INTRODUCTION: Being a houseman in Malaysian hospitals can be very stressful. Stress can affect decision making to a great extent while addressing the needs of the patient in an emergency setting. This necessitated a study to find out the main sources of stress among housemen.
METHODS: This was a cross-sectional descriptive study carried out among 55 housemen using a questionnaire on sources of stress. The data was analysed using SPSS version 17.
RESULTS: A total of 16 factors leading to stress were studied among the housemen. Poor work and social life balance, annoying non-clinical personnel and medico-legal threats were among the top causes of stress.
CONCLUSION: The factors leading to stress among housemen should be considered for effective working of the hospital and improving the workplace atmosphere for the housemen.
Traumatic elbow dislocations in children are rare but most of them are complex dislocations, and in such dislocations, medial humerus epicondyle fractureis the most common associated injury. Fracture incarceration in the elbow joint occurs in 5-18% of medial humerus epicondyle fractures but ulnar neuropraxia is very rare. Open reduction internal fixation is indicated in medial humerus epicondyle fracture with fracture incarceration, ulnar neuropraxia, marked instability or open fracture. Operative treatment options include fragment excision and sutures, closed or open reduction and Kirschner wire fixation, open reduction and suture fixation, open reduction and smooth pin fixation, and open reduction and screw fixation. However, ulnar nerve transposition is debatable as good outcome had been reported with and without nerve transposition. We report a case of a 13-year old boy, who presented with right elbow dislocation and intra-articular entrapment of medial humerus epicondyle fracture fragment, complicated with sensory ulnar neuropraxia, following a fall onto his right outstretched hand in a motor vehicle accident. The elbow joint was reduced using close manipulative reduction but the fracture fragment remained entrapped post-reduction. The patient then underwent open reduction and screw fixation of the medial humerus epicondyle fracture without ulnar nerve transposition. He had good functional outcome six weeks after surgical intervention, with complete recovery of ulnar neuropraxia six months later. Currently, he is doing well at school and is active with his sporting activity.
Separate studies have reported spina bifida patients to be especially allergic to proteins of 27 and 23 kDa found in the serum of centrifuged natural rubber latex. An insoluble latex protein located on the surface of small rubber particles, Hev b 3, has similarly been found to be allergenic to spina bifida patients. In this study, internal amino acid sequences of Hev b 3 showed similarity to the published sequences for the 27- and 23-kDa latex proteins. The latter allergens are hence identified as Hev b 3. Determination of the molecular weight of Hev b 3 revealed various species of 22-23 kDa. The consistent gaps of about 266 Da observed between various forms of the intact protein suggest that the protein undergoes post-translational modification. To determine whether Hev b 3 also occurs in a soluble form in the latex serum, its presence in molecular-filtered serum was checked by ELISA and Western blot. The results showed Hev b 3 to be largely absent in the C-serum from fresh latex. The protein is therefore insoluble in its native state. However, a small amount of the solubilized protein was detected in ammonia-stabilized latex (commonly used in the manufacture of latex products).
The title compounds, C20H19NO3, (1), and C20H17Cl2NO, (2), are the 3-hy-droxy-benzyl-idene and 2-chloro-benzyl-idene derivatives, respectively, of curcumin [systematic name: (1E,6E)-1,7-bis-(4-hy-droxy-3-meth-oxy-phen-yl)-1,6-hepta-diene-3,5-dione]. The dihedral angles between the benzene rings in each compound are 21.07 (6)° for (1) and 13.4 (3)° for (2). In both compounds, the piperidinone rings adopt a sofa confirmation and the methyl group attached to the N atom is in an equatorial position. In the crystal of (1), two pairs of O-H⋯N and O-H⋯O hydrogen bonds link the mol-ecules, forming chains along [10-1]. The chains are linked via C-H⋯O hydrogen bonds, forming undulating sheets parallel to the ac plane. In the crystal of (2), mol-ecules are linked by weak C-H⋯Cl hydrogen bonds, forming chains along the [204] direction. The chains are linked along the a-axis direction by π-π inter-actions [inter-centroid distance = 3.779 (4) Å]. For compound (2), the crystal studied was a non-merohedral twin with the refined ratio of the twin components being 0.116 (6):0.886 (6).
Introduction: Supracondylar fracture of the humerus is the most common fracture around the elbow in children. Pinning with Kirschner wires (K-wires) after open or closed reduction is generally accepted as the primary treatment modality. However, it comes with the risk of persistent instability and if the K-wire is not inserted properly, it may cause displacement and varus deformity. We present our two-year experience with a new technique of lateral external fixation and K-wiring of the humeral supracondylar fracture. Materials and Methods: A total of seven children with irreducible Gartland Type III supracondylar humeral fracture were treated with closed reduction and lateral external fixation and lateral Kirschner wiring. Patients with ipsilateral radial or ulnar fracture, open fracture and presence of neurovascular impairment pre-operatively were excluded. All the patients were followed up at one, three and six weeks and three and six months. The final outcomes were assessed based on Flynn's criteria. Results: All the patients achieved satisfactory outcomes in terms of cosmetic and functional aspects. All patients except one (85.5%) regained excellent and good cosmetic and functional status. One patient (14.3%) sustained pin site infection which resolved with oral antibiotic (Checketts- Otterburn grade 2). There was no neurological deficit involving the ulnar nerve and radial nerve. Conclusion: The introduction of lateral external fixation and lateral percutaneous pinning provide a promising alternative method for the treatment of humeral supracondylar fracture. This study demonstrates that it has satisfactory cosmetic and functional outcomes with no increased risk of complications compared to percutaneous pinning.