduced to 20.7 days. Conclusions Reduced mortality and LOS reinforce evidence that rib fixation improves outcomes. The re-audit shows that patients are identified for fixation sooner, which is important as the evidence has not identified optimal time for fixation. LOS further decreased in our re-audit, which indicates that earlier fixation results in patients avoiding the sequelae of rib fractures.

Different Species of Epigeic and Anecic Earthworms Cause Similarly Effective and Beneficial Biocomposting-A Case Study Involving the Pernicious Aquatic Weed Salvinia (Salvinia molesta, Mitchell).

As reported recently by the present authors, vermicomposting by the epigeic earthworm Eisenia fetida transforms the highly ligninous and allelopathic aquatic weed salvinia (Salvinia molesta) into a benign organic fertilizer. The present study was carried out with four other earthworm species, including three epigeic species of different sizes and phytophagic habits: Eisenia andrei, Lumbricus rubillus, and Perionyx sansibaricus. One anecic species, with geophytophagous habits, was also explored for comparison: Drawida willsi. The objective was to see whether the type of salvinia transformation caused by E. fetida is a general phenomenon or whether there are significant differences in the nature of biocomposts generated by different earthworm species. Accordingly, the characteristics of the biocomposts separately generated by each of the six species mentioned above were assessed with UV-visible spectrophotometry, Fourier-transform infrared spectrometry, differential scanning calorimetry, thermogravimetry, and scanning electron microscopy. The studies reveal that, with minor variations, the biocomposting by all four species was able to remove the intransigence of salvinia and impart plant/soil-friendly attributes to it in substantial measures. All the findings obtained with different techniques corroborated each other in arriving at this conclusion. Hence, it can be said that, in general, biocomposting by earthworms takes away the toxicity of pernicious weeds such as salvinia, converting them into plant-friendly and soil-friendly biofertilizers.

Do Platelet-Rich Plasma Injections for Knee Osteoarthritis Work?

BACKGROUND: Recent evidence suggests a benefit in platelet-rich plasma injections (PRP) for the knee in the management of mild to moderate osteoarthritis (OA). There is a reported reduction in pain, stiffness, and improved function. However, there is very little level-one literature available that supports this practice and conclusively proves a benefit gained throughout the course. Three main randomized control trials (RCTs) conducted in North America are often referenced and cited to prove their efficacy. This study aimed to look at the outcomes of patients having undergone this treatment to determine if there was any benefit. AIMS: This study aimed to determine if PRP injections administered in patients with knee OA over a six to eight-week time period demonstrated any benefit. METHODS: The Western Ontario and McMaster Universities arthritis index (WOMAC) tool was used before each of the three PRP injections over the six to eight-week period, and six weeks after the final injection in 31 patients. Each injection was given spaced two to three weeks apart. The outcomes observed were pain, stiffness, and physical function, and the total WOMAC score was calculated. RESULTS: The third injection showed a reduction in total WOMAC score, pain, stiffness, and physical function by 16.36%, 16.37%, 5.12%, and 18.03%, respectively. However, all scores returned close to baseline at the sixth-week follow-up post treatment. CONCLUSION: Results showed a trend of reduction in the WOMAC score. However, they are overall indicative of a placebo effect from the injections. Further studies are needed to explore whether the grade of OA and patients' weight have a significant impact on the results.

The fecundity and the vermicomposting efficiency of three generations of four earthworm species in high-rate vermireactors fed with the pernicious aquatic weed salvinia.

With vermireactors designed on the basis of the concept of high-rate vermicomposting recently introduced by S.A. Abbasi and co-workers, it has become possible to directly vermicompost phytomass, including pernicious weeds. It has also been shown that upon vermicomposting, even toxic and allelopathic weeds get transformed into highly plant-friendly and soil-friendly organic fertilizers. Pre-existing vemireactors were not able to achieve direct vermicomposting of weeds or other plant biomass, for reasons explained in the main text. But it is necessary to ascertain whether vermireactors can be operated indefinitely with problematic weeds and whether earthworms born in such vermireactors have adequate health and reproductive ability to sustain the vermireactors interminably. Hence the present work has been undertaken to assess the performance of three successive generations of four earthworm species in terms of their ability to vermicompost the highly ligninous aquatic weed salvinia and reproduce in the vermireactors solely fed by it. It was seen that in all cases the first generation of animals, which had been born and grown to adulthood in cow-dung fed vermiculture systems, took time to adapt to the weed-feed, but did so and remained healthy. The next generation which was born and raised in salvinia-fed vermireactor was significantly more efficient in vermicomposting salvinia while the third generation was still more efficient in comparison to the second generation. The trend of third generation being superior to the second and the second being superior to the first was manifest in the production of offspring (juveniles and cocoons) as well. All-in-all the findings, covering 16 months of uninterrupted vermireactor operation, reveal that earthworms tend to get acclimated to have salvinia as their exclusive feed and the successive generations of earthworms that are born and grown in the weed-feed reactors manifest not only greater vermicomposting efficiency but also superior reproductive ability than the earthworms which had been raised on animal manure.

A comparison of endovascular versus open repair for ruptured abdominal aortic aneurysm - Meta-analysis of propensity score-matched data.

BACKGROUND: Optimal management of ruptured abdominal aortic aneurysms (rAAA) has been heavily debated in the literature. The aim of this review is to assess comparative outcomes from propensity-matched studies of endovascular versus open for rAAA. METHODS: Electronic databases (MEDLINE and Embase) were searched in January 2021 using the Healthcare Databases Advanced Search interface. Eligible studies compared endovascular versus open repair for rAAA using propensity-matched cohorts. Pooled estimates of perioperative outcomes were calculated using odds ratio (OR) or mean difference (MD) and 95% confidence interval (CI) using the random-effects model. Time-to-event data meta-analysis was conducted using the inverse-variance method and reported as summary hazard ratio (HR) and associated 95% CI. The quality of evidence was graded using a system developed by the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) working group. RESULTS: Six studies published between 2010 and 2020 were selected for qualitative and quantitative synthesis, reporting a total of 6731 patients. The odds of perioperative mortality after endovascular aneurysm repair (EVAR) were significantly lower than after open surgical repair (OSR) (OR 0.52, 95% CI 0.41-0.65). The hazard of overall mortality during follow-up was lower, although not significantly, after EVAR than after OSR (HR 0.79, 95% CI 0.62-1.01). The odds of acute kidney injury and early aneurysm-related reintervention were both significantly lower after EVAR than after OSR (OR 0.34, 95% CI 0.14-0.78 and OR 0.57, 95% CI 0.33-0.98, respectively). Patients treated with EVAR stayed in hospital for significantly less time than those treated with OSR (MD -5.13, 95% CI -7.94 to -2.32). The certainty of the body of evidence for perioperative mortality was low and for overall mortality was very low. CONCLUSION: The evidence suggests that EVAR confers a significant benefit on perioperative mortality.

Has Lockdown and COVID-19 Led to a Change in the Characteristics of Deep Vein Thrombosis and Patients Who Are Afflicted With It?

BACKGROUND: There is growing evidence identifying coronavirus disease 2019 (COVID-19) as a significant risk factor for thrombosis in inpatients. However, it remains uncertain if patients in the community have been influenced during the COVID-19 pandemic and national lockdown. This study, across four centres in the United Kingdom (UK), reviewed outpatients with deep vein thrombosis (DVT). AIM: This study aims to find out whether lockdown and COVID-19 led to a change in the characteristics of DVT and patients who are afflicted with it, alongside a review of DVT service. METHODS: Data was collected retrospectively from electronic patient records system for the following periods: April 1 to June 30, 2019, and April 1 to June 30, 2020. These were the key months during the first national lockdown in UK. Data were analysed for patient demographics, risk factors, characteristics of DVT, management, and DVT reoccurrence. Statistical analyses were performed using GraphPad Prism 8 (Dotmatics, Boston, Massachusetts, United States). RESULTS: During the study periods, 227 outpatients from the community sustained DVT in 2019 and 211 in 2020. Of these patients, 13 in 2020 were COVID-19 positive. There was a difference in gender distribution with 128 males and 99 females in 2019, and 93 males and 118 females in 2020 (p= 0.0128). No significant difference was noted in the incidence of thrombophilia with nine in 2019 and three in 2020 (p=0.1437). Fewer long-haul journeys were made in 2020 (only two), compared to 16 in 2019 (p=0.012). Fewer patients had immobility as a risk factor in 2020 (n=55) compared to 2019 (n=79) (p=0.0494). However, there were more patients using oral contraceptive pills, with one in 2019 and nine in 2020 (p=0.0086) . CONCLUSION: There is no significant difference in the characteristics, extent, and management of DVT prior to and during the COVID-19 lockdown. National lockdowns do not affect DVT in the community; however, it is important to highlight the surrounding inpatient numbers.

Ability of Indian pennywort Bacopa monnieri (L.) Pennell in the phytoremediation of sewage (greywater).

The freely and abundantly available amphibious plant Indian pennywort Bacopa monnieri (L.) Pennell was able to phytoremediate sewage (greywater) quickly and substantially in SHEFROL® ("sheet flow root level") bioreactors, achieving reductions in the levels of several indicator parameters: suspended solids, chemical oxygen demand, biological oxygen demand, nitrogen, phosphorus, zinc, copper, nickel, and manganese to the extents of about 90%, 76-77%, 80%, 65%, 55%, 56%, 42%, and 41%, respectively at hydraulic retention times of just 6 h. As these indicators of primary, secondary, and tertiary treatments were achieved simultaneously in a single reactor compartment, the system presented in this paper promises to be simple, rapid, and economical, in achieving significant treatment of greywater.

Generation of highly potent organic fertilizer from pernicious aquatic weed Salvinia molesta.

Utilization of Salvinia molesta, an aquatic weed which is notorious for its allelopathy and invasiveness, has been explored by its vermicomposting. Fourier transform infrared spectroscopy (FT-IR) and plant bioassay tests were conducted to analyze the composition and fertilizer value of S .molesta vermicompost. Germination and seedling growth tests were performed in soil supplemented with vermicompost at levels ranging from 0.75 to 40% by weight of the soil on three common food plants, ladies finger (Abelmoschus esculentus), cucumber (Cucumis sativus), and green gram (Vigna radiata). The influence of S. molesta's vermicompost on some of the physicochemical and biological attributes of the soil was also studied. FT-IR analysis revealed that S. molesta loses its allelopathy, as the chemical compounds that are responsible for it are largely destroyed, in the course of its vermicomposting. There is also an indication that a portion of lignin content of S. molesta is degraded. Vermicompost enhanced the germination success and promoted the morphological growth and biochemical content of the plant species studied. It also bestowed plant friendly physicochemical and biological attributes to the soil. The findings raise the prospect that billions of tons of S. molesta biomass-which not only goes to waste at present but is also a cause of serious harm to the environment-may become utilizable in organic agriculture.

Detoxification of parthenium (Parthenium hysterophorus) and its metamorphosis into an organic fertilizer and biopesticide.

BACKGROUND: Vermicompost of the toxic and allelopathic weed parthenium (Parthenium hysterophorus) was explored for its possible use as an organic fertilizer. Replicated plant growth trials were conducted using four levels of parthenium vermicompost (0, 2.5, 3.75, and 5 t/ha) to assess their effects on the germination, growth, and fruition of a typical food plant ladies finger (Abelmoschus esculentus). Additionally the role of vermicompost in reducing plant pests and disease was evaluated. RESULTS: Vermicompost encouraged the germination and growth of ladies finger at all levels of vermicompost application, with best results obtained in 5 t/ha treatments. The positive impact extended up to the fruit yield. Vermicompost application also improved the quality of fruits in terms of mineral, protein, and carbohydrate contents, and reduced the disease incidence and pest attacks. CONCLUSIONS: The studies establish the fact that parthenium acquires all the qualities of a good organic fertilizer with concomitant loss of its toxic and allelopathic properties after it gets vermicomposted. The findings raise the prospects of economical and eco-friendly utilization of billions of tons of parthenium biomass which is generated annually but goes to waste at present.

Veterinary public health capacitybuilding in India: a grim reflection of the developing world’s underpreparedness to address zoonotic risks

Veterinary public health (VPH) is ideally suited to promote convergence betweenhuman, animal and environmental sectors. Recent zoonotic and emerginginfectious disease events have given rise to increasing calls for efforts to buildglobal VPH capacities. However, even with their greater vulnerability to suchevents, including their economic and livelihood impacts, the response from lowand middle-income countries such as India has been suboptimal, thereby elevatingglobal health risks. Addressing risks effectively at the human–animal interface inthese countries will require a clear vision, consistent policies, strategic approachand sustained political commitment to reform and refine the current VPH capacitybuilding efforts. Only then can the discipline serve its goal of disease prevention,poverty alleviation and support for sustainable livelihoods through improvementsin human and animal health.