bluuebunny/crossref_metadata_2025 huggingface dataset:
Molecular characterisation of multidrug-resistant Pseudomonas aeruginosa from a private hospital in Durban, South Africa
Authors: Adjei Cosmos B. , Govinden Usha , Moodley Krishnee , Essack Sabiha Y.
Published: September 2019

Background: Multi-drug resistant Pseudomonas aeruginosa pose a clinical challenge globally. This study delineated the molecular mechanisms of resistance to β-lactam antibiotics in multidrug-resistant P. aeruginosa isolated from a single private hospital in Durban, South Africa and ascertained clonality with regard to the isolates carrying β-lactamase genes.Methods: Seventeen P. aeruginosa isolates recovered from sputum, urine, catheter tips, pus swabs, nasal swabs and endotracheal aspirates underwent MIC determination, and phenotypic screening using the Double Disk Synergy Test (DDST) and Modified Hodge Test (MHT) to identify putative extended-spectrum β-lactamases (ESBLs), metallo-β-lactamases and other carbapenemases. Selected β-lactamase encoding genes were genotypically confirmed by PCR and sequencing. REP-PCR was conducted to determine the clonal relatedness of the 11 isolates carrying β-lactamase genes. Results: Sixteen isolates (94%) were resistant to aztreonam and piperacillin, 15 isolates (88%) were resistant to imipenem and ticarcillin, 14 (82%) were resistant to meropenem, and 13 isolates (76%) were resistant to ceftazidime and piperacillin/tazobactam. Resistance to ciprofloxacin and amikacin were 82% and 29% respectively. Of the 17 isolates tested, GES-2, VIM-2 and OXA-21 were present in 10 (59%) four (24%) and one (6%) of the isolates respectively. Three of the isolates harboured both GES-2 and VIM-2 and one isolate harboured OXA-21 and VIM-2. REP-PCR revealed seven clusters with clusters A and F having two (18%) and four (36%) isolates respectively, while the remaining five isolates were unrelated.Conclusion: GES-2 and VIM-2 enzymes were predominantly responsible for carbapenemase resistance. Clones A and F intimated patient-to-patient spread within the ICU and surgical ICU. This apparent dissemination as well as the multi-drug resistance observed points to sub-optimal infection prevention and control and dwindling antibiotic treatment options for P. aeruginosa respectively in this institution.
A primary care physician’s approach to a child with meningitis
Authors: Govender I , Steyn C , Maricowitz G , Clark C C , Tjale M C
Published: September 2019

Background: Paediatric meningitis remains a common cause of childhood morbidity and mortality in developing countries. In children the peak age for meningitis is six to 12 months old, with 90% of cases occurring in children younger than five years. It is imperative that a primary healthcare physician be aware of and is capable of managing this life-threatening condition as most caregivers first present to a primary healthcare physician with their sick child.Discussion: Common symptoms are headaches, photophobia, drowsiness, fatigue, unexplained crying, convulsions, irritability, and lethargy. Signs include fever, vomiting, neck stiffness and signs of increased intracranial pressure. Acute bacterial meningitis, especially meningococcal meningitis can present with petechiae and/or purpura. Cranial nerve palsy occurs commonly in cryptococcal meningitis, which can occur as part of immune reconstitution inflammatory syndrome (IRIS) after initiation of antiretroviral therapy. Older children may present with behavioural changes and localising signs such as hemiparesis and coma.Conclusion: This paper discusses the lumbar puncture technique and findings, drug and non-drug management, information on chemoprophylaxis for bacterial meningitis, and the possible complications of meningitis in children. This is an important area for the primary care physician as they are usually the first port of call by caregivers.
Antibiotic resistance profiles of biofilm-forming bacteria associated with urine and urinary catheters in a tertiary hospital in Ile-Ife, Nigeria
Authors: Osungunna Michael O. , Onawunmi Grace O.
Published: September 2019

Background: Microorganisms that infect humans differ in pathogenesis, virulence factors and antimicrobial resistance profiles. In natural settings, bacterial cells are most often found in close association with surfaces and interfaces, in the form of multicellular aggregates commonly called biofilms. Given their ubiquity and importance in the microbial world, it is hardly surprising that biofilms have attracted the attention of the scientific community. Biofilm formation on medical implant devices such as catheters is also a major problem that is closely tied to the adhesion and resistance-related abilities of the biofilm.Methodology: The ability of 216 bacterial isolates from mid-stream urine (100), catheter-stream urine (52) and catheter tips (64) to form biofilms was investigated using the tissue culture plate method, the tube and Congo red agar methods as well as their antibiotic resistance profiles using the agar disc diffusion method.Results: These revealed that Klebsiella spp. was the predominant bacterial genera accounting for 45.8% of the total isolates. A total of 50 isolates were biofilm-formers with 22% identified by the tissue culture plate method and 78% identified by the Congo red agar method. Klebsiella spp. had the highest ability to form biofilm while antibiotic resistance profiles showed all the biofilmformers to be multiply antibiotic resistant with least resistance to ofloxacin.Conclusion: It can therefore be concluded that some bacterial isolates associated with urinary tract infections have a propensity to form biofilm, thereby becoming multiply antibiotic resistant, and ofloxacin remains the antibiotic of choice in the treatment of such infections.
Coordinating Health and Industrial Policy in South Africa; A Case Study of the Vaccine Public-Private Partnership
Authors: Walwyn David R. , Nkolele Adolph T.
Published: September 2019

Established in 2003 as a Public-Private Partnership (PPP) covering vaccine research and development, manufacturing and supply, the Biovac Institute has grown from an initial base of 24 staff and a revenue of R188 million to an organisation of 250 people and an annual revenue of R1.8 billion (as of January 2018). The institute earns a premium on the procurement cost of a broad range of vaccines required by the National Department of Health (NDoH), the net value of which reached R1.14 billion over the period 2010–2014 and was used to finance the institute’s operations, including vaccine distribution and quality control. In this study, we have evaluated the value-for-money of the partnership within a context of tension between health and industrial policy. According to the respondents in the qualitative survey, its principal benefit has been the uninterrupted supply of vaccine and the ability to respond quickly to vaccine shortages. The main disadvantages appear to have been the slow establishment of vaccine manufacturing, and initially a limited ability to negotiate highly competitive vaccine prices. Overall, it is concluded that the institute has delivered value-for-money and met the objectives of both industrial and health policy. However, the experience appears not to have convinced the NDoH of the value of such initiatives.
Risk factors associated with nosocomial infections in the Neonatal Intensive Care Unit at Mahatma Gandhi Memorial hospital between 2014 and 2015
Authors: Rameshwarnath Sharita , Naidoo Saloshni
Published: September 2019

Background: Nosocomial infections are one of the main causes of neonatal morbidity and mortality in low- and middle-income countries. The neonatal intensive care unit is a suitable environment for disseminating infections. The aim of this study was to identify risk factors associated with having a nosocomial infection in the neonatal intensive care unit at Mahatma Gandhi Memorial hospital between 2014 and 2015.Methods: An observational, analytical case-control study was conducted at the neonatal intensive care unit at Mahatma Gandhi Memorial hospital in 2017 following ethical approval (BE336/16). A retrospective review of medical records for a sample size of 144 cases and 144 matched controls from 2014 to 2015 was analysed. Descriptive statistics were presented and multivariate conditional logistic regression was used to determine associations between the independent variables and having a nosocomial infection.Results: A total of 144 neonates developed nosocomial infections as proven by positive cultures with Klebsiella pneumoniae being most frequent (n = 60; 41.67%). On multivariate logistic regression analysis, multiple deliveries, low birth weight, respiratory distress, prematurity, neonatal jaundice, hyaline membrane disease, the use of total parenteral nutrition, blood transfusion and surfactant administration, immediate use of oxygen and intravenous fluid and central line insertion were significantly associated with having a nosocomial infection (p ≤ 0.001).Conclusion: Neonatal-related factors and treatment modalities were identified as factors that increased the risk for nosocomial infections. A review of treatment modalities and related infection prevention and control in neonatal management are the key to prevention, early detection and management of nosocomial infections.
Evaluation of a screening chest X-ray programme for the detection of pulmonary tuberculosis in asymptomatic military members
Authors: Van der Westhuizen Gerhard , Naude Mianda , Meyer Carin , Nel Mariette
Published: September 2019

This study evaluated reports from screening chest X-rays (s-CXRs) done by the South African Military Health Services on asymptomatic military members over the age of 40. Focus was placed on the yield of tuberculosis (TB) positive s-CXRs and a total of 29 (1.2%) patients showed signs of active TB from a study population of 2 371 patients during a 54-month study period. Although the results from this study cannot be extrapolated to the general population, the findings indicate that screening of the general population could be of value in South Africa where there is a high incidence of TB.
Influence of vaccination status and clinical, seasonal and sociodemographic factors on rotavirus prevalence in KwaZulu-Natal, South Africa
Authors: Asowata Osaretin E. , Ashiru Olubisi T. , Mahomed Saajida , Sturm A. Willem , Moodley Prashini
Published: September 2019

Human rotavirus infection is the leading cause of diarrhoea in infants and young children worldwide. In South Africa, diarrhoea is a major cause of childhood morbidity and mortality in children less than five years old, and before the vaccine was introduced rotavirus had been reported as causing one-third of all diarrhoeal related hospital admissions. This study assessed factors influencing the prevalence of rotavirus in children aged five years and under in KwaZulu-Natal, South Africa between June 2014 and June 2015. In addition, genotypes of the rotaviruses were determined. A stool specimen was collected from children presenting with diarrhoea to a regional hospital. Clinical, vaccination status, seasonal and sociodemographic information was collected using a structured questionnaire. ELISA (enzyme linked immunosorbent assay) was performed to detect rotavirus antigen in the stool. Rotavirus from selected positives specimens were genotyped using RT–PCR (reverse transcriptase polymerase chain reaction). The data were analysed using SPSS. In total, 365 stool specimens were collected. Rotavirus antigen was detected in 83 (23%) patients. The prevalence of rotavirus was not affected by vaccination status (p = 0.3; OR 1.5; CI 0.7–3.1), HIV status (p = 0.2; OR 0.6; CI 0.2–1.5), breastfeeding (p = 0.9; OR 1.1; CI 0.5–2.5) and administration of anti-helminth treatment (p = 0.6; OR 0.8; CI 0.3–1.9). The highest rotavirus prevalence was observed in the winter season (p 0.001; OR 43.3; CI 14.9–125.0). The G9P[8] was the most prevalent genotype (21%) followed by G9P[4] (14%). Rotavirus remains a major contributor to childhood diarrhoeal aetiology and hospitalisation in KwaZulu-Natal. Further investigation is needed to better understand the key drivers of rotavirus infection despite a successful vaccination programme in South Africa.
Antimicrobial Use and Misuse at the End of Life: A Retrospective Analysis of a Treatment Escalation/Limitation Plan
Authors: Wilder-Smith Adrian , Gillespie Thomas , Taylor D Robin
Published: September 2019

Background

Antimicrobial treatment is common at end of life. A treatment escalation/limitation plan (TELP) offers the opportunity to avoid non-beneficial treatment in critically ill patients. Our aim was to evaluate antimicrobial prescribing in terminally ill patients, and assess whether it was modified using a TELP.

Methods

Appropriateness of antimicrobial treatment was audited using a priori criteria in 94 consecutive hospital deaths. Prescribing in patients whose death was expected/unexpected, and who had a TELP with/without a ‘ceiling’ for antimicrobials, were compared.

Results

Twenty three of 94 patients (24.5%) were receiving antimicrobials at time of death. This was not influenced by evidence of infection or whether death was expected. The use of a TELP (n = 81) with an antimicrobial ‘ceiling’ (28 with, 53 without) was associated with a significant reduction in antimicrobials administered (28.6% vs 81.1%; p < 0.0005).

Conclusions

Many complex factors contribute to antimicrobial misuse at end of life. An appropriately constructed TELP reduces inappropriate prescribing.
Biomarkers and Newer Laboratory Investigations in the Diagnosis of Sepsis
Authors: Raveendran Arkiath Veettil , Kumar Anoop , Gangadharan Sheema
Published: September 2019

Sepsis is a major cause of death in hospitalised patients accounting for mortality rates as high as 60% and, hence, is called ‘a hidden public health disaster'. Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis is not a disease but is a clinical syndrome, where the initial features are nonspecific resulting in delayed diagnosis. Lack of specific laboratory tests to diagnose the syndrome adds to the diagnostic confusion. Failure to identify sepsis in the early stages itself delays effective treatment resulting in high morbidity and mortality. Various biomarkers and newer laboratory tests help to address these issues. However, to date there is no ideal test to diagnose sepsis. The most commonly used markers are C-reactive protein (CRP) and procalcitonin (PCT). There are around 180 biomarkers reported to be useful in sepsis. In addition to CRP and PCT, various emerging laboratory markers, such as like serum amyloid A, soluble triggering receptor expressed on myeloid cell-1, mannan and antimannan antibodies, and interferon γ inducible protein-10 etc., have been reviewed and their clinical usefulness discussed in this paper.
Pneumocystis Jirovecii Infection of Bilateral Adrenal Glands in an Immunocompetent Adult: A Case Report
Authors: Sharma Niharikaa , Ahlawat Ravinder Singh , Singh Harpreet , Sharma Chandan , Anuradha Subramanian
Published: September 2019

Pneumocystis jirovecii (PJ) infection is one of the most common opportunistic infections occurring in patients with HIV/AIDS and other immunocompromised states. It is not known to cause clinically significant illness in immunocompetent hosts. We report a 48-year-old HIV-negative, diabetic male who presented with fever and adrenal insufficiency. Abdominal sonography and PET-CT revealed bilateral enlarged adrenal glands with peripheral enhancement and central necrosis. An endoscopic ultrasound-guided fine-needle aspiration cytology of the left adrenal gland demonstrated well-defined, round cysts of PJ. There was no evidence of pulmonary involvement. The response to first-line treatment was poor and the patient responded to second-line treatment for Pneumocystis infection.
Quality Criteria for Core Medical Training: A Resume of Their Development, Impact and Future Plans
Authors: Armstrong Miriam , Black David , Miller Alastair
Published: September 2019

Background

In 2015 the Joint Royal Colleges of Physicians Training Board (JRCPTB), acting on behalf of the three UK Royal Colleges of Physicians, launched a set of quality criteria designed to improve the educational experience of Core Medical Trainees.

Methods

The criteria were developed with key stakeholders from Core Medical Training (CMT) and monitored via the General Medical Council's annual National Training Survey. This paper describes the development, implementation and impact of these criteria, which have been implemented by UK postgraduate schools of medicine since 2015.

Results

There were trainee-reported improvements from baseline (2015-18) in at least eight out of the 13 core criteria measured.

Conclusions

The results demonstrate that a coordinated UK-wide approach to quality improvement, focused on a specific set of clearly defined and measurable outcomes that galvanise trainer engagement, can lead to greater trainee satisfaction in a demanding area of medicine without significant additional resources.
Fungal Infection: A Hidden Enemy in Diabetic Foot Ulcers
Authors: Sanniyasi Saravanan , Balu Jagan , Narayanan Cunnigaiper Dhanasekharan
Published: September 2019

Diabetic foot ulcers are on the rise and increasingly associated with amputations. Fungal infections have recently been implicated in the nonhealing nature of these wounds. One hundred five patients treated as in-patients with nonhealing diabetic ulcers in a tertiary care hospital were included in this prospective study. Wound swabs and deep tissue biopsies were taken from these ulcers for fungal stain and culture and bacterial culture. Once the fungal stain or the culture study is positive, oral Fluconazole was started. Nineteen patients grew fungus in the ulcer, commonest species being Candida tropicalis (10.5%). The most common bacterial organism isolated with fungal infection is Pseudomonas followed by Enterococcus. Patients on prolonged antibiotic therapy showed statistically significant increase in fungal infection. Patients who underwent amputation within 15 days of admission were higher in fungal culture positive group, due to progression of ulcer in spite of antibiotic therapy. There is a definite correlation between incidence of amputation and fungal infection in whom antifungal therapy was not started, though not statistically significant. Fourteen patients, who did not undergo amputation, had faster wound healing and lesser progression of disease, with none of them requiring amputation after initiating antifungal therapy. Our study reveals that there is a definite relation between fungal infections and nonhealing nature of diabetic ulcers. Further randomized trials are necessary to substantiate this finding.

How to cite this article

Sanniyasi S, Balu J, Narayanan CD. Fungal Infection: A Hidden Enemy in Diabetic Foot Ulcers. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):74-76.
Achilles Tendon Rupture Secondary to Kite String (Manja) Injury: A Rare Etiology seen in Two Cases
Authors: Bagaria Vaibhav , Nemade Amit , Joshi Nilesh
Published: September 2019

Achilles tendon is the strongest and the thickest tendon of the human body. Due to its superficial location and stress, it has to face due to loading, the tendon is susceptible to injuries and ruptures. This is aggravated due to the precarious blood supply in the region and also age-related changes that occur in the tendon. Of the specific causes age-related and steroid induced tendinosis and sports injuries are the commonest mechanism of injury. Kite playing is a very common sport in the Indian subcontinent, which involves the use of a string (manja) often coated with powdered glass to fly the kite. Many grievous injuries are reported due to its use especially in two wheeler riders. However, to the best of our knowledge a kite thread injury causing Achilles tendon tear due to direct impact has so far not been reported. In this case series, we describe two cases that had such injury and a brief note on specifics of management of this case is described.

How to cite this article

Bagaria V, Nemade A, Joshi N. Achilles Tendon Rupture Secondary to Kite String (Manja) Injury: A Rare Etiology seen in Two Cases. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):90-93.
Ethibond Suture Granuloma following Tibialis Anterior Tendon Transfer Mimicking Osteomyelitis of Foot
Authors: Gopinathan Nirmal Raj , Saibaba Balaji , Santhanam Siva Swaminathan , Kanojia Rajendra Kumar
Published: September 2019

Tibialis anterior tendon transfer is routinely done for the correction of dynamic supination deformity of foot in children with congenital talipes equinovarus (CTEV). Surgeons commonly make use of a nonabsorbable suture—‘ethibond number 2’ for anchoring the transferred tendon to the new recipient site. We would like to report a case of suture granuloma following tibialis anterior tendon transfer in a 4 years old child, presenting with a swelling and discharging sinus clinically mimicking osteomyelitis. Unlike osteomyelitis, the patient did not have fever or pain clinically, nor was any organism detected microbiologically. The clinical presentation and the successful management of the case have been described in detail along with relevant review of literature.

How to cite this article

Gopinathan NR, Dhillon MS, Saibaba B, Santhanam SS, Kanojia RK. Ethibond Suture Granuloma following Tibialis Anterior Tendon Transfer Mimicking Osteomyelitis of Foot. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):97-100.
Revision Ankle Syndesmosis Fixation: Functional Outcome after TightRope® Fixation
Authors: Rajagopalan Senthil , Moonot Pradeep , Sangar Anurag , Taylor Heath
Published: September 2019

Introduction

Syndesmotic injuries present a challenge to orthopedic surgeons. Malreduction of the syndesmosis has been reported to cause instability and secondary osteoarthritis and is correlated with poor subjective and objective outcomes. There are very few studies that report the outcome after revision fixation of these injuries. Previous studies have reported varying techniques for revision syndesmosis reconstruction, including screw fixation and tendon transfers.

We present the results of the use of the TightRope® suture for revision syndesmosis fixation. This implant has the advantage of maintaining physiological motion whilst allowing for healing of syndesmotic ligaments and prevents the need for further surgery to remove screws in already scarred soft tissues.

Materials and methods

We retrospectively analyzed 124 patients who required syndesmotic stabilization from January 2000 until December 2009. Eight of these 124 patients required surgical revision of their failed syndesmosis fixation, each of which was stabilized with the TightRope® Suture. All eight patients were followed up and their outcomes assessed. Seven of the eight patients in our study had technically sound initial fixation of the syndesmosis. Four of the eight patients had syndesmotic separation after screw removal 10 weeks after primary fixation.

Results

In our study, 6 of the 8 patients had good or satisfactory outcomes based on American Orthopedic Foot and Ankle Society (AOFAS) scores. In spite of accurate revision fixation of the syndesmosis, two patients required further surgery. One patient had conversion to an ankle fusion because of persistent syndesmotic widening and ongoing pain after revision surgery. Another patient required syndesmotic arthrodesis as a result of persistent pain.

Conclusion

TightRope® suture fixation is a good method of syndesmosis stabilization in patients requiring revision surgery. Randomized studies would be required to compare the effectiveness of this method of fixation with screw fixation.

How to cite this article

Rajagopalan S, Moonot P, Sangar A, Taylor H. Revision Ankle Syndesmosis Fixation: Functional Outcome after TightRope® Fixation. J Foot Ankle Surg (Asia- Pacific) 2016;3(1):23-27.
Diabetic Foot Infection: An Indian Scenario
Authors: Rastogi Ashu , Bhansali Anil
Published: September 2019

Introduction

Diabetes mellitus is assuming epidemic proportions and with that an increasing burden of diabetic foot complications. Diabetic foot infections (DFIs) contribute not only to morbidity, amputation, and increased health-care costs but also to mortality.

Aim

To review the literature regarding the epidemiology and management of DFIs in India.

Results

The socioepidemiology of diabetic foot and its complications in India is different from the West. There is a considerable delay in seeking a physician for foot problems, as patients continue invalidated and indigenous methods of treatment. At presentation, most of the foot ulcers are chronic, harbor infection, and neuropathic in origin compared to the West with predominantly neurovascular ulcers. A predominance of Gram-negative bacterial species is reported in DFIs, with Pseudomonas aeruginosa as the most common isolated organism. An initial empirical antibiotic choice covering Gram-negative bacteria is suggested.

Conclusion

There are very few studies on the countrywide prevalence of foot complications from India. In India, DFIs behave differently from the West because of sociocultural and economic differences. We need indigenous ways for prevention and management of DFIs in India.

How to cite this article

Rastogi A, Bhansali A. Diabetic Foot Infection: An Indian Scenario. J Foot Ankle Surg (Asia-Pacific) 2016;3(2):71-79.
Repair of the Chronic Rupture of tendo Achilles Tendon using Peroneus Brevis Tendon
Authors: Singh Manjit , Aggarwal Hari O , Sareen Sanjeev , Vashisht Deepak
Published: September 2019

Aim

To report 20 patients who underwent repair of chronic rupture of tendo Achilles tendon with peroneus brevis tendon.

Materials and methods

Records of 6 women and 14 men aged 26 to 58 (mean, 36) years who underwent repair of chronic rupture of tendo Achilles tendon with peroneus brevis tendon transfer were reviewed. Patients were evaluated at 3, 9, and 12 months using the foot and ankle outcome score (FAOS) questionnaire.

Results

Out of 20 patients, 4 developed superficial skin complications which healed gradually in 3 patients, and 1 patient underwent skin grafting surgery. No patient had a re-rupture of the tendo Achilles tendon. At the 1-year follow-up, all patients achieved good functional outcome in terms of the FAOS.

Conclusion

Repair of chronic rupture of tendo Achilles tendon with peroneus brevis tendon transfer achieved good functional outcome.

How to cite this article

Aggarwal HO, Singh M, Sareen S, Vashisht D. Repair of the Chronic Rupture of tendo Achilles Tendon using Peroneus Brevis Tendon. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):30-34.
Foot and Ankle Surgery: The Indian Scenario in 2016
Authors: Ebnezar John , John Rakesh
Published: September 2019

In this review, we try to analyze the current scenario of foot and ankle surgery in India, with special emphasis on the problems faced by the indigenous population and also the challenges faced by foot and ankle surgeons of our country. Chronic infections of the foot (like tuberculosis, leprosy), neglected or mismanaged trauma cases (which usually result from a lack of awareness in the people regarding foot and ankle problems), foot and ankle problems faced by sportspersons, geriatric population, etc., form the crux of the discussion in this article.

How to cite this article

Dhillon MS, Ebnezar J, John R. Foot and Ankle Surgery: The Indian Scenario in 2016. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):40-44.
Anterior Inferior Tibiofibular Ligament Reconstruction with Anchor Sutures compared with Trans-syndesmotic Screw Fixation for Ankle Syndesmotic Injuries
Authors: Kim Jin Su
Published: September 2019

Background

Acute syndesmotic injuries were usually treated with trans-syndesmotic screw fixation. However, screw fixation is too strong compared with the physiologic ankle joint movement. In addition, it needs removal and leads to delayed rehabilitation. We propose the reconstruction of the anterior inferior tibiofibular ligament (AITFL) using suture anchors to substitute trans-syndesmotic screw fixation.

Materials and methods

We compared the results after trans-syndesmotic screw fixation and AITFL suture anchor fixation in syndesmotic injuries with or without ankle fracture. Consecutively, the trans-syndesmotic screw (group I) was conducted between June 2011 and June 2013, and since July 2013, suture anchor fixation was performed (group II). Reductions in quality, the American Orthopedic Foot and Ankle Society (AOFAS) score, and the Olerud–Molander ankle score (OMAS) were evaluated.

Results

The final AOFAS score and OMAS in both groups were not significantly different (p = 0.98, 0.67). Tibiofibular overlapping, tibiofibular space, and tibiofibular overlapping ratio to the tibial width in both groups had satisfactory reduction from the standards. Computed tomographic (CT) evaluation also confirmed that both groups had been anatomically reduced in standard. Anteroposterior axis reduction in CT was more accurate in group II. Nonclinically related complications were three broken screws in final follow-up in group I.

Conclusion

Both trans-syndesmotic screws and suture anchor fixation have satisfactory clinical outcomes. The suture anchor fixation for syndesmotic injury does not need removal and is less complicated compared with the trans-syndesmotic screw fixation.

How to cite this article

Kim JS. Anterior Inferior Tibiofibular Ligament Reconstruction with Anchor Sutures compared with Trans-syndesmotic Screw Fixation for Ankle Syndesmotic Injuries. J Foot Ankle Surg (Asia-Pacific) 2017;4(2):57-62.
How We do It. Trimalleolar Fractures: Fixing the Posterior Malleolus by Posterolateral Approach
Authors: Bansal Tungish , Dhillon, Mandeep S , Dureja, Kamal
Published: September 2019

The understanding of trimalleolar fractures and, in particular, the posterior malleolus fragment has drastically evolved over the last decade. There has been a tilt in favor of fixing almost all posterior malleolus fragment in contrast to the old school thought of the 20th century. The concept of stability offered by posterior malleolus fixation to the syndesmotic stability is well understood now. Posterolateral approach has almost evolved as a gold standard approach for posterior malleolus fixation.

How to cite this article

Dhillon MS, Dureja K, Patel S, Bansal T. How We do It. Trimalleolar Fractures: Fixing the Posterior Malleolus by Posterolateral Approach. J Foot Ankle Surg (Asia-Pacific) 2017;4(2):63-68.
Cardiac Magnetic Resonance Imaging: The New Tool for Clinicians
Authors: Paul Rudrajit , Sarkar Rathindranath
Published: September 2019

Cardiac magnetic resonance imaging (cMRI) scan is rapidly becoming an indispensable tool for the management of various disorders. This technique has the advantages of good temporal and spatial resolution and no exposure to radiation. Various ischemic and non-ischemic conditions of the heart may be diagnosed with high sensitivity and specificity. This review article aims to introduce the clinicians to the various uses of cardiac MRI and its future potential.
Therapeutic Diet: What We Need to Consider!
Authors: Ghosh Amrita
Published: September 2019

Therapeutic diet is needed so that nutritional factors may not affect individuals in diseases during convalescence and rehabilitation. Different research groups have observed a correlation between diseases and diets with diagnosis, prognosis, clinical outcomes and complications. In spite of considerable progress in healthcare, there is scarce evidence-based research excellence on community-level compliance on dietary advice. We need to change our mindset to find user-friendly dietary guidelines for the improvement in clinical approach and treatment in patients with diverse diseases in daily medical practice.
A etnografia na ciência da informação: um método para espaços virtuais
Authors: Pérez Martínez Luis Carlos , Alcará Adriana Rosecler , Monteiro Silvana Drumond
Published: September 2019

Este artigo expõe um breve panorama do desenvolvimento da etnografia como método de pesquisa qualitativa em diferentes áreas sociais. Apresentam-se alguns conceitos da etnografia aplicada em ambientes virtuais, assim como as principais características que ela possui. Objetivo: Identificar a relevância e a aplicação da etnografia como abordagem metodológica na Ciência da Informação (CI) e em particular no ciberespaço. Método: Utiliza-se a pesquisa bibliográfica e documental para descrever os elementos principais da etnografia. Adicionalmente, por meio de busca do termo “etnografia” na Biblioteca Digital Brasileira de Teses e Dissertações, identificou-se a produção de pesquisas da CI que usaram o método. Resultado: Do número de pesquisas recuperadas, só duas apresentavam uma combinação de métodos, incluindo a etnografia. A amostra denota uma escassa produção com abordagem etnográfica na área, particularmente em estudos do ciberespaço. Conclusões: A etnografia é um método que pode ser aplicado para diferentes ambientes virtuais e para entender processos culturais. Esses espaços são ambientes de interação social, que permitem desenvolver novas pesquisas para conhecer formas de colaboração e compartilhamento do conhecimento e da informação.
A performance na sociedade de História: relações com o documento, com a informação e com a memória
Authors: Coelho Ana Cláudia Lara dos Santos , Da Fonseca Vitor Manoel Marques , De Souza Elisabete Gonçalves
Published: September 2019

Objetivo: Discutir as aproximações entre os conceitos de performance, documento, informação e memória, a fim de identificar as possíveis contribuições da ação e dos resultados dos registros para essa forma de arte.Método: Pesquisa de natureza teórica, pautada nos conceitos apresentados por Paul Otlet e Suzanne Briet (documento), Ana Maria Camargo e Heloísa Bellotto (documento de arquivo), Michael Buckland (informação), Renato Cohen, Peggy Phelan, Jorge Glusberg e Regina Melim (performance) e  Pierre Nora e Ulpiano Meneses (memória).Resultado: A noção dos documentalistas clássicos, apesar de ampliada, não abdica da materialidade física/durável dos documentos. Como a performance não possui tal materialidade, não pode ser considerada documento. No âmbito da arquivologia, a performance é entendida como a atividade do artista, não sendo, portanto, documento. Com relação à informação, a performance se encaixa no tipo informação-como-conhecimento, já que é um evento. A respeito da memória, a performance é confrontada por dois anseios: o de resistir à sociedade de história e a necessidade social pelo conhecimento e pela permanência.Conclusões: Entende-se que os documentos gerados a partir da performance, ao invés de comprometerem  sua identidade, podem ampliar as possibilidades de existência e resistência dessa manifestação artística na sociedade de história.
O Interdomínio dos Estudos Métricos da Informação em Medicina: Aproximação entre discurso e prática de seus pesquisadores
Authors: Lazzarotto Freitas Juliana , Santiago Bufrem Leilah , Cabrini Grácio Maria Cláudia
Published: September 2019

Analisa o interdomínio de Estudos Métricos da Informação (EMI) na Medicina, a fim de reconhecer teórica e empiricamente as relações de produção científica ali representadas. Utiliza como corpus de análise, um conjunto de 132 artigos extraídos da base Scopus, produzidos pelos autores brasileiros mais representativos do interdomínio. Como modalidade metodológica adota a análise de conteúdo das respostas do questionário aplicado aos autores representantes desse interdomínio, para objetivar suas percepções sobre as próprias práticas de pesquisa relacionadas aos EMI, bem como a análise da produção periódica científica desses autores. Apreende assim, suas percepções sobre as atividades de pesquisa que vêm realizando no âmbito dos EMI. Como resultados, confronta a produção periódica científica dos autores com suas respostas, descrevendo a coesão entre seus discursos e suas práticas de produção científica. Por fim, considera as análises de interdomínios como uma oportunidade de contribuição ou colaboração entre campos para a realização de metapesquisas.
The impact of full-spectrum endoscopy on pathological lesion detection in different regions of the colon: a randomised, controlled trial
Authors: Pasternak Artur , Szura Miroslaw , Solecki Rafal , Bogacki Pawel , Bachul Piotr , A. Walocha Jerzy
Published: September 2019

Introduction

Colonoscopy is crucial for detecting and localising pathological lesions within the colon. Colonoscopy quality is defined by the caecal intubation rate, withdrawal time, adenoma detection rate, and polyp detection rate. The newly introduced full-spectrum endoscope (FUSE®) provides a 330° field of view, allowing endoscopists to observe more colonic anatomy. It is intended to increase detection of pathological lesions, especially those situated behind the haustral folds of the bowel. This diagnostic modality should increase the adenoma detection rate (ADR), especially in the right hemicolon. The aim of this study was to explore the efficacy of FUSE for detecting pathologic lesions in different colonic regions.

Material and methods

The study enrolled 408 patients who were randomised to either a standard frontal view (SFV) or the novel full-spectrum colonoscopy. Analysis was performed among three broad regions of the colon: right, transverse, and left colon, according to the Boston Bowel Preparation Scale.

Results

FUSE yielded a higher diverticula detection rate (DDR) in the right and middle colon (DDR-R [p < 0.05], DDR-T [p < 0.05], DDR-L [p = 0.862]). ADR (p = 0.761), advanced ADR (aADR) (p = 0.950), and DDR (p = 0.967) in respective regions of the colon were similar between the groups; however, the total number of adenomas detected with FUSE was higher in the right and middle regions of the colon compared with those detected by SFV (p < 0.05).

Conclusions

Full-spectrum colonoscopy allows for effective recognition of pathological lesions in the right and middle regions of the colon. Although full-spectrum colonoscopy did not statistically affect ADR, the absolute number of adenomas detected was higher compared with classical endoscopy.
Influence of late Quaternary climate on the biogeography of Neotropical aquatic species as reflected by non-marine ostracodes
Authors: Cohuo Sergio , Macario-Gonzalez Laura , Wagner Sebastian , Naumann Katrin , Echeverria Paula , Pérez Liseth , Curtis Jason , Brenner Mark , Schwalb Antje
Published: September 2019

Abstract. We evaluated how ranges of four endemic and non-endemic aquatic ostracode species changed in response to long-term (glacial-interglacial cycles) and abrupt climate fluctuations during the last 155 ka in the northern Neotropical region. We employed two complementary approaches, fossil records and species distribution modeling (SDM). Fossil assemblages were obtained from sediment cores PI-1, PI-2, PI-6 and Petén-Itzá 22-VIII-99 from Petén Itzá Scientific Drilling Project, Lake Petén Itzá, Guatemala. To obtain a spatially resolved pattern of (past) species distribution, a downscaling cascade is employed. SDM's were reconstructed for the Last Interglacial (~ 120 ka BP), the Last Glacial Maximum (~ 22 ka BP) and the middle Holocene (~ 6 ka BP). During glacial/interglacial cycles and Marine Isotope Stages, modeled paleo-distributions and paleo-records show nearly continuous presence of endemic and non-endemic species in the region, suggesting negligible effects of long-term climate variations on aquatic niche stability. During periods of abrupt ecological disruption such as Heinrich Stadial 1 (HS1), endemic species were resilient, remaining within their current areas of distribution. Non-endemic species, however, proved to be more sensitive. Modeled paleo-distributions suggest that the geographic range of non-endemic species changed, moving southward into Central America. Due to the uncertainties involved in the downscaling from the global numerical to the highly resolved regional geospatial statistical modelling, results can be seen as benchmark for future studies using similar approaches. Given relatively moderate temperature decreases in Lake Petén Itzá waters (~ 5 ºC) and persistence of some aquatic ecosystems even during periods of severe drying in HS1, our data suggest 1) existence of micro-refugia and/or 2) continuous interaction between central metapopulations and surrounding populations, enabling aquatic taxa to survive climate fluctuations in the northern Neotropical region.
Basal thermal regime affects the biogeochemistry of subglacial systems
Authors: Dubnick Ashley , Sharp Martin , Danielson Brad , Saidi-Mehrabad Alireza , Barker Joel
Published: September 2019

Abstract. Ice formed in the subglacial environment can contain some of the highest concentrations of solutes, nutrients, and microbes found in glacier systems. Upon glacial melt, these materials are released to downstream freshwater and marine ecosystems and glacier forefields. Despite the potential ecological importance of basal ice, our understanding of its biogeochemical characteristics, and their spatial and temporal variability, remains limited. We hypothesize that the basal thermal regime of glaciers is a dominant control on subglacial biogeochemistry because it influences the degree to which glaciers mobilize material from the underlying substrate and controls the nature and extent of biogeochemical activity that occurs at glacier beds. Here, we characterize the solutes, nutrients, and microbes found in the basal regions of a cold-based glacier and three polythermal glaciers and compare them to those found in overlying glacier ice. Compared to its parent glacier ice, basal ice from polythermal glaciers was consistently enriched in major ions, dissolved organic matter (including a specific fraction of humic-like fluorescent material), and microbes, and occasionally enriched in dissolved phosphorus and reduced nitrogen (NH4+) and in a second dissolved component of humic-like fluorescent material. In contrast, the biogeochemistry of basal ice from the cold-based glacier was remarkably similar to that of its parent glacier ice. Although basal ice from the cold-based glacier may have acquired some inorganic and organic nutrients from the underlying substrate, it did not appear to contain significant amounts of either solutes or microbes derived from the glacier bed. These findings suggest that a glacier's basal thermal regime can play an important role in determining the mix of solutes, nutrients, and microbes that are acquired from subglacial substrates and/or produced in situ.
Fifty years of recorded hillslope runoff on seasonally frozen ground: the Swift Current, Saskatchewan, Canada, dataset
Authors: Coles Anna E. , McDonnell Jeffrey J. , McConkey Brian G.
Published: September 2019

Abstract. Long records of hillslope runoff and nutrient concentrations are
rare – on seasonally frozen ground they are almost non-existent. The Swift
Current hillslopes at the Swift Current Research and Development Centre on
the Canadian Prairies provide such a long-term hydrological record. Runoff,
runoff nutrient concentration, snowpack depth, density and water equivalent,
soil moisture, and soil nutrient concentration were monitored on the three 5 ha hillslopes over a 50-year period (1962–2011). Digital elevation data
are available for the three hillslopes at a 2 m horizontal resolution, and,
for one of the hillslopes (Hillslope 2), at a 0.25 m horizontal resolution.
Runoff from the hillslopes was generated episodically during snowmelt and
occasional rainfall events. Hillslope runoff was measured with a 0.61 m H-flume. Daily runoff nutrient concentration data are available for
nitrate–N (March 1971–April 2011), ammoniacal–N (February 1996–April
2011), and phosphate-P (March–April 1971; June 1991–April 2011). Snowpack
data (snowpack depth, density, and water equivalent) were determined via
manual snow surveys carried out several times each winter, between January
and March, between 1965 and 2011. Gravimetric soil moisture content was
measured in October and April each year between 1971 and 2011 at five depth
intervals (0–15, 15–30, 30–60, 60–90, and 90–120 cm) at nine points on each
hillslope. We provide these hillslope data in two publicly available
repositories: (1) 1962–2011 data on runoff, runoff nutrients, snowpack, soil
moisture, soil nutrients, and crop and tillage practices at https://doi.org/10.23684/hhn5-rz52 (McConkey and Thiagarajan, 2018); and (2) digital elevation data at
https://doi.org/10.20383/101.0117 (Coles et al., 2018).
Complete climate data recorded at a Environment and Climate Change Canada
meteorological station located 390 m from the three hillslopes are
publicly available at http://climate.weather.gc.ca/ (last access: 30 August 2019).
Alfredo Adolfo Camús y el problema del pauperismo. De los antiguos esclavos a los modernos indigentes
Authors: Teodoro Peris Josep L.
Published: September 2019

Las opiniones sobre el pauperismo de Camús están influenciadas por su conocimiento de la antigüedad clásica, pero sus propuestas siguen la línea del pensamiento social católico que comienza a conformarse en Francia a partir de 1840. Camús es uno de los primeros en exponer en España las ideas de los principales ideólogos de esta corriente.
La cuestión política en el capitalismo neoliberal global
Authors: Martínez Matías Paloma
Published: September 2019

Ante la relevancia en el panorama político occidental de formaciones cuya pretensión de recuperar la soberanía nacional converge en ciertos aspectos con reivindicaciones de partidos calificados de populistas, este ensayo pretende evaluar la validez de estas propuestas políticas a la luz del examen de la configuración actual del capitalismo. Tomando como base los análisis de Marx sobre su funcionamiento, se estudian en un primer momento los rasgos específicos de este régimen productivo en la presente fase de su evolución, así como el papel que en ella juega el capital financiero. Partiendo de los resultados obtenidos, se aborda el problema del desequilibrio entre el alcance de la acción de la política nacional y el poder efectivo de una economía que opera al margen de todo control territorial. El objetivo último es incidir sobre la necesidad de acometer una redefinición de la política capaz de ajustarse al carácter globalizado del capitalismo actual.
El eslabón perdido: la gestión del suelo en las políticas de urbanización bajo los Planes Federales de vivienda en Avellaneda y Ciudad de Buenos Aires
Authors: Brikman Denise , Najman Mercedes , Aramburu Florencia , Di Virgilio María Mercedes
Published: September 2019

En el marco de la salida de la crisis social, económica y política del año 2001, se desarrollaron en Argentina un conjunto de programas habitacionales que habilitaron procesos de urbanización de asentamientos informales con implementaciones y resultados bien diversos. Las características del suelo y los mecanismos para su gestión no fueron incorporadas en los diseños, lo que habilitó estrategias diversas que facilitaron (o no) la implementación de las políticas. Este artículo propone caracterizar los distintos modelos de gestión del suelo desarrollados e identificar si condicionaron las posibilidades de su implementación. Se analizan, mediante un abordaje cualitativo, cuatro casos de intervención ubicados en zonas centrales del Área Metropolitana de Buenos Aires —Avellaneda y la Ciudad de Buenos Aires— que reflejan instrumentos de gestión y resultados diversos. El análisis demuestra que ciertas características intrínsecamente territoriales –como la localización, la propiedad del suelo, la escala de los barrios- en relación con los actores participantes y la definición de los destinatarios, condicionaron el desarrollo de los instrumentos de gestión del suelo y posibilitaron distintos resultados.