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BackgroundRabies is endemic in low- and middle-income countries. It is caused mainly by the bite of a rabid dog and is fatal if not treated effectively and in a timely manner with quality post-exposure prophylaxis. Despite a profusion of private and public healthcare centres in Sindh province, most are ill-equipped to treat dog bites.MethodsWe analysed 129 human deaths from rabies who presented at the emergency departments of two tertiary care hospitals in Karachi over 10 y. Demographic data, time, location of the bite and distance travelled to report symptoms of rabies were recorded.ResultsMost victims were male, and children were more often affected; almost none had received post-exposure prophylaxis. A total of 12% of bites were on the face, head or neck. The mean incubation period was 56 d. Most (60%) of the rabies victims travelled long distances, hoping to receive treatment.ConclusionsRabies deaths were either due to a lack of awareness or the non-availability of rabies immunobiologicals within easy reach. Public health services must raise awareness, conduct surveillance and provide appropriately spaced centres for free treatment of dog bites. This lethal disease must be prevented at all costs.

We assess impacts of the 2020 COVID-19 lockdown on ambient air quality in Delhi, building on over three years of real-time measurements of black carbon (BC) and nonrefractory submicrometer aerosol (NR-PM1) composition from the Delhi Aerosol Supersite and public data from the regulatory monitoring network. We performed source apportionment of organic aerosol (OA) and robust statistical analyses to differentiate lockdown-related impacts from baseline seasonal and interannual variability. The primary pollutants NOx, CO, and BC were most reduced, primarily due to lower transportation emissions. Local and regional emissions such as agricultural burning decreased during the lockdown. PM2.5 declined but remained well above WHO guidelines. Despite the lockdown, NR-PM1 changed only moderately compared to prior years. Differences in the trends of hydrocarbon-like OA and BC suggest that some sources of primary aerosol may have increased. Despite notable reductions in some primary pollutants, the lockdown restrictions led to rather small perturbations in the primary fraction of NR-PM1, with secondary aerosol continuing to dominate. Overall, our results demonstrate the impact of secondary and primary pollution on Delhi's air quality and show that large changes in emissions within Delhi alone are insufficient to bring about needed improvements in air quality. © 2021 American Chemical Society.

In humans, gene mutations in voltage-gated sodium channels can cause a range of epileptic symptoms, including genetic (generalized) epilepsy with febrile seizures plus (GEFS+) and Dravet syndrome (DS). The SCN9A is a member of the SCN9 gene family that encodes sodium transporter proteins. In the current case report, we delineate a 12-year-old patient who was referred to a pediatric neurology clinic for infantile-onset generalized epileptic seizures and progressive neurodevelopmental delay. Novel heterozygous mutations c.4702AC (p.Asn1568His) in the SCN9A gene, and c.65GA (p.Arg22Gln) in the MLC1 gene were detected using targeted next-generation gene sequencing. The replacement of Histidine (His) with Asparagine (Asn) at position 1568 in the topological domain of SCN9A channel protein provides new insights into the impaired excitation and inactivation patterns of sodium channels. The case report adds this new patient with genetic link of SCN9A variants with progressive myoclonic epilepsy and cognitive difficulties.

CASE A 10-year-old boy presented with vague symptoms, a few days after a nondescript injury to his left knee. History, examination and blood tests, and imaging were unremarkable. Because of his severe pain, we proceeded to arthroscopy. On proceeding to arthroscopy, a wooden toothpick was found inside the knee joint. The wooden toothpick was removed arthroscopically. CONCLUSION The physicians/surgeons have to be vigilant and should approach holistically toward history and examination of a child presenting with vague signs and symptoms.

Aim Our Aim was to show what the benefits of Rivaroxaban over Enoxaparin post-operatively in trauma and orthopaedics. Doing a meta-analysis of previous studies and comparing post-op thrombotic risk in both rivaroxaban and Enoxaparin. To compare costs of using Enoxaparin vs Rivaroxaban in the major trauma centre. Method Meta-analysis of four studies conducted;Lassen 2008, Turpie 2005, Turpie 2009, Xie 2017 and Zou 2014. Gathered data from the British national formulary about Rivaroxaban cost and enoxaparin cost. Results This illustrated that rivaroxaban after TKA(Total knee Arthroplasty) had a significantly lower rate of symptomatic VTE, symptomatic DVT, asymptomatic DVT, distal DVT, and proximal DVT (shown in figure 1). The study shows that rivaroxaban after TKA is more effective than enoxaparin and did not increase major bleeding or cause increased mortality Major venous thromboembolism occurred in 9 of 908 patients (1.0%) given rivaroxaban and 24 of 925 (2.6%) given enoxaparin in a study done by Lassen et al Rivaroxaban requires less training for the patient, enoxaparin requires the patient to be taught proper administration. Rivaroxaban is considerably cheaper compared to enoxaparin. Enoxaparin provided by both Inhixa and Clexane cost £30.27 for a batch of 10 pre-filled disposable injections of 40mg, whilst rivaroxaban costs £18 for 10 tablets of the dose 10mg. Conclusions Rivaroxaban is cheaper to use for post-op anticoagulation, less resource intensive as patient is not required to be taught optimal administration method. Rivaroxaban has significantly reduced occurrence of thrombus compared to that of enoxaparin (based of the meta-analysis).

Background There is a longstanding culture of repeat x-rays after total knee replacement (TKR) as part of follow up, often combined with a clinic review. This is to check that the prosthesis is in a satisfactory position. There are inherently a number of issues with this historic approach including exposure of patients to further radiation who may be asymptomatic, time delays in busy clinics or x-ray departments and costs. Objectives The aim of this audit was to assess whether follow up plain films after TKR are methodically undertaken and of benefit to confirm satisfactory appearance if immediate post -operative x-rays were unremarkable. The findings of a six month follow up x-ray was specifically evaluated. The secondary aim was to establish the timing of further follow up x-rays within the department. Method 200 patients were included within the analysis, they all received a TKR at a major trauma centre, over a one-year period between December 2017 and December 2018. Results It was found that 100% of those patients having a post-operative film had a satisfactory appearance. 78% of patients had at least one further follow op x-ray of which 99.4% were satisfactory. Up to five follow up x-rays were taken with 53.5% of patients having a follow up x-ray at 6 months. Conclusions From the above results there is minimal, if any, evidence within the data set to support routine, additional follow up imaging if initial post-operative films are satisfactory, and the patient is asymptomatic.

Background Periprosthetic fractures are most commonly classified according to the Vancouver classification system and more recently the Unified Classification System. The aim of this study is to provide a descriptive analysis of fracture patterns in femoral periprosthetic fractures (PPFs) by femoral stem fixation. Methods A retrospective observational study of all femoral PPFs over a 10-year period at our institution was conducted. Presenting radiographs were examined to assess the fracture pattern. Results Over the 10-year period, 138 femoral PPFs that underwent operative treatment were examined. Mean age of patients was 78 years with 45.7% male and median American Society of Anaesthesiologists grade 3. The femoral stem fixation was cemented in 83 patients and uncemented in 55 patients. Uncemented femoral stems most commonly caused a simple oblique fracture pattern (69.1%) with a more comminuted pattern seen in cemented fixation (59%). Conclusion Fracture patterns differ according to femoral stem fixation. A simple “sickle-like” oblique fracture pattern was more commonly seen in uncemented stems while cemented tapered stems resulted in a comminuted “axe splitting” pattern.

The current field of orthopedics is the result of many decades of minor and major advancements. The evolution of orthopedics has culminated into the modern field seen today. This article presents 10 inventions that played a key role in shaping modern orthopedics.

Because people desire a high quality of life, health is a vital standard of living factor that is attracting considerable attention. Thus, the development of methods that enable rapid and real-time evaluation and monitoring of the human health status has been crucial. In this study, we systematically reviewed the techniques of data mining and machine learning (ML) for wearable health monitoring (WHM) and their applications, including conventional ML methods (artificial neural networks, the Kriging model, support vector machines, and principal component analysis) and the latest advance in deep learning (DL) algorithms for WHM; specifically, the advantages of the DL-based approaches over the traditional ML methods were analyzed in line with metrics associated with data feature extraction and identification performances. Moreover, to attain an intuitive insight, this study further reviewed the developments on the classifier performance with regard to detection, monitoring, identification, and accuracy. Finally, with regard to the characteristics of time series data acquired using health condition monitoring through sensors, recommendations and advices are provided to apply DL methods to human body evaluation in specific fields. Moreover, future research trends required to improve the capability of DL algorithms further are offered.

Amyand's hernia (AH) is a rare form of an inguinal hernia where the vermiform appendix is found within the hernia sac. Diagnosis is usually based on incidental finding intraoperatively. The AH makes up a small proportion of all inguinal hernia cases, and concurrent acute ischemic complication makes up an even smaller subset. We present an 85-year-old male who was referred to general surgery services for a growing mass on his right lower quadrant in the inguinal region. This was non-tender on palpation, and therefore there was no suspicion of ischaemic complications. An open hernioplasty was performed with resection of the appendix. The AH in this patient would be conventionally classified as type 1 AH, which would be managed with hernial reduction and mesh repair. The anatomical variance in our patient's AH increased the risk for hernial incarceration; hence an appendectomy was also performed despite the absence of acute appendicitis. This approach was also deemed necessary to avoid the recurrence of hernia due to its large size and adhesions within the hernial sac. This study reports a novel management approach for an incidentally discovered type 1 AH. It highlights that there is a lack of management guidance for the AH anatomical variants. The classification and management for AH under the conventional Losanoff and Basson's AH classification model have limitations that can be amended by incorporating the physical dimensions of the AH. This approach will enable surgeons to recognize and manage more variations of AH while mitigating downstream complications.

Introduction The most important factor determining survival in patients with head and neck squamous cell carcinoma (HNSCC) is a disease recurrence. A high rate of recurrence was noted in previous studies conducted in Pakistan; however, these studies did not consider margin status as inadequate margin clearance leads to disease recurrence. In this study, we determined cancer recurrence in patients with HNSCC after nullifying this factor. Methods This cross-sectional observational study was conducted in Liaquat National Hospital (LNH) for a duration of three years. Data collection period was from January 2015 to December 2017. A total of 150 patients that underwent surgery at LNH for HNSCC with margin-free frozen sections were included in the study. Pathological tumor characteristics such as tumor type, size, depth of invasion and nodal status were determined. Results The mean age of the patients was 50.31±12.90 with mean tumor size of 3.38±1.76. Nodal metastases were present in 45.3% cases with 17.3% showing extranodal extension. Recurrence was observed in 66% of cases with median disease-free survival of 12 months and perineural invasion was noted in 12% cases. We found a significant association of disease recurrence with larger tumor size, depth of invasion and extranodal extension. Moreover, younger age (50 years) groups showed higher rates of recurrence than the middle age group (30-50 years). Similarly, univariate and multivariate analyses revealed that tumors with ≥1 cm depth of invasion and the presence of extranodal extension were more likely to have disease recurrence than tumors with

Despite the use of safer tubes with high-volume, low-pressure cuffs, post-intubation injury is still the leading cause of benign, acquired, tracheoesophageal fistula (TEF). Cuff pressure, which is their primary pathogenetic driver, is not routinely monitored as a quality metric. To highlight the devastating consequences, we report this case of a fatal, iatrogenic fistula in a 64-year-old Asian male. He had undergone tracheostomy due to amyotrophic lateral sclerosis (ALS) and had a series of hospitalizations due to recurrent episodes of pneumonia. A TEF was eventually diagnosed to be the underlying cause. Esophageal stenting was ineffective. We intend to present teaching points aimed at reducing the risk of TEF in ventilator-dependent patients.

Nowadays, there is an increasing number of patients prescribed regular antithrombotics. With these long-term medications, complications like postoperative bleeding are extremely important. Despite available guidelines on this issue, disparities in approach have been noticed. The current study aimed to explore the knowledge, attitude, and practice of dental professionals associated with a dental school in Saudi Arabia regarding the management of patients with oral antithrombotic medications.A cross-sectional study was conducted on institutional-based dental professionals in Saudi Arabia. Fifty-six subjects, including 12 interns, 20 demonstrators, and 24 faculty members were included in the study. A modified semistructured questionnaire comprising 20 questions was used to gather respondents' knowledge, attitude, and practice related to oral antithrombotic medications. The chi-square test was applied for computing inferential statistics. Spearman correlation coefficient was performed for significant variables.The faculty members had comparable knowledge (P = .010) as well as practice (P = .001) levels, and significantly outscored the other two groups. The interns displayed a significantly higher knowledge score over the demonstrators, whereas the reverse scenario was seen for practice scores. Interestingly, participants were frequently found to be significantly overestimating the bleeding risk for procedures falling into the "no risk" category. A significantly positive correlation regarding the professional level could be shown in all domains.Professionals need to regularly update about novel anticoagulants, and should strictly comply with the established practice guidelines, thus improving the quality, safety, and value of dental health care.

Proximal humerus fractures account for 4%-6% of all the fracture presentations. There are many ways of treating different kinds of proximal humerus fractures. We describe the percutaneous fixation of proximal humerus which is not widely used but is a cost effective, less invasive and comparable to other techniques with regard to results.

Coronavirus disease 2019 (COVID-19) is a declared global pandemic. There are multiple parameters of the clinical course and management of the COVID-19 that need optimization. A hindrance to this development is the vast amount of misinformation present due to scarcely sourced manuscript preprints and social media. This literature review aims to presents accredited and the most current studies pertaining to the basic sciences of SARS-CoV-2, clinical presentation and disease course of COVID-19, public health interventions, and current epidemiological developments. The review on basic sciences aims to clarify the jargon in virology, describe the virion structure of SARS-CoV-2 and present pertinent details relevant to clinical practice. Another component discussed is the brief history on the series of experiments used to explore the origins and evolution of the phylogeny of the viral genome of SARS-CoV-2. Additionally, the clinical and epidemiological differences between COVID-19 and other infections causing outbreaks (SARS, MERS, H1N1) are elucidated. Emphasis is placed on evidence-based medicine to evaluate the frequency of presentation of various symptoms to create a stratification system of the most important epidemiological risk factors for COVID-19. These can be used to triage and expedite risk assessment. Furthermore, the limitations and statistical strength of the diagnostic tools currently in clinical practice are evaluated. Criteria on rapid screening, discharge from hospital and discontinuation of self-quarantine are clarified. Epidemiological factors influencing the rapid rate of spread of the SARS-CoV-2 virus are described. Accurate information pertinent to improving prevention strategies is also discussed. The penultimate portion of the review aims to explain the involvement of micronutrients such as vitamin C and vitamin D in COVID19 treatment and prophylaxis. Furthermore, the biochemistry of the major candidates for novel therapies is briefly reviewed and a summary of their current status in the clinical trials is presented. Lastly, the current scientific data and status of governing bodies such as the Center of Disease Control (CDC) and the WHO on the usage of controversial therapies such as angiotensin-converting enzyme (ACE) inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs) (Ibuprofen), and corticosteroids usage in COVID-19 are discussed. The composite collection of accredited studies on each of these subtopics of COVID-19 within this review will enable clarification and focus on the current status and direction in the planning of the management of this global pandemic.

Color Doppler vascular index (VI) was assessed alone and in combination with grey-scale ultrasound (GSU) in regionally subdivided thyroid nodules in diagnosing thyroid cancer. Color Doppler sonograms of 111 thyroid nodules were evaluated by a home-developed algorithm that performed “offsetting” (algorithm for changing the area of a region of interest, ROI, without distorting the ROI’s contour) and assessed peripheral, central and overall VI of thyroid nodules. Results showed that the optimum offset for dividing peripheral and central regions of nodule was 22%. At the optimum offset, the mean VI of peripheral, central, and overall regions of malignant nodules were significantly higher than those of benign nodules (26.5 ± 16.2%, 21.7 ± 19.6%, 23.8 ± 4.6% v/s 18.2 ± 16.7%, 11.9 ± 15.1% and 16.6 ± 1.8% respectively, P P

Introduction The aim of this study is to assess the readability and reliability of internet-based information on pelvic and acetabular fractures. Methods The three most popular English-based internet search engines are Google, Yahoo, and Bing. Quality was assessed using the DISCERN tool, the Journal of the American Medical Association tool, and the presence of the Health on the Net Code (HONcode) seal. Readability was assessed using a combination of the Flesch Reading Ease Score and the Flesch-Kincaid grade level. Inclusion criteria included English language websites with the relevant search terms. We excluded videos, YouTube links, or sponsored advertisements. Search terms included acetabular fracture/fractured acetabulum and pelvic fracture/fractured pelvis. The top 25 websites in each search engine were reviewed. The searches for acetabular fractures and pelvic fractures generated 75 websites in total. Duplicates were excluded. Results The search for acetabular fracture revealed 36 discrete websites among the three search engines, and the search for pelvic fractures revealed 45 websites. Overall, the average reading grade was 9.7 for acetabular websites and 13.6 for pelvis websites. The quality of the websites was poor across all key performance indicators studied. Conclusion Physicians should be aware of the quality of medical information available to patients via internet searches because physicians should play a central role in the navigation of poor quality information to help direct patient-centered care.

The current trend in hand surgery has streamlined the treatment of acute hand trauma to the modern-day surgery unit. As the volume of hand trauma caseloads continues to increase, it is becoming increasingly difficult to schedule patients for theater on the day of injury. It, therefore, becomes paramount to adequately triage patients in accordance with best clinical evidence and predictors of poor clinical outcomes. Animal models suggest that the earlier flexor tendons are repaired, the better the patient functional outcome. The largest study to date examining the timing of injury to functional post-operative outcome also recognizes that the faster these injuries are repaired, the better the patient outcome. Age-related changes to tendon biomechanics and structure are well-documented. However, no conclusive evidence exists specific to the degenerative changes and mechanical properties of flexor tendons in humans. The animal model strongly suggests that increasing age is associated with local architectural and biological changes that directly affect the tendon repair functional outcome. Although retrospective analyses to date suggest that smoking is a negative outcome predictor for functional tendon outcome, no prospective large-scale studies exist. A large, single-center prospective study specifically examining the positive and negative outcome predictors of flexor tendon repairs and functional post-operative outcome is warranted. The negative predictive model of patient care may enable us to further council patients preoperatively and stratify patients according to clinical need.

Introduction Nurses usually check patients scheduled for surgery while the patients are still in the ward. A lack of complete preoperative patient preparation can cause delayed care and disastrous outcomes. The objective of this study was to assess the number of patients en route to surgery who had been fully preoperatively prepared and evaluate any change in that number once a proforma was introduced as part of the preparation protocol. Methods We conducted a two-part audit of preoperative preparedness to assess factors such as up-to-date blood work, group and save, cross-match, and surgical site marking, among others. We then devised a proforma to be signed and checked by the ward doctor (e.g., intern or senior house officer). We compared the number of patients marked completely ready for surgery in the six weeks prior to use of the proforma with the number of patients marked completely ready for surgery for six weeks after implementation of the proforma. Results The study included the preoperative audit of 35 patients prior to the use of the proforma and 30 patients after the implementation of the proforma. Use of the proforma improved preoperative patient preparation by 50% compared to the level of preparedness when no proforma was used. Conclusion Health care facilities may benefit from a similar proforma for supplementing standardized, widely accepted preoperative protocols as an additional safety measure.

Electronic health (e health) initiatives are being employed in various health programs for disease monitoring. Very few such studies have been conducted in India, so this study was planned.Assess feasibility and usefulness of e health interventions for health workers, ASHA (accredited social health activist) in screening and management of hypertension.Prospective observational cohort study. ASHA's were recruited in two selected villages of Rajasthan and trained to use this technology.A web-based application was developed for use on portable device (tablet) to screen and diagnose hypertension, provide health education focused on diet, physical exercise and promote adherence to therapies by repeated sessions of one-to-one health education. Statistical analysis was done by Excel.With the use of e health initiatives, among population above 18yrs, we found 19.1% hypertensives (464/2430) with 46.5% new cases of hypertension and 38.9 % (945/2430) prehypertensive. Mean age of hypertensives was 52.6 yrs. ± 15.2 and 36.8 yrs. ± 14.2 for prehypertensive and highly significant (p0.001). Mean systolic blood pressure level of hypertensives decreased from 147.14 Hg ±13.86 to 133.3 Hg ±13.07 and for prehypertensive from 123.18 mm Hg ± 4.5 to 117.55 mm Hg ± 6.9 after follow up, the difference in change was highly significant (P0.001). Also, could start 27.4% hypertensives on treatment, while 50.2% were already on treatment.Training ASHA worker in e health technology is feasible and can assist in screening and management of diseases.

INTRODUCTION: Gastrointestinal (GI) symptoms and liver function test (LFT) abnormalities are increasingly being reported in patients with COVID-19 but there is no reliable data on the real magnitude of GI tract involvement We present the results of our study of 711 patients for GI and liver manifestations of COVID-19 METHODS: We performed a retrospective chart review of the 711 adult patients who visited the Richmond University Medical Center and/or its ambulatory centers in New York City up until May 13, 2020, and tested positive for COVID-19 We analyzed the reported incidence of dysgeusia, anorexia, nausea, vomiting, diarrhea, abdominal pain, and GI bleeding as well as LFT abnormalities In case of deranged LFTs, we looked for preexisting liver disease, alcohol abuse, and anti-retroviral medication use RESULTS: A total of 711 patients were studied using inpatient charts, and laboratory data to identify abnormal findings The mean age of patients was 60 5 years with slight male predominance (n = 395 vs 316) 27 1% (n = 193) reported GI symptom and an additional 56 9% (n = 405) had at least one liver enzyme abnormality Diarrhea was the most common with a frequency of 17 3% (n = 86), nausea 16 2% (n = 80), anorexia/vomiting 13 7% (n = 68), and abdominal pain 5 6% (n = 28) The least reported symptoms were dysgeusia 3 2% (n = 16) and GI bleeding 2 2% (n = 11) Lipase level was elevated in 27 8% patients (n = 138) Among LFTs, AST alone was elevated in 16 6% (n = 118), ALT alone in 15 0% (n = 6), both AST/ALT 15 7% (n = 112), alkaline phosphatase 23% (n = 164), and bilirubin 10% (n = 71) Potential confounders were preexisting liver disease (n = 8), patients taking HIV medications (n = 9) and alcohol abuse However, the enzyme levels in these patients were elevated above their baseline PT/ INR was elevated in 13 4% (n = 95) of patients while only 27 of them were on oral anticoagulant 88 6% (n = 630) of patients were admitted with respiratory failure, and 28 5% (n = 203) died CONCLUSION: GI symptoms were experienced by 27% and hepatic dysfunction was at 57% in this study of 711 COVID-19 patients This reflects a fairly high burden of GI involvement As the covid- 19 pandemic continues its rampage, our understanding of its GI and hepatobiliary aspects is growing This will improve our diagnostic, therapeutic, and preventive armamentarium Other implications for gastroenterlogists include prolonged viral shedding in stools, potential for fecal-oral transmission and risk of exposure during endocsopy (Table Presented)

A 79-year-old African American woman presented with acute hematemesis after progressive dysphagia for 6 weeks and 12-pound weight loss. She had no predisposing immunocompromising comorbidity such as the human immunodeficiency virus or active malignancy. Computed tomography showed air-fluid levels within the esophagus with partial obstruction. Upper endoscopy revealed a 1-cm mass lesion in the midthoracic esophagus, and biopsy results surprisingly showed esophageal actinomycosis. The patient's symptoms resolved on antimicrobial therapy at a one-month follow-up, and the lesion was not seen on repeat endoscopy with biopsy at 3 months. We believe that inhaled corticosteroids for chronic obstructive pulmonary disease may have created the growth milieu by impairing local defenses. Correct inhaler technique, avoiding swallowing the water after mouth rinsing, and a spacer device are recommended to reduce esophageal corticosteroid exposure.

Background Inflammatory spinal disease is one of three inflammatory musculoskeletal manifestations which frequently occur in PsA. There is very limited data about the axial involvement in PsA, especially as regards treatment, with treatment guidelines based largely on data from AS trials. The efficacy of corticosteroids in PsA patients with inflammatory back pain has not been studied to date. Objectives In this controlled trial, we aimed to investigate the comparative performance of corticosteroids for active axial-PsA (AxPsA) versus those with active AS. Methods PsA patients (fulfilling CASPAR criteria), and AS as per the 1984 Modified New York Criteria, were suitable for inclusion. Among them, patients with active AxPsA and active AS ((naive to biologic therapies) were recruited. The active disease was defined as patients with inflammatory back pain, with spinal pain score of ≥4 and BASDAI score ≥4 despite taking NSAIDS. Furthermore, only those AxPsA and AS patients with an MRI proven sacroiliac joint bone marrow oedema (MRI of sacroiliac joints performed within the 6 months prior to recruitment) were considered for inclusion. Hence, all recruited patients with AxPsA and AS had not only clinically active disease, but also had bone marrow oedema on MRI of sacroiliac joints. Moreover, we recruited a control group of non-inflammatory lower back pain. All patients received a single, intra-muscular dose of depot corticosteroid injection (Triamcinolone Acetonide 80 mg) at baseline. The intra-muscular corticosteroid option was used to overcome any drug compliance issues. Clinical outcome assessments were made at following time points: baseline, week-2, and week-4. The primary efficacy end point was the mean change in Ankylosing Spondylitis Disease Activity Score (ASDAS) at week-2. Key secondary outcome were the mean change of BASDAI, BASFI and ASQoL at week-2 and week-4. Results In total, 40 patients were recruited – AxPsA=15, AS=15, control=10. At week-2 following corticosteroid treatment, patients with AxPsA had significantly higher improvements in the mean ASDAS compared to patients with AS (1.43±0.39 vs. 1.03±0.30, p=0.004), and the same was the case when compared to controls (p Conclusions Axial inflammation in PsA potentially responds significantly better to corticosteroids than in patients with AS. This furthers the argument and adds to the growing evidence that AxPsA and AS are distinct entities. Future studies should further investigate the use of corticosteroids and of sDMARD usage among patients with active IBP in PsA. Disclosure of Interest M. Haroon Grant/research support from: Abbie, Pfizer, Speakers bureau: Abbie, Pfizer, UCB, M. Ahmad: None declared, N. Baig: None declared, O. Mason: None declared, J. Rice: None declared, O. FitzGerald: None declared

Hip dysplasia is an abnormal development of the hip that consists of a spectrum of different abnormalities featuring an abnormal relation of the femoral head to the acetabulum. It can be treated in early childhood when it is diagnosed. Later in adult life, it is more challenging. We present a case of a 50-year-old woman who presented to us with adult hip dysplastic changes; we undertook the care of her left hip and treated her surgically.

Lateral femoral prosthesis perforation is an uncommon periprosthetic fracture. Periprosthetic fractures may be fixed with open reduction and internal fixation, or with revision arthroplasty, depending on the type of fracture, the condition of the host bone in the proximal femur, the stability of the implant, and occasionally the medical co-morbidities of the patient. Proximal femoral replacement is a complex and challenging procedure but provides a better chance of early mobilisation. We describe a case of treating a 71-year-old woman who presented with an unusual type of periprosthetic fracture, treated with a revision arthroplasty procedure using a proximal femur replacement.

Percutaneous Gastrostomy (PEG) tube is an endoscopic-guided procedure to provide enteral nutrition, medications and/or fluids to patients with oral or esophageal pathologies. PEG tubes are a relatively safe intervention but commonly known to have complications like insertion site infection, tube leakage, and tube blockage. This was an unusual case in which the PEG tube was discovered to be obstructing the third part of the duodenum after migration resulting in mechanical gastric obstruction with septic shock and severe hemodynamic instability. PEG induced gastric obstruction is often misdiagnosed during a triage due to the atypical presentation of this condition leading to aggressive management, testing and consultations. PEG dependent patients have rapidly increased over the years and a complete physical examination of the PEG site should be performed by all physicians in order to prevent related complications.

Objective: The current study aimed to determine the prevalence and pattern of partial edentulism among dental patients attending the College of Dentistry, Aljouf University, Saudi Arabia. Patients and Methods: A total of 142 patients were selected, and the prevalence of partial edentulism among the selected patient was recorded. Patients were grouped into three age groups; Group I: 21-30 years, Group II: 31-40 years, and Group III: 41-50 years. Kennedy's classification was used to determine the pattern of partially edentulous arches. Modification areas were not included in the assessment to avoid complexity. Data was analyzed using the Statistical Package for the Social Sciences version 20.0 for windows. Results: The results showed that the occurrence of Kennedy Class III partial edentulism was 67.2 % in the maxillary arch and 64.1% in the mandibular arch. Followed by Class II in both maxillary and mandibular arch with an average of 16.3 % in maxillary arch and14.8% in the mandibular arch. Based on these results, class III has the highest prevalence in group II (31- 40 years). Class I and class II have the highest incidence among group III Patients (41-50 years). Conclusions: Among selected patients, Class III dental arch was the most prevalent pattern in maxillary and mandibular arches. Class IV being the least dominant pattern between all classes. There are a rise in Kennedy Class I and Kennedy Class II pattern and a decline in Class III and Class IV with an increase in age.

A 14-year-old girl with a suprasellar mixed malignant germ cell tumor was treated with complete surgical resection, chemotherapy, and radiation therapy. We performed a literature search to explore the current treatment options and prognosis of such a diagnosis. In reviewing the literature on mixed germ cell tumors, it appears that platinum-based chemotherapy regimens combined with radiation therapy provide the best outcome in terms of survival rates. Although controversial and debated, initial therapy should include surgical resection or a stereotactic biopsy when resection is not possible. By obtaining tissue for histopathology, one can tailor treatment plans accordingly and provide greater prognostic accuracy. In this case report, all three therapeutic modalities were used in the treatment of a mixed malignant germ cell tumor. Thus far, 20 months posttreatment, the patient is doing well and is neurologically intact, but diagnosis and treatment were relatively recent. Only time will tell the efficacy of this treatment plan.

We prospectively studied acute Achilles tendon rupture in patients over a two 2-year period and reviewed the causes, outcome and complications. There were 53 patients included with acute Achilles rupture with minimum follow up period of 6 months. We compared the outcomes including infection rate and Boyden score between the two groups repaired by Polydioxanone and Polyester respectively. All infected cases had a suture repair using the polyester suture. The difference in the infection rate was highly significant between the 2 groups (p=0.001). All 34 patients (100%) in the PDS group had good / excellent results based on the Boyden clinical assessment. Conversely, only 16 patients 9(68.4%) had good or excellent results IN Polyester repair group. Patients treated with a non- absorbable suture (ethibond) material for repair had a higher incidence infection and worse Boyden scores than the absorbable PDS group.

On-package graphics have the potential to influence consumers’ product-related attitudes and behaviours. In the reported study graphics designs on the labels of two products (water and vodka) were manipulated with respect to shape angularity, orientation, and left–right alignment. Participants’ evaluations indicated a preference for rounded shapes that could not be accounted for by differences in design typicality; and preference for upward shape orientation. An interaction between these response variables for ratings of purchase likelihood suggested that congruence between graphical and product form (droplet shape) may be advantageous. Effects of alignment were not consistent with existing theories, with right-aligned graphics being preferred. An explanation that distinguishes processing efficiency and hemispheric efficiency is proposed. Finally, as predicted, a halo effect was apparent, such that effects of aesthetic manipulations extended to ratings of product attributes that were not experienced. Theoretical and practical implications of these results are discussed.

Aim Single-access laparoscopic surgery is a recent voguein the field of minimally invasive colorectal surgery. Whileselected series have indicated feasibility, we prospectivelyexamined its usefulness for resectional surgery in routinepractice.Method All patients undergoing laparoscopic colorectalresection over a 12-month period were considered for asingle-access approach by a single surgical team ina university hospital. This utilized a ‘glove’ port via a3–5 cm periumbilical or stomal site incision, with stan-dard rigid laparoscopic instruments then being used.Results Of 76 planned laparoscopic colorectal resec-tions, 35 (47%) were performed by this single-incisionlaparoscopic modality without disruption of theatre listefficiency or surgical training obligations. The mean(range) age and body mass index of these 25 consecutiveright-sided resections, eight total colectomies (sevenurgent operations) and two anterior resections was 58(22–82) years and 23.9 (18.6–36.2) kg ⁄m 2 , respectively.The modal postoperative day of discharge was 4. Forright-sided resections, the mean (range) postoperativestay in those undergoing surgery for benign disease was4.0 days, while for those undergoing operation forneoplasia (n = 18, mean age 71 years) it was 5.8 daysand the average lymph node harvest was 13. Use of theglove port reduced trocar cost by 58% (€60 ⁄£53) byallowing the use of trocar sleeves alone without obtura-tors.Conclusion Single-incision laparoscopic surgery is aneffective option for abdominal surgery and seems espe-cially suited for laparoscopic-assisted right-sided colonicresections. The glove port technique facilitates proceduralfrequency and familiarity and proves economically favour-able.Keywords Single-access laparoscopic surgery, single-incision laparoscopic surgery, surgical glove port, laparo-scopic colorectal surgery, laparoscopic right hemicolec-tomy, laparoscopic total colectomyWhat is new in this paper?While feasibility of colorectal resection by single portlaparoscopy is now established, few studies have assessedits role in routine practice. Use of a surgical ‘glove’ portand avoidance of specialised instrumentation aids in thisregard as it prevents cost inflation undermining thisaccess modality.