Does the Proximal Femur Geometry Predict Early Functional Outcome after Plate Fixation of Geriatric Pertrochanteric Fractures?

BACKGROUND: The proximal femur geometry determines the hip force distribution. The femoral neck axis length (FNAL), the hip axis length (HAL), the femoral head diameter, and the femoral neck-shaft angle (FNSA) could influence the risk and outcome of pertrochanteric fractures. Restoring these parameters to their prefracture values could predict early hip function. AIM: To determine if the postoperative proximal femur geometry of geriatric patients with plating for pertrochanteric fractures predicts the early functional outcome. MATERIALS AND METHODS: The study was a prospective study carried out at the National Orthopaedic Hospital Enugu for 18 months. Geriatric patients who had Proximal Femoral Locking fixation for pertrochanteric fractures were recruited. Radiological parameters of the proximal femur in the unaffected and fixed hips were measured and compared. The functional outcomes of the patients were measured at 3 months postoperative period using the Harris hip score (HHS). Multiple linear regression was conducted on the parameters to determine the HHS. RESULTS: Thirty patients participated in the study, with a significant difference (P < 0.001) in the mean FNSA between unaffected (M = 128.69, standard deviation (SD) =2.93) and operated hips (M = 121.81, SD = 8.86). The FNSA was the only significant predictor of hip function, with a 1-degree increase improving the HHS by 1.30. CONCLUSION: There is a significant difference in the FNSA between the unaffected and the operated hips. The FNSA significantly predicts the early hip function and should be reconstructed to within normal range during surgery.

Characterization, kinetics and thermodynamics of epoxidation-esterification of Irvingia gabonensis kernel oil methyl ester.

Epoxidation-esterification of fatty acid methyl ester obtained from Irvingia gabonensis kernel oil (IGKO), as well as its characterization, kinetics and thermodynamics were the main focus of this study. The methyl ester obtained via base catalyzed transesterification was used for epoxidation-esterification modification process. Epoxidation kinetics and thermodynamics parameters were also investigated. The properties of the IGKO and epoxidized-esterified Irvingia gabonensis kernel oil (IGKO) methyl ester (MIGKOe) were determined using standard methods. Rate constant K and activation energy Ea for the epoxidation process was found to be of the order 10 - 5 Lmol-1s-1 and 46.02 kJ/mol, respectively. ΔG, ΔH, and ΔS values for the epoxidation process were (94.74-101.42 kJ mol-1), 43.30 kJ mol-1, and - 167.20 J mol-1 K-1, respectively, indicating the non-spontaneous, endothermic, and endergonic nature of the process. The physicochemical characteristics of MIGKOe were: 9 °C, 298 °C, 840 kg/dm3, 13.84 mm2/s, 1.351 mg KOH/g oil, 1.01 mg/kg and 39.78 kV, for pour point, flash point, density, viscosity, acid value, moisture content and dielectric strength, respectively. The MIGKOe properties indicated its potential for use as a bio-transformer fluid, upon further treatment with pour point depressant.

Sustaining global partnerships for simulation integration: lessons from the field.

AIM: A reciprocal partnership between two World Health Organization Collaborating Centers in the Americas region aimed to strengthen nursing and midwifery education through innovative integration of high-fidelity simulation. METHODS/IMPLEMENTATION: Immersion of a visiting scholar in six-week training within a North American nursing school (host) solidified simulation champion designation, upon return at the home institution. Next, two expert nursing faculty implemented a train-the-trainer simulation course on-site. Following evaluation and virtual debriefing, a midwifery faculty visited the host institution for second-round training. CONCLUSION: This ongoing program targets faculty development needs through a strong academic partnership, built upon global awareness and sustainable engagement.

The prevalence of orthostatic hypotension in type 2 diabetes mellitus patients in a diabetic clinic in Enugu South-East Nigeria.

BACKGROUND: Orthostatic Hypotension is a serious and common complication of diabetes mellitus. AIMS: To determine the prevalence and risk factors of Orthostatic Hypotension in type 2 diabetic patients in a diabetes mellitus clinic in Enugu South-East Nigeria. METHOD AND MATERIALS: A structured questionnaire was administered to the eligible and consenting seventy type 2 diabetes mellitus patients. The supine and erect blood pressures of each patient were recorded. The patients with Orthostatic Hypotension were compared with those without Orthostatic Hypotension for different clinical and biochemical parameters. STATISTICAL ANALYSIS USED: The data was analyzed using Statistical Package for Social Sciences (SPSS) version 19 software. Odds ratio was calculated for the presence of Orthostatic Hypotension amongst the variables and p-value < 0.05 was considered statistically significant. RESULTS: The prevalence of Orthostatic Hypotension in type 2 diabetic patients was 23.3%. Orthostatic Hypotension had statistically significant association with the presence of peripheral neuropathy, retinopathy and proteinuria. CONCLUSIONS: Orthostatic Hypotension is a common complication in type 2 diabetes mellitus patients seen at Enugu. It is recommended that measurement of erect and supine blood pressures should be part of the standard care of type 2 diabetic patients.

How important is the choice of the nutrient profile model used to regulate broadcast advertising of foods to children? A comparison using a targeted data set.

BACKGROUND/OBJECTIVE: The World Health Assembly recommends that children's exposure to marketing of unhealthy foods should be reduced. Nutrient profile models have been developed that define 'unhealthy' to support regulation of broadcast advertising of foods to children. The level of agreement between these models is not clear. The objective of this study was to measure the agreement between eight nutrient profile models that have been proposed for the regulation of marketing to children over (a) how many and (b) what kind of foods should be permitted to be advertised during television viewed by children. SUBJECTS/METHODS: A representative data set of commercials for foods broadcast during television viewed by children in the UK was collected in 2008. The data set consisted of 11,763 commercials for 336 different products or brands. This data set was supplemented with nutrition data from company web sites, food packaging and a food composition table, and the nutrient profile models were applied. RESULTS: The percentage of commercials that would be permitted by the different nutrient profile models ranged from 2.1% (0.4%, 3.7%) to 47.4% (42.1%, 52.6%). Half of the pairwise comparisons between models yielded kappa statistics less than 0.2, indicating that there was little agreement between models. CONCLUSIONS: Policy makers considering the regulation of broadcast advertising to children should carefully consider the choice of nutrient profile model to support the regulation, as this choice will have considerable influence on the outcome of the regulation.

Patterns of hearing loss in tympanic membrane perforation resulting from physical blow to the ear: a prospective controlled cohort study.

OBJECTIVES: To evaluate the incidence and pattern of hearing loss in non-explosive blast injury of the ear. STUDY DESIGN: Prospective clinical study. SETTING: Tertiary referral centre. PARTICIPANTS: Consecutive patients who suffered physical blow to the ear resulting in tympanic membrane perforations without history of previous middle ear disease. MAIN OUTCOME MEASURES: Incidence of conductive and sensorineural hearing loss, extent of air-bone gap versus size and site of perforation, post-healing hearing loss recovery. RESULTS: Fifty-one patients, 31 males (61%) and 20 females (39%) aged 10-56 years, were recruited over a 30 month study period. The prevalence of hearing loss was significantly more in the injured ears than contralateral normal ears (chi(2) = 76.26; P = 0.000). Pure conductive hearing loss occurred in 39%, while 28% (14 patients) had mixed hearing loss. Three patterns of sensorineural loss were observed: dip involving several adjacent high frequencies, a dip in a single frequency, and two separate dips involving low and high frequencies. The extent of air-bone gap correlated with the size of perforation (r = 0.33; P = 0.01). Ears that sustained small tympanic membrane perforation showed significantly small average air-bone gap (t = 2.97; P = 0.005). The mean air-bone gap difference between the anterior and posterior perforations was not significant (t = 1.7; P = 0.09). Closure of air bone gap following healing was significant (t = 15.08; P < 0.01), while recovery of bone conduction abnormality was less favourable. CONCLUSION: Conductive hearing loss occurring in the speech frequencies was the most common form of hearing loss in this group of patients with non-explosive blast injury to the ear. The accompanying sensorineural loss mostly affected several adjacent high frequencies. Healing of perforation favoured significant recovery of the conductive loss, but recovery of sensorineural loss was less favourable.

Determinants of spontaneous healing in traumatic perforations of the tympanic membrane.

OBJECTIVES: To analyse the various factors influencing spontaneous healing of traumatic tympanic membrane perforation in West Africa. STUDY DESIGN: Prospective clinical study. SETTING: Tertiary referral centre. PARTICIPANTS: Consecutive patients with traumatic tympanic membrane perforations without history of previous middle ear disease. MAIN OUTCOME MEASURES: Healing outcome at 4, 8, 12 weeks; effects of perforation size, location, and mode of injury, active intervention and ear discharge on healing outcome. RESULTS: Fifty-three patients, 32 (60%) men and 21 (40%) women, aged 2-86 years, with traumatic tympanic membrane perforation who met our inclusion criteria were analysed. Ninety-four percent of the perforations healed spontaneously. Spontaneous healing was significantly correlated with age (P < 0.05). It was significantly delayed by large perforations estimated at 50% or more of entire tympanic membrane, ear discharge, wrong intervention on acute perforation by ear syringing, and by penetrating injuries sustained through the ear canal (P < 0.05, P < 0.01, P < 0.01 and P < 0.01 respectively). Perforations in the anterior versus posterior quadrants showed no significant difference in the healing rate (P > 0.05). Non-healing of the traumatic perforation was significantly associated with the large perforations, ear discharge and wrong intervention by ear syringing in chi-square test (P = 0.01, P = 0.02 and P < 0.001 respectively), but only with penetrating injuries sustained through the ear canal and the ear syringing intervention in logistic regression test (P = 0.02 and P = 0.04 respectively). CONCLUSION: The rate of spontaneous healing of traumatic tympanic membrane perforation varied inversely with age of patient and size of perforation. It was delayed by middle-ear infection, as well as in ears that sustain direct injuries and in ears that had wrong interventions. However, it was not dependent on whether the perforation was in the anterior or posterior location. Logistic regression analysis revealed that penetrating injuries sustained through the ear canal and the ear syringing intervention were the only risk factors important in predicting the non-healing of traumatic tympanic membrane perforation.

Successful treatment of scabies with oral ivermectin in Nigeria.

Currently, several topical scabicides are available but there is yet no oral or parenteral drug which has been established for the treatment of scabies in Nigeria. Ivermectin which is a modified avermectin, known to be an ectoparasiticidal agent in animals, has been used in adults for systemic parasitosis. In Nigeria, 25% benzyl benzoate is being extensively used for the treatment of scabies in adults. It is effective and readily available. The present study was carried out to evaluate the efficacy and safety of ivermectin in the treatment of patients with scabies at the skin clinic of the University of Nigeria Teaching Hospital, Enugu. Fifty-eight patients with scabies were recruited for the study; 13 (22.4%) were children aged between 5-14 years. Oral ivermectin was given in a single dose of 200 [microg/kg body weight to 29 patients. The remaining 29 patients had to apply 25% benzyl benzoate emulsion. All patients received a full physical and dermatological examination prior to onset of treatment and weekly for 4 weeks. Skin scrapings were taken to confirm the diagnosis of scabies. There was a 93% resolution of pruritus with ivermectin and 48% with benzyl benzoate. No side effects were observed with ivermectin. Our results show that oral ivermectin is a promising, effective and safe alternative in both children and adults of Nigeria when compared to 25% benzyl benzoate topical application.