Akin Osteotomy: A Review of Modern Fixation Techniques.

Akin osteotomy is commonly used to correct hallux valgus interphalangeus (HVI) deformity. The preferred implant for fixation remains an area of debate, often influenced by the surgeon's inclinations and expertise. This review compares the outcomes of contemporary fixation methods utilized in Akin osteotomy. PubMed served as the primary electronic database for the search. The interventions encompassed the use of screw(s), staple(s), and suture(s). The participants considered were adults aged 18 and above, undergoing Akin osteotomy either as a primary procedure or as an adjunct. Excluded were osteotomies performed via percutaneous or minimally invasive methods. Seven studies involving 590 feet were analysed, showcasing an impressive 99.8% overall union rate. The incidence of overall complications stood at 8.98%, with metal prominence notably higher in the screw fixation group (10.5%). All studies exhibited postoperative improvement in radiological angles. Screw, staple, and suture fixations demonstrated excellent union rates. While screws and staples offer robust osteotomy fixation, they pose risks of metal irritation and prominence. Suture fixation delivers comparable outcomes to the other two stabilization methods at a lower cost.

Recurrent early-onset severe obstetric cholestasis in a patient with two variants in the ABCB4 gene.

A 36-year-old patient presented with severe early-onset obstetric cholestasis on a background of having pre-term induction of labor at 33 weeks during her only previous pregnancy. The patient had significantly abnormal liver biochemistry with a bilirubin of 78 µmol/L, ALP of 318 u/L, ALT of 280 µmol/L, and bile acid levels of 420 µmol/L. The patient received ursodeoxycholic acid 750 mg 3 times a day, rifampicin 500 mg twice a day, aspirin 150 mg once a day, and metformin 500 mg 3 times a day. However, despite this, the patient still suffered from intractable pruritus and her bile acid level was still above the 100 µmol/L target that the obstetrics team was aiming for to avoid early delivery at 32 weeks. Due to the nature and severity of her cholestasis, the patient had a number of investigations done postnatally including genetic analysis, which confirmed that the patient was heterozygous for a pathogenic variant of the ATP-binding cassette subfamily B member 4 gene (c.959C>T [p.Ser320Phe]) and also a variant of unknown significance (c.1679C>T [p.Thr560Met]).

The underlying mechanism between compulsory citizenship behaviors and employee innovative work behaviors and knowledge sharing: A moderated mediation model.

Purpose: This paper draws on conservation of resources theory to advance the literature on extra-role performance behaviors among academics, particularly innovative work behaviors and knowledge sharing, through the lens of work stressors. Methods: We develop a moderated-mediated model based on multi-source, multi-timed, and multi-level data from a sample of 207 academics and 137 direct supervisors in five higher education institutions in the United Arab Emirates (UAE). Findings: Results show that academics' compulsory citizenship behaviors positively influence negative affectivity, which, in turn, negatively impacts academics' innovative work behavior and knowledge sharing. The detrimental effect of compulsory citizenship behaviors on negative affectivity is then positively moderated by passive leadership, which amplifies this relationship. The combined effect of compulsory citizenship behaviors and negative affectivity exerted on innovative work behavior and knowledge sharing are magnified amid the elevated presence of passive leadership, while gender does not significantly influence this association. Originality: This is a pioneering study in the context of UAE to look into the counterproductive impact of CCB on employee innovative work behaviors and knowledge sharing. Implications: Pertinent theoretical and managerial implications are discussed.

Correction: Organizational Resilience of Higher Education Institutions: An Empirical Study during Covid-19 Pandemic.

[This corrects the article DOI: 10.1057/s41307-022-00272-2.].

Organizational Resilience of Higher Education Institutions: An Empirical Study during Covid-19 Pandemic.

Resilient organizations and academic institutions have been identified as contributing immensely to resilient communities. The majority of organizations showing preparedness to mitigate the impact of COVID-19 have deployed an efficient organizational resilience framework. Yet, there is little research on organizational resilience, and the conceptualization of resilience as a complex variable has not been achieved. Focusing on the higher education sector in the UAE during the COVID-19 pandemic, the current study aims to contribute to this promising research area by exploring and expanding a theoretical model on organizational capabilities that constitute organizational resilience. A qualitative phenomenological research design was utilized, where a total of 13 executives from reputable universities were interviewed, followed by a thematic analysis of the data. Findings provided deep insight into the status of universities in the UAE that are currently in the early adaptation stage of the current crisis. Organizational resilience was conceptualized as a process that comprises three successive stages (anticipation, coping, and adaptation), five key antecedents (knowledge, resources availability, social resources, power relationships, and innovative culture), and two main moderators (crisis leadership traits and employee resilience). Important findings were also identified on the needed crisis leadership styles. Recommendations for practice and research are discussed.

Effect of institution volume on mortality and outcomes in osteoporotic hip fracture care.

Hospitals that treat more patients with osteoporotic hip fractures do not generally have better care outcomes than those that treat fewer hip fracture patients. Institutions that do look after more such patients tend, however, to more consistently perform relevant health assessments. INTRODUCTION: An inveterate link has been found between institution case volume and a wide range of clinical outcomes; for a host of medical and surgical conditions. Hip fracture patients, notwithstanding the significance of this injury, have largely been overlooked with regard to this important evaluation. METHODS: We used the UK National Hip Fracture database to determine the effect of institution hip fracture case volume on hip fracture healthcare outcomes in 2019. Using logistic regression for each healthcare outcome, we compared the best performing 50 units with the poorest performing 50 institutions to determine if the unit volume was associated with performance in each particular outcome. RESULTS: There were 175 institutions with included 67,673 patients involved. The number of hip fractures between units ranged from 86 to 952. Larger units tendered to perform health assessments more consistently and mobilise patients more expeditiously post-operatively. However, patients treated at large institutions did not have any shorter lengths of stay. With regard to most other outcomes there was no association between the unit number of cases and performance; notably mortality, compliance with best practice tariff, time to surgery, the proportion of eligible patients undergoing total hip arthroplasty, length of stay delirium risk and pressure sore risk. CONCLUSIONS: There is no relationship between unit volume and the majority of health care outcomes. It would seem that larger institutions tend to perform better at parameters that are dependent upon personnel numbers. However, where the outcome is contingent, even partially, on physical infrastructure capacity, there was no difference between larger and smaller units.

Vanishing Bile Duct Syndrome Associated With Non-Hodgkin's Lymphoma and Hepatitis E Virus Infection.

The vanishing bile duct syndrome (VBDS) is a condition secondary to inciting triggers resulting in destruction and eventual disappearance of intrahepatic bile ducts leading to cholestasis. The overall outcome varies and often depends on the nature of the precipitating cause. VBDS has been found to be associated with adverse drug reactions, infectious diseases, autoimmune diseases, ischemia, and humoral factors associated with malignancies and is often irreversible. The objective of this clinical case report is to highlight the need for a broad differential to include VBDS in similar scenarios to aid rapid diagnosis and management. We hope this could lead to a more favourable outcome for patients presenting with VBDS such as the one described in this case report with concurrent non-Hodgkin's lymphoma and infection with hepatitis E virus. To the best of our knowledge, this is the first ever reported case of VBDS associated with non-Hodgkin's lymphoma and hepatitis E virus infection.

Safety of balanced propofol and midazolam in upper gastrointestinal endoscopy for sedation in cirrhotic patients.

OBJECTIVE: Sedation for upper gastrointestinal endoscopy (UGIE) in patients with cirrhosis is theoretically associated with high incidence of adverse events due to low levels of binding proteins and decreased hepatic clearance of drugs. The objective of the study was to assess the safety of combined propofol and midazolam sedation in cirrhotic patients undergoing UGIE. METHOD: A total of 500 patients undergoing UGIE were divided in to two groups in a prospective observational study from Jan 1st 2018 to June 30th 2018. Group (I) consisted of cirrhotic patients who underwent the procedure with sedation and Group (II) consisted of non-cirrhotic patients who opted for sedation. The main outcome measurements included vitals monitoring before, during and after procedure, total sedation dose, time to initial and deep sedation, recovery time and complications. RESULTS: There was no significant difference between sedation safety and rate of complications for the cirrhotic and non-cirrhotic patients except for the recovery period during initial 10 minutes. The Modified Aldrete score for the cirrhotic patients was 9.5±0.5 min as compared to 9.8±0.4 min for non-cirrhotic patients (p<0.001) at 10 minutes. Grade 2 hepatic encephalopathy was seen in 0.8% of the cirrhotic patients who required hospitalization for 24 hours. Also balanced sedation was acceptable by the patients and the endoscopists equally with statistically significant scores on endoscopist's assessment of co-operation and assessment of patient's satisfaction scores. CONCLUSIONS: Balanced propofol and midazolam sedation has a good index of safety for both cirrhotic and non-cirrhotic patients and is acceptable by the patients and endoscopists equally.

COVID-19 Pneumonia: ST-segment Elevation Myocardial Infarction (STEMI) and Myocarditis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with numerous cardiac complications. We describe a case of type 1 ST-segment elevation myocardial infarction (STEMI) with focal myocarditis unmasked in a patient infected with SARS-CoV-2 with no previous cardiac history, in the hope of increasing understanding of the severity and possible complications of coronavirus disease 2019 (COVID-19) and improving its clinical management.

Retraction: The Use of CT Coronary Angiography and CT Fractional Flow Reserve in the Investigation of Patients With Suspected Coronary Artery Disease.

[This retracts the article DOI: 10.7759/cureus.7908.].

The Use of CT Coronary Angiography and CT Fractional Flow Reserve in the Investigation of Patients With Suspected Coronary Artery Disease.

Objective To assess the diagnostic performance of CT fractional flow reserve (CT-FFR) and to assess whether its use in addition to CT coronary angiography (CTCA) changed the investigation and management of patients with suspected coronary artery disease (CAD). Method A retrospective case note review was carried out for 200 consecutive patients at Russells Hall Hospital, Dudley, United Kingdom, who had CTCA sent for Heartflow CT-FFR analysis (HeartFlow, Redwood City, CA) between January 2018 and December 2019. Results Patients with CT-FFR > 0.8 were significantly less likely to require further investigation with coronary angiography (p: < 0.00001) than those with CT-FFR < 0.8. The use of CT-FFR significantly reduced need for further functional imaging (6% vs 26%) (p: 0.00012). A total of 15 patients in this study had both a CT-FFR and an invasive FFR measured, with seven (46.66%) of the CT-FFRs correlating with the invasive FFR. Approximately 54% of patients who had a CT-FFR < 0.8 were found to have an invasive FFR of >0.8. Of the 56 patients who underwent coronary angiography, the CT Coronary Artery Disease-Reporting and Data System (CAD-RADS) and angiography CAD-RADS were the same in 66% of the cases with 82% of CT CAD-RADS results being within ±1 of the angiography CAD-RADS. Conclusion The use of CT-FFR alongside CTCA led to a significant reduction in need for coronary angiography and functional testing. Further studies are required to look at the diagnostic accuracy of CT-FFR in direct comparison with invasive FFR.

Role Of Fine Needle Aspiration Cytology In Diagnosis Of Palpable Breast Lesions And Their Comparison With Histopathology.

BACKGROUND: The aim of this study was to compare the diagnostic utility of fine needle aspiration cytology (FNAC) in breast lesion with gold standard of histopathological diagnosis. METHODS: This descriptive cross-sectional study was conducted in Pathology department of Bannu Medical College in collaboration with Surgery Department of Khalifa Gul Nawaz Teaching Hospital Bannu as well as other private surgical hospitals of the territory. A total of 88 FNAC of palpable breast lesions were performed and compared with their corresponding histopathological reports. Patients age, location of lesion in breast, and other necessary findings were recorded on predesigned proforma, FNAC performed by using 10 ml syringes. Slides prepared and processed for cytological staining and reported by cytopathologist. Corresponding biopsies were processed for histopathological examination and diagnosis. All female patients of any age with breast lesions were included, and those breast lesions for which no histopathological report was available were excluded. Statistical Package for Social Sciences (SPSS) version 20 was used for calculation of frequencies with percentages and mean with standard deviation. Also, specificity, sensitivity, diagnostic accuracy, positive predictive value and negative predictive value were calculated by using formulas. RESULTS: In this study the mean age was 34.44±21.57 years and age range was from 16 to 80 years. The most common age group was 26-35 years followed by 36-45 years. In this study sensitivity was (83.33%), specificity was (100 %), positive predictive value was (100 %), negative predictive value was (99.27%) and diagnostic accuracy was 99.30%. CONCLUSIONS: FNAC breast is an easily approachable, less invasive, cheap, rapid and almost accurate diagnostic tool in the diagnosis of palpable as well as non palpable breast lesions.

Challenges in implementing the 2015 BASHH guidelines for the appropriate use of post-exposure prophylaxis for HIV following sexual exposure.

The use of post exposure prophylaxis for human immunodeficiency virus (HIV) following sexual exposure (PEPSE) was retrospectively audited in an inner city genitourinary clinic against the 2015 national guidelines by the British Association for Sexual Health and HIV (BASHH). One-hundred out of a total of 101 patients (99%) had a baseline HIV test done. 82.1% (n=83) of patients were given PEPSE prescriptions fitting within recommended indications lower than the 90% target set by BASHH. 84.2% (n=85) of patients had PEPSE administered within 72 hours lower than the 90%. 61.4% (n=62) of patients were known to have completed four weeks of PEPSE lower than the 75% target. 61.4% (n=62) of patients were screened for sexually transmitted infections (STIs) lower than the 90% target. 59.4% (n=60%) of patients had post-PEPSE HIV bloods slightly lower than the 60% target.

"Why we could not eradicate polio from pakistan and how can we?"

Polio is a major health problem and a deadly infectious disease in the developing countries. It is a viral illness caused by polio virus that can lead to paralysis, limb deformities, breathing problems or even death. Polio virus resides only in humans and passes on to the environment in the faeces of someone who is infected. Polio is still endemic in three countries, i.e., Pakistan, Nigeria and Afghanistan and is eradicated from the rest of the world. Pakistan is considered as the exporter of Wild Polio Virus (WPV) with highest number of polio outbreaks among endemic countries. With the start of World Polio Eradication Initiative in 1988, the number of polio cases has been reduced up to 99% worldwide until now. In 2015, Pakistan has shown a decrease of 70-75% in number of polio cases as compare to last year which is the result of good government's initiatives. Militant organizations such as Tehreek-e-Taliban Pakistan, Al-Qaeda and Boko haram movement of northern Nigeria are a major hurdle in the eradication of polio from these countries. The misconception of people about polio vaccine, insecurity within the country and poor health system are the reasons of failure of polio eradication campaigns in these regions. Awareness campaigns about polio for locals and development of proper health system will help in the eradication of polio. Once polio is eradicated, about 40-50 billion dollars can be saved globally. With the strong commitment, seriousness and good initiatives, polio will be eradicated from Pakistan within two years more likely.

The TONK score: a tool for assessing quality in trauma and orthopaedic note-keeping.

INTRODUCTION: Medical case notes are the only lasting interpretation of a patient-physician interaction and are important for good quality patient care. Accurate, legible and contemporaneous note-keeping is important however it can be substandard. This can lead to errors in handover of patients and to medicolegal vulnerability. We present a comprehensive auditing tool for Trauma & Orthopaedics medical case notes and our experience in using it over the last 12 months. PATIENTS AND METHODS: The TONK score was developed from a pre-existing system with some additions for Trauma & Orthopaedic case notes, with the incorporation of a legibility scoring system. An initial audit was carried out evaluating the case notes for each team against the TONK score. In order to evaluate the reproducibility of this score, we employed the Cohen's Kappa coefficient and noted substantial agreement. The individual team scores were analysed and the audit cycle completed four months later with the provision of feedback. RESULTS: Our first audit revealed a mean of 81 with a range from 70 to 90. Subsequent audits over the next two quarters revealed mean scores in excess of 90. Significant improvement has been noted in all areas of documentation and it has been decided to conduct this audit every six months in our department. CONCLUSIONS: The TONK score is an easy, quick and reproducible tool, which aims to eliminate the weaknesses in Trauma & Orthopaedic medical note-keeping. It emphasises the medicolegal importance of accurate medical note-keeping to doctors at all levels of training.

Efficacy and tolerability of carbamazepine for the treatment of painful diabetic neuropathy in adults: a 12-week, open-label, multicenter study.

OBJECTIVE: Anticonvulsants are increasingly being used in the symptomatic management of several neuropathic pain disorders. The present observational study was designed to evaluate the efficacy, tolerability, and quality of life (QoL) of carbamazepine use for 12 weeks in patients with painful diabetic neuropathy, in Pakistan. METHODS: This was a 12-week, multicenter, open-label, uncontrolled trial in adult type 2 diabetic patients (aged 18-65 years) suffering from clinically confirmed neuropathic pain (Douleur Neuropathique en 4 [DN4] score ≥4). Change in neuropathic pain at week 12 compared with baseline was assessed using the Brief Pain Inventory Scale-Short Form (pain severity score and pain interference score). QoL was determined by the American Chronic Pain Association QoL scale. Safety was assessed based on patient reported adverse events (AEs) and serious AEs. RESULTS: Of the total 500 screened patients, 452 enrolled and completed the study. The mean (± standard deviation [SD]) pain interference score decreased from 4.5±2.0 at baseline to 3.1±1.9 at week 12 (P<0.001). The mean (± SD) pain severity score decreased from 5.8±2.0 at baseline to 3.6±2.2 at week 12 (P<0.001). There was a decrease of ≥30% in the pain severity score between visits. The mean (± SD) QoL scale score improved from 5.9±1.6 at baseline to 8.0±1.7 at week 12. A total of ten (2.2%) patients reported AEs during the study period. No patient discontinued the study due to AEs. CONCLUSION: In this real-life experience study, carbamazepine, when prescribed for 12 weeks to adult diabetic patients suffering from neuropathic pain, showed pain-relief effect, with reduced mean pain severity and mean pain interference scores and with improved QoL and good tolerability profile.

Bone Glue Modified Asphalt: A Step towards Energy Conservation and Environment Friendly Modified Asphalts.

Asphalt has been modified for the past several decades using various additives, including synthetic polymers. Polymer modification improves structural and engineering characteristics of the binder, which is a result of improvement in rheological characteristics of binder as well as its adhesion capability with the aggregate. Such enhancement inevitably enhances the performance characteristics of hot mix asphalts (HMA) such as fatigue life, resistance to rutting, and thermal cracking. Even though polymer-modified HMA is popular in North America and European countries, its use is still limited in developing countries of Southeast Asia due to high costs associated with its manufacturing, processing, and energy consumption. In this study, a new kind of asphalt modifier derived from animal wastes, such as bones, hides, and flesh commonly known as Bone Glue, is studied. This biomaterial which is a by-product of food and cattle industries is cheap, conveniently available, and produced locally in developing countries. The results of the research study showed that the bone glue can easily be mixed with asphalt without significantly altering the asphalt binder's viscosity and mixing and compaction temperatures of HMA. Additionally, improvements in complex shear modulus for a range of temperatures were also determined and it was found that complex shear modulus was improved by bone glue modification.