When the answer is a maybe: a retrospective review of indeterminate SARS-CoV-2 results and their associations.

Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using reverse transcriptase polymerase chain reaction (RT-PCR) may generate indeterminate results (with a cycle threshold ≥30), requiring further investigation to determine the clinical significance. Patient variables which could predict a definitive result ('Detected'/'Not detected') post indeterminate result would aid in optimization of bed management and utilization of limited resources. A retrospective observational study of indeterminate SARS-CoV-2 results in an Irish tertiary hospital from March 2020 to March 2022 was performed to determine whether demographics, comorbidities and immunosuppression were associated with a definitive result upon subsequent investigation. Data was obtained from patient and laboratory records. Analysis of association was explored using Fisher's exact test, and predictability was tested using logistic regression. Of 411 patients with an initial indeterminate test, investigation showed that 299 (72.2%) patients had a subsequent definitive result; 29 were Detected and 270 were Not detected. In the Detected group, a prior diagnosis of COVID-19 was associated with a reduced risk of becoming Detected (crude odds ratio (COR) = 0.10, 95% CI 0.03-0.35). In the Not detected group, vaccinated patients were less likely to have a Not detected result on subsequent testing (adjusted odds ratio (AOR) = 0.57, 95% CI 0.34-0.94). Patients with previous COVID-19 infection were less likely to have a Detected result and vaccinated patients were less likely to have a Not detected result upon investigation of an indeterminate result. This study emphasizes the need for a good clinical and medical history in the management of SARS-CoV-2.

Icebergs in the Nordic Seas Throughout the Late Pliocene.

The Arctic cryosphere is changing and making a significant contribution to sea level rise. The Late Pliocene had similar CO2 levels to the present and a warming comparable to model predictions for the end of this century. However, the state of the Arctic cryosphere during the Pliocene remains poorly constrained. For the first time we combine outputs from a climate model with a thermodynamic iceberg model to simulate likely source regions for ice-rafted debris (IRD) found in the Nordic Seas from Marine Isotope Stage M2 to the mid-Piacenzian Warm Period and what this implies about the nature of the Arctic cryosphere at this time. We compare the fraction of melt given by the model scenarios with IRD data from four Ocean Drilling Program sites in the Nordic Seas. Sites 911A, 909C, and 907A show a persistent occurrence of IRD that model results suggest is consistent with permanent ice on Svalbard. Our results indicate that icebergs sourced from the east coast of Greenland do not reach the Nordic Seas sites during the warm Late Pliocene but instead travel south into the North Atlantic. In conclusion, we suggest a continuous occurrence of marine-terminating glaciers on Svalbard and on East Greenland (due to the elevation of the East Greenland Mountains during the Late Pliocene). The study has highlighted the usefulness of coupled climate model-iceberg trajectory modeling for understanding ice sheet behavior when proximal geological records for Pliocene ice presence or absence are absent or are inconclusive.

An evaluation of the Cortrak Enteral access system in our intensive care.

Appropriate nutrition is considered a cornerstone of Intensive care; however its successful initiation is frequently impeded by decreased gastric emptying secondary to opiates, sepsis, or ileus. The presence of a postpyloric tube will guarantee delivery of calories while reducing the incidence of reflux and aspiration. Enteral nutrition is approximately 100 fold cheaper than parenteral nutrition. A nasojejunal tube may be placed blindly (success 15%), by direct vision with a gastroscope, or under fluoroscopic guidance in the X-ray department. This study examines the use of the Cortrak Enteral access system (CEAS) in placement of nasojejunal tubes, a method facilitated by the use of an electromagnet. A retrospective review was conducted to evaluate the effectiveness of the CEAS for establishing nasojejunal feeding in the Intensive Care Unit (ICU) between January and December 2010. Our results found that the CEAS was successful in positioning a nasojejunal tube in ten out of twelve patients (83% success rate). Successful placement was confirmed by portable abdominal / chest x-ray. Placement took an average of 30 minutes, and prokinetic agents were used to facilitate two placements. The duration of successful enteral nutrition varied from 2 to 15 days post placement. The CEAS is a simple bedside tool for placing postpyloric tubes. While there is a learning curve associated with its use, it may confer significant benefits to individual patients and also to those responsible for ever shrinking budgets.

Operative outcomes for cervical myelopathy and radiculopathy.

Cervical spondylotic myelopathy and radiculopathy are common disorders which can lead to significant clinical morbidity. Conservative management, such as physical therapy, cervical immobilisation, or anti-inflammatory medications, is the preferred and often only required intervention. Surgical intervention is reserved for those patients who have intractable pain or progressive neurological symptoms. The goals of surgical treatment are decompression of the spinal cord and nerve roots and deformity prevention by maintaining or supplementing spinal stability and alleviating pain. Numerous surgical techniques exist to alleviate symptoms, which are achieved through anterior, posterior, or circumferential approaches. Under most circumstances, one approach will produce optimal results. It is important that the surgical plan is tailored to address each individual's unique clinical circumstance. The objective of this paper is to analyse the major surgical treatment options for cervical myelopathy and radiculopathy focusing on outcomes and complications.

The influence of preclinical anaemia on outcome following total hip replacement.

INTRODUCTION: Preoperative anaemia confers a higher intraoperative and postoperative risk of complications on a patient. Preclinical anaemia is defined as a patient with laboratory indices of anaemia but without any of the symptoms. The patient population who undergo total hip replacement (THR) are elderly and are more likely to fall into this category. Our aim was to assess the effect of preclinical anaemia on a patient's postoperative course. MATERIALS AND METHODS: A prospective analysis of elective THRs performed over a 10-month period was carried out. Preoperative haematological indices were recorded and correlated with postoperative complication rates. RESULTS: A total of 225 elective THRs were included in the study. Patients with preclinical anaemia on admission had a higher incidence of postoperative infection and transfusion (p<0.001) and a longer postoperative inpatient stay. Preoperative iron supplementation in patients with preclinical iron deficiency anaemia resulted in a reduction in transfusion requirements (p=0.00125). CONCLUSIONS: Identification and treatment of patients with preclinical anaemia preoperatively may reduce postoperative infection and transfusion needs and result in a shorter inpatient stay.

Evaluation of a diabetic foot screening and protection programme.

We set out to evaluate a clinical foot-screening programme in terms of primary outcomes (reductions in the incidence of ulcers and lower limb amputation) and process outcomes (compliance with screening, the number of patients not completing the programme and the use of chiropody services and prescribed footwear and cost). All but 4 of 2001 patients attending a general diabetic out-patient clinic were allocated randomly to index and control groups. The exceptions were patients who presented with active ulcers and were placed in the index group. Primary and secondary screening programmes identified 128 high risk patients in the index group and these were admitted to the foot protection programme. At 2-year follow-up, 11 fewer ulcers were reported from the index group. There were 7 amputations (1 major, 6 minor) in the index group and 23 (12 major and 13 minor) in the control group. The differences were not statistically significant for ulceration or minor amputations but significant for major amputations (p < 0.01). The total cost of the 2-year programme was pounds sterling 100,372 (1991-92 costs), with a mean cost per patient of approximately pounds sterling 100. Taking pounds sterling 12,000 as a conservative estimate of the cost of a major amputation, the foot clinic was cost-effective in terms of amputations averted. The process outcomes were much less satisfactory. Cost-effectiveness could have been improved if it had been possible to improve patient compliance.

Osteochondritis dissecans of the head of the talus.

We present a case of osteochondritis dissecans of the head of the talus, without a history of trauma. The clinical and radiological features and a 2-year and 3-month follow-up are discussed.

The development of consensus standards for medical devices in Canada.

The Canadian Standards Association Health Care Technology Program is a new, innovative program initiated by the Canadian Standards Association four years ago in response to the great increase in technology which has innundated our health care facilities. The goal of the program is to develop consensus standards in the medical engineering field and to help in implementing those standards across Canada through education, input to professional societies, and input to provincial or federal legislation.