METHODS: We conducted a randomized controlled study on patients with closed fracture of the distal end of the radius requiring open reduction and plating from January 2019 till April 2020. We recruited 65 patients (33 patients in the WALANT group and 32 patients in the GA group). Randomization was done via block randomization. Data were collected to evaluate preoperative anxiety using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) score, intraoperative pain score during injection (baseline) (V1), 10 minutes after injection (V2), during incision (V3), during gentle manipulation (V4), during aggressive manipulation (V5) and during first drilling of screw (V6), blood loss, duration of surgery and post-operative pain score. Additionally, intraoperative visual analog scale (VAS) score was obtained in the WALANT group. At three weeks, six weeks, three months and six months after operation, the Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) scores and range of motion (ROM) of the wrists were obtained.
RESULTS: The average age in the WALANT group was 47.19 (range, 36-64) years and GA group was 49.48 (range, 38-60) years. The mean APAIS score obtained was 7.78 (WALANT group) and 7.36 (GA group) with no statistical difference. For intraoperative VAS, only during V4 and V5 were the scores 1/10; otherwise at all other phases, the VAS score was 0. The average time for surgery was statistically longer in the WALANT group (61.22 minutes) compared to the GA group (55.33 minutes) (p = 0.003). There was no statistical difference in mean blood loss in both groups. The average post-operative VAS showed statistical significance only at 1 hour and 12 hours post-operation with no statistical difference at 2 and 24 hours post-operation. There was no difference in the post-operative ROM including wrist flexion, extension, supination and pronation for both groups up to six months' follow-up.
CONCLUSION: There was no statistically significant difference in terms of preoperative anxiety level, intraoperative and post-operative VAS score, amount of blood loss and clinical outcome in both groups for plating of the distal end radius. However, the operating time was slightly longer in the WALANT group. We conclude that distal radius plating under WALANT has similar outcomes to GA. In centres with limited resources, WALANT offers a safe, reliable and cheaper option, reserving GA time for head, abdominal and thoracic surgery.
Materials and methods: A retrospective review of all surgically treated DRF cases with one year follow-up in a tertiary hospital in Malaysia was done. Patients who left the follow-up clinic before one-year post-surgery or before fracture union were excluded. A total of 82 patients with 88 DRF were finally included into the study and outcome in terms of union time and need of multiple surgeries were analysed along with the predictors.
Results: In this study, mean age of the patient was 46.2 years. Motor vehicle accident was the commonest cause of the fracture and AO Type C fracture was the commonest fracture type. Seventeen (19.3%) out of 88 fractures were compound fracture. Open reduction and internal fixation with volar plate was the most common surgical technique done in this series (93.2%). Three (3.5%) out of 88 fractures required multiple surgeries and eighty-three (94.3%) DRF cases were united before nine months of the surgery in this study. There was statistically significant association between clinical type of the fracture and the union time (p-value <0.05).
Conclusion: There was a 1.7:1 male-female ratio with AO-C fracture being the most common type of fracture. The most common method of fixation was ORIF with volar locked plate. Patients with closed fractures have a higher rate of union compared to open fractures at nine months.
MATERIALS AND METHODS: Air temperature (T), relative humidity (RH), air movement (AM), carbon dioxide (CO2), formaldehyde (HCHO), and particulate matter (PM) are the monitored parameters. Monitoring was carried out in the kindergarten for three consecutive days starting from 8.00am to 12.00pm.
RESULTS: Indoor carbon dioxide readings were higher at 0800 when parents drove to kindergarten to drop off their children without turning off the engine. In addition to this, the PM10 reading at 1000 was high but still within the standard range according to ICOP-IAQ 2010.
CONCLUSION: The findings highlight the importance of indoor air quality improvement measures for kindergarten buildings which can be used to improve indoor air quality in kindergarten environments.
MATERIALS AND METHODS: This cross-sectional study was conducted among 60 registered nurses in the ICU at Taiping Hospital. to assess the nurses' knowledge and attitude level using the Knowledge and Attitude on prevention of PUs questionnaire. A descriptive analysis and Pearson Correlation were used to analyze the data.
RESULT: From a total of 60 nurses 36 (60%) of nurses demonstrated a moderate level of KAP, and 17 (28%) demonstrated a high level of knowledge. They also exhibited neutral attitudes towards PUs prevention 49 (82%). The findings revealed a positive relationship between nurses' KAP toward implementing preventive measures on PUs (p=0.04; r=0.3). The findings show that nurses regularly performed the assessment of the risk factors of PUs for all hospitalized patients when performing PUs care. However, the plan for preventive nursing care was not properly reviewed.
CONCLUSION: This study suggested that appropriate guidelines, education programs, and an environment that makes it possible to provide continuing education should be created for nurses to prevent PUs in the ICU.
METHODS:: Eighty-six patients scheduled for trigger finger release between July 2016 and December 2017 were randomized into a control group (1% lignocaine and 8.4% sodium bicarbonate with arm tourniquet; given 10 min prior to procedure) and an intervention group (1% lignocaine, 1:100,000 of adrenaline and 8.4% sodium bicarbonate; given 30 min prior to procedure), with a total of 4 ml of solution injected around the A1 pulley. The onset of anesthesia and pain score upon injection of the first 1 ml were recorded. After the procedure, the surgeon rated for the hemostasis score (1-10: 1 as no bleeding and 10 being profuse bleeding). Duration of surgery and return of sensation were recorded.
RESULTS:: Hemostasis score was grouped into visibility score as 1-3: good, 4-6: moderate, and 7-10: poor. The intervention group (with adrenaline) had a 74% of good surgical field visibility compared to 44% from the controlled group (without adrenaline; p < 0.05). Duration of anesthesia was longer in the intervention group (with adrenaline), with a 2.77-h difference.
CONCLUSION:: WALANT provides excellent surgical field visibility and is safe and on par with conventional methods but without the usage of a tourniquet and its associated discomfort.
RESULTS: In vitro, cultured MDSC spontaneously differentiated into insulin-expressing islet-like cell clusters as revealed using MDSC from transgenic mice expressing GFP or mCherry under the control of an insulin promoter. Differentiated clusters of beta-like cells co-expressed insulin with the transcription factors Pdx1, Nkx2.2, Nkx6.1, and MafA, and secreted significant levels of insulin in response to glucose challenges. In vivo, undifferentiated MDSC injected into streptozotocin (STZ)-treated mice engrafted within 48 h specifically to damaged pancreatic islets and were shown to differentiate and express insulin 10-12 days after injection. In addition, injection of MDSC into hyperglycemic diabetic mice reduced their blood glucose levels for 2-4 weeks.
CONCLUSION: These data show that MDSC are capable of differentiating into mature pancreatic beta islet-like cells, not only upon culture in vitro, but also in vivo after systemic injection in STZ-induced diabetic mouse models. Being nonteratogenic, MDSC can be used directly by systemic injection, and this potential reveals a promising alternative avenue in stem cell-based treatment of beta-cell deficiencies.
METHODS: The authors describe a modified second toe transfer that addresses cosmesis in six patients. These include (1) harvesting a flap from the adjacent side of the great toe and insetting it into the volar aspect of the second toe to give more bulk, (2) making skin excisions on each side of the tip to reduce the bulbous appearance, and (3) excising the eponychium to produce apparent lengthening of the nail.
RESULTS: The mean follow-up period was 18 months (range, 6 to 36 months). The procedure resulted in good function and improved cosmesis in all six cases. Part of the great toe flap was lost in one case. The mean two-point discrimination in the transferred toes was 10.1 mm, with protective sensation present in the flaps. The range of motion of the transferred toe was 14 to 38 degrees at the metatarsophalangeal joint, 16 to 55 degrees at the proximal interphalangeal joints, and 20 to 36 degrees in the distal interphalangeal joints. All patients except one were happy with the appearance of the transferred toe.
CONCLUSION: This novel approach will allow patients to take advantage of the lower morbidity to the donor site afforded by second toe-to-thumb transfer and provide the patients with a more aesthetic appearance of the new thumb.