Highly pathogenic avian influenza (HPAI A H5N1) outbreak in Spain: its mitigation through the One Health approach - a short communication.

Highly pathogenic avian influenza (HPAI A H5N1) has occurred over the past few years, especially during the 1918-1919 Spanish Flu pandemic, which wiped out many people in the world. It caused acute illness in about 25-30% of the world's population, which led to the deaths of up to an estimated 40 million people. Of recent, public health authorities in Spain reported the detection of avian influenza A in two poultry workers on a single farm, following an outbreak in poultry confirmed on 20 September which was likely to be due to exposure to infected poultry or contaminated environments and poor interprofessional collaborations among the Spanish health workers. This is a public health challenge for the Spanish government and the world at large. Thus, we believed that through the One Health approach in Spain, there would be a stop to and prevention of further spread of the recent outbreak of avian influenza A in Spain, as well as other infectious diseases and future outbreaks in the country and the world at large.

Shoulder impingement syndrome: outcome of arthroscopic subacromial decompression.

OBJECTIVE: To describe the outcome of cases with subacromial impingement syndrome managed with arthroscopic subacromial decompression. STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Section of Orthopaedics, Department of Surgery, The Aga Khan University Hospital, Karachi from April 2005 to March 2006. METHODOLOGY: Thirty patients with impingement syndrome who underwent arthroscopic subacromial decompression after failed conservative treatment were included. The Constant and Murley shoulder scoring system was used for the clinical assessment of pain and function pre-operatively and 1, 6 and 24 weeks postoperatively. RESULTS: The postoperatively significant improvement was observed in the Constant and Murley scores in all the patients (by mean 40 points, p < 0.01), which was progressive over six months. Lower scores were noted in patients over 40 years of age, with advanced stage of impingement and partial tears of the rotator cuff. CONCLUSION: Arthroscopic subacromial decompression was effective in reducing pain and improving function in the studied patients with subacromial impingement syndrome.

Bullet-induced synovitis as a cause of secondary osteoarthritis of the hip joint: A case report and review of literature.

BACKGROUND: With increasing prevalence of gunshot injuries we are seeing more patients with retained bullet fragments lodged in their bodies. Embedded lead bullets are usually considered inert after their kinetic energy has dissipated hence these are not removed routinely. However, exposure of any foreign body to synovial fluid may lead to rapid degradation and hence result in systemic absorption, causing local and systemic symptoms. We present the case of a thirty year old man who came to our out patient department with a history of progressive, severe hip pain ten years after a gun shot injury to his right hip. CONCLUSION: The common belief that intraarticular bullets should not be removed has no benefit and may result in unwanted long term complications.