bluuebunny/crossref_metadata_2025 huggingface dataset:
Sustainability and Competitiveness of Transforming Tourist Accommodation
Authors: Chandra Shweta , Ranjan Aditya
Published: June 2022

Accommodation is a base of the tourism industry, forming a vital and fundamental part of the tourism supply. As guest experience evolved, the accommodation industry needed to find new ways to differentiate itself. It led to the commercialization of the accommodation industry, impacting the competitiveness and sustainability of tourist accommodations. Moreover, accommodation has been identified as a resource‐intensive tourism subsector, contributing to local or global environmental problems. Hence, the chapter highlights the need for sustainability and how tourist accommodations could offer competitiveness in the current scenario and plan effectively for future endeavors. It further outlines how complying with the sustainable policies, the accommodation industry could co‐create tourism experiences to improve customer experience and lead to greater satisfaction. The chapter also highlights how accommodation managers can utilize precise and comprehensive visibility and awareness of tourist preferences to effectively confront the complexity of tourist experience management.
Editorial Note
Authors: Gnanapala Athula , Cooper Malcolm , Dewasiri N. J. , Arachchi R. S. S. W.
Published: June 2022

No abstract available
Countryside Capitalization and Community Empowerment through Tourism
Authors: Peiris T. U. I. , Sandaruwani J. A. R. C. , Aslam M. S. M. , Wijekoon W. M. S. S.
Published: June 2022

Even though, there were many programmes for poverty alleviation in Sri Lanka, rural areas are still undergoing various socio-economic and environmental challenges along with deprivation and marginalization in development process. However, most of these rural areas that suffers from poverty are abundant with natural and socio-cultural resources. Therefore, it is inevitable to investigate the role of prolonged poverty alleviation programmes and social welfare policies on countryside capitalization and community empowerment. Inductive empirical investigations through explorative research design of case studies of selected three villages; Ihalagalagama, Mudaliwatta, and Rideegama enables the study to unveil multiple truths from the socially constructed world. Focus group discussion, in-depth interview of key informants through snowball sampling, direct observations and artefacts in three villages were used in arriving at the conclusions. The findings of the study indicate that, these villages are full of priceless diverse socio-cultural and environmental capital, which were not at all taped by the poverty alleviation programmes. Sustainable capitalization of human and natural geographical resources through poverty alleviation will be inevitable for community empowerment, which is the primary intention of poverty alleviation programmes. This intensifies redefining and redesigning of poverty alleviation and socio-economic welfare policies to stimulate the countryside capitalization and community empowerment.
Bibliometric Analysis on Internet of Things (IoT) and Tourism Industry: A Study Based on Scopus Database
Authors: Kumar Suneel , Saini Aarti , Kumar Sanjeev , Kumar Varinder
Published: June 2022

The systematization of scientific expositions and methodology for exploring the Internet of Things (IoT) and tourism penetration every day reveals that researchers have made significant contributions to enhance this field of study. This article outlines the scholarly discussion on altering Tourism industry procedures in the face of the rapid rise of the Internet of Things. The primary goal of this research is to evaluate the structure and functions of scholarly papers related to the concerns of IoT development from the perspective of the tourism industry. The research idea is an analysis backdrop on exploring the trend in the interaction between the IoT and tourism business and published in the reputable database Scopus till 2021. The collection of scholarly papers indexed in the Scopus database by the keywords "Internet of Things" and "Tourism" serves as the research object. As of December 17, 2021, a total of 340 relevant publications surfaced in Scopus Database that matched the search criteria. Consequently, only 26 articles, review papers, conference papers, and book chapters were appropriate to be included in the next step. The article titles, abstracts, and keywords were used to do the publishing search. This analysis used data released in many topic areas from 2013 to 2021. VOSviewer and Scopus software were used to visualize the chosen papers. Thus, the bibliometric analysis enabled the illustration of the dynamic of publishing activity, highlighting the most impactful articles and credible journals, visualizing keyword co-occurrences in papers, co-authorship between nations, and the trend of the publication year by year.
Determinants of inbound travellers’ motivation to select Sri Lanka as a preferred holiday destination: Perspective of Russian travellers
Authors: Azhar A. , Udunuwara M.
Published: June 2022

This study explored the determinants of inbound traveller motivations to select Sri Lanka as a destination of choice for holidays. It specifically looked at the Russian travellers, since the influx of Russian travellers visiting Sri Lanka has significantly increased over the last six months, as per the arrival statistical reports published by Sri Lanka Tourism Development Authority (SLTDA). This study attempted to understand what motivates Russian travellers to choose a holiday destination in general and Sri Lanka in particular by using the push and pull factors in the theory of motivation, to explore what they think of Sri Lanka as a holiday destination and to identify the ideal product mix to promote a desirable product mix to target them. A qualitative study was conducted with 18 in-depth interviews with Russian nationals who had taken a foreign holiday within the last three years. The purposive sampling technique was used to choose the relevant participants for the study. The interviews were conducted between February 20, 2022, to March 3, 2022. All interviews were recorded and transcribed. The NVivo software was used for thematic analysis. This study identified numerous push and pull motivation factors affecting Russian travellers in general and Sri Lanka in particular.
Local Vibration Therapy, Oxygen Resaturation Rate, and Muscle Strength After Exercise-Induced Muscle Damage
Authors: Percival Stuart , Sims Dave T. , Stebbings Georgina K.
Published: June 2022

Context

Exercise-induced muscle damage (EIMD) is associated with transient reductions in strength and athletic performance. Muscle microvascular damage and disruption of blood flow are believed to be among the causes. Previous researchers reported modulations in muscle blood flow, oxygenation, and strength with vibration therapy (VT).

Objective

To observe whether local VT alleviated the impairments and hemodynamic changes associated with EIMD.

Design

Controlled laboratory study.

Setting

Laboratory and public gymnasium.

Patients or Other Participants

A total of 10 healthy participants (6 men and 4 women; age = 38 ± 15 years; height = 1.72 ± 0.48 m; mass = 72.0 ± 10.4 kg) were randomized into experimental (VT) and control groups.

Interventions

Both groups performed 10 sets of 10 eccentric wrist flexions at 70% of their 1-repetition maximum to induce muscle damage. Subsequent assessment of flexor carpus ulnaris muscle oxygen saturation and wrist-flexor strength occurred at 1, 24, and 48 hours postexercise. The experimental group underwent 10 minutes of local VT (45 Hz) starting 1 hour postexercise and applied twice daily (separated by 8 hours) for 48 hours during habitual waking hours. The control group received no local VT.

Main Outcome Measure(s)

Resting muscle oxygen saturation (SmO2), grip strength, and muscle oxygen desaturation and resaturation rates.

Results

No difference in SmO2 resaturation was evident over time (P > .05), but the VT group had a greater resaturation rate than the control group at 1 hour (P = .007, d = 2.6), 24 hours (P = .001, d = 3.1), and 48 hours (P = .035, d = 1.7) post-EIMD. No difference in grip strength was observed pre-EIMD, but the VT group demonstrated greater strength at 1 hour (P = .004), 24 hours (P = .031), and 48 hours (P = .021) post-EIMD than did the control group.

Conclusions

Local VT successfully attenuated the effects of EIMD and increased SmO2 resaturation in flexor carpus ulnaris muscles. Including local VT as part of a recovery protocol post-EIMD could be beneficial for rehabilitation and strength training purposes.
Indian venaseal™ Experience study – Outcomes of nonthermal and nontumescent endovenous glue ablation for treatment of truncal reflux in varicose vein disease
Authors: Shah Rutvij Asitkumar , Bedi Varinder S , Yadav Ajay R , Agarwal Sandeep , Satwik Ambarish , Srivastava Apurva , Chaudhari Nikhil Vilas
Published: June 2022

Background:

Varicose veins is a common disease in nearly 37.25% of the Indian population significantly affecting the quality of life. Endovenous thermal ablation has been the first-line treatment for superficial venous reflux. A new technique, available now, is nonthermal nontumescent vein sealing system (VenaSeal™), which comprises endovenous delivery of cyanoacrylate tissue adhesive into the vein causing obliteration of lumen and has shown better results in terms of safety and efficacy. Being a new modality, only handful of institutes across India perform this procedure and there is a scarcity of Indian data on its outcomes.

Aims and Objectives:

To evaluate the outcomes of VenaSeal™ glue ablation in terms of vein occlusion rates and improvement in Venous Clinical Severity Score (VCSS). Materials and Methods: Single-centre prospective study of fifty patients over 1 year and 4 months with 3- and 6-month follow-up.

Results:

The study showed the mean age of the study group to be 43.8 years and the majority (90%) had an early varicose vein (C2/C3) disease. The average length of vein treated per limb was 89.1 cm, and the average glue used per limb was 2.95 ml. All patients showed improvement in VCSS score from preoperative average of 2.6 ± 1.4 to 0.32 ± 0.19 (P < 0.0001, n = 89) with target vein occlusion rate of 100% at 3 months and 97.75% at 6 months.

Conclusion:

Thus, VenaSeal™ glue ablation procedure is a promising and effective modality for the treatment of varicose veins with excellent treatment success rates, minimal complications, and maximum patient acceptability. It is a feasible Out patient department (OPD) based procedure.
Lower Extremity Vascular Trauma Assiut University Hospital Experience
Authors: Shahat Mohammed , Abdelmonem Mostafa
Published: June 2022

Background:

There is globally increase incidence in vascular trauma as a result of increase rate of civilian violence and increase rate of road traffic accident. Vascular injury affects young males and associated with high mortality and long-term morbidity. Here, we present our experience as tertiary health centers in the management of this type of injury, also we present our result as regards to primary and secondary amputation rates. The most important factors affecting these rates were ischemia time and condition of surrounding soft tissue.

Aims and Objectives:

Detect rate of limb salvage after trauma injury in assuit university hospital, and risk factors for limb loss.

Materials and Methods:

Our study is prospective study of all patients who vascular lower extremity trauma from January 2014 to January 2015 during the period of the study(from January 2014 to January 2015), 135 cases of vascular injury presented to Assiut University Hospital, 87 of them had lower limb vascular injury representing 64.4%.

Results:

Surgical intervention was done in 82 patients representing 94.3%, endovascular intervention was done in 2 patients representing 2.3, 1 patient had endovascular balloon control then surgical intervention representing 1.15%, and two patients had conservative management representing 2.3%.

Conclusion:

vascular trauma is prevalent health problem in our locality, which have huge socioeconomic impact in our community as it affects mainly young men. The main controlling factor in secondary amputation rate is ischemia time, infection which accompanies severe soft tissue damage. At the end trauma with vascular injury is considered, a complex process needs urgent intervention with multidisciplinary team in well-equipped facility.
Acute Forearm Compartment Syndrome Postdialysis
Authors: Aggarwal Ankur , Bharat N R Manju , Narasimhan Sunder
Published: June 2022

Postdialysis compartment syndrome is a rare but very devastating condition which needs emergent diagnosis and treatment. This can happen due to bleeding from puncture site due to inadequately applied pressure/coagulopathy. This case report illustrates a case of postdialysis pseudoaneurysm formation followed by forearm compartment syndrome. The patient was managed by emergency forearm fasciotomy and skin grafting along with rotation flap. This diagnosis should always be kept in mind when evaluating a patient with sudden onset of pain and swelling postdialysis. This will help in salvage of the patient's upper limb as well as of the precious arteriovenous fistula.
Spectrum of Vertebral Artery Pathologies on Imaging
Authors: Onkar Prashant Madhukarrao , Dhok Avinash Parshuram , Nimje Varun Vasant , Mane Priyanka Jayant
Published: June 2022

Background:

Vertebral artery pathologies are not as common on ultrasound examination. Careful ultrasound examination of the vertebral artery can provide useful information about the proximal brachiocephalic vessels as well as the intracranial portion of the vertebral artery.

Objectives:

To illustrate a variety of vertebral artery pathologies on ultrasound and their abnormal color Doppler findings with confirmation of some cases on magnetic resonance imaging.

Materials and Methods:

A 3-12 MHz linear ultrasound probe was used to examine the vertebral artery segments. The examination began with a B-mode examination of the first and second portions of the vertebral arteries, followed by color Doppler examination to determine the direction of blood flow. Spectral Doppler is used to identify flow anomalies.

Conclusion:

Evaluation of proximal great vessels by ultrasound can sometimes be difficult, so careful examination of vertebral artery by ultrasound can be an important tool to detect occlusions or stenosis of proximal great vessels. In addition, vertebral artery waveforms in the cervical segment provide useful information regarding the intracranial portion of the vertebral artery.
Role of Ankle Brachial Pressure Index (ABI) in Screening Patients with Risk Factors For Developing Peripheral Vascular Disease
Authors: Yadav Mithilesh , Haseen Mohd Azam , Rizvi Syed Amzad Ali , Yadav Mayank
Published: June 2022

Background:

Peripheral vascular diseases (PVDs) are trigged by various risk factors. The presence of PVD is associated with higher cardiovascular morbidity and mortality. Ankle brachial index (ABI) is the sensitive and also cost-effective diagnosing tool for peripheral artery disease. ABI is important for screening of peripheral arterial disease in patients at risk and for diagnosing the disease in patients having lower-extremity symptoms.

Materials and Methods:

This prospective observational study was performed at J. N. Medical College, A. M. U., Aligarh, UP on 135 adult patients who are asymptomatic for PVD but have one or more risk factors. Demographic and clinical data were recorded. Systolic Blood pressure of both arms and lower limb were measured using sphygmomanometer and hand held Doppler. Ankle brachial pressure index (ABPI) is detected by dividing higher of the two ankle pressures by the higher of the two brachial artery pressure.

Results:

Majority of the patients were aged between 46 and 65 years, males more than females. It was observed that diabetes, hypertension, smoking, and dyslipidemia patients have significantly lower ABPI score (<0.9) compared to other patients. USG Doppler has showed 10.4% were having abnormal findings and the ABI (0.68 ± 0.17) was significantly lower than the normal ones (0.89 ± 0.09). Receiver operating curve shows that ABPI below 0.77 can be used as cut-off to predict the occurrence and risk of developing PVD for screening asymptomatic with sensitivity 88.4 and specificity 85.7 and accuracy 90.1%.

Conclusion:

Comorbid conditions such as smoking, diabetes, hypertension, and dyslipidemia increase the risk of PVD. ABPI is a valid method to screen PVD with high levels of sensitivity and specificity.
Total Hip Arthroplasty for Failed Osteosynthesis of Proximal Femoral Fractures: Clinical Outcomes from a Low- and Middle-Income Country
Authors: Rastogi Devarshi , Singh Shailendra , Ozair Ahmad , Waliullah Shah , Singh Shitanshu Kumar , Srivastava Rajeshwar Nath
Published: June 2022

Introduction

Total hip arthroplasty (THA) has a demonstrated utility in the surgical management of patients with proximal femoral fractures that fail internal fixation, with good outcomes reported from high-income countries. Given the lack of data from resource-limited settings, this work sought to report the clinical outcomes of THA for failed proximal femoral osteosynthesis from a low- and middle-income country (LMIC).

Methods

The work was conducted and reported in accordance with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. A retrospective cohort study was carried out on all patients who underwent rescue THA for failed osteosynthesis of proximal femoral fractures, from January 2016 to June 2020, at a tertiary care center in Northern India. Primary study outcomes were functional outcomes as assessed by Harris Hip Score (HHS) at 1-year postoperatively and the frequency of perioperative complication as assessed by Clavien-Dindo-Sink Grading System.

Results

Twenty-eight patients with mean age of 43.25 ± 10.5 years were included, with 18 males and 10 females. For their femur fracture stabilization, the most common method used had been dynamic hip screw (n = 16, 57.1%), followed by cannulated cancellous screw (n = 6, 21.5%), proximal femoral nail (n = 3, 10.7%), dynamic condylar screw (n = 2, 7.1%), and Schanz Screw (n = 1, 3.6%). Causes of failure had included cut-out of screw (n = 14, 50.0%), avascular necrosis (n = 8, 28.6%), back-out of screw (n = 3, 10.7%), non-union (n = 2, 7.1%), and secondary osteoarthritis (n = 1, 3.6%). THA was carried out after mean 26.64 ± 9.01 months after index procedure. HHS improved significantly from 39.71 ± 10.89 preoperatively to 79.54 ± 4.22 at 1-year follow-up (mean difference 39.82, 95% confidence interval 43.66–35.98, P < 0.001). Perioperative complications occurred in two patients of Clavien-Dindo-Sink Grade III and another of Grade II, with no mortality occurring by 1 year.

Conclusions

In resource-limited settings like LMICs, THA may be a safe and efficacious surgical modality for failed osteosynthesis of proximal femoral fractures.
Functional Outcomes in Quadruple Arthroplasty of the Hips and Knees: A Literature Review of 306 Cases with a Minimum Follow-Up of 2 Years
Authors: Vaishya Raju , Yadav Chandra Bhusan , Vaish Abhishek
Published: June 2022

Quadrupled arthroplasties of the lower limb are required mostly in cases with chronic and severe inflammatory arthritis. There may be a requirement of additional surgery for the foot and ankle or joints of an upper limb, especially in inflammatory arthritis, to improve the functional outcomes. The patient’s self-motivation and patient selection for four joint arthroplasties are necessary for favorable outcomes. Surgical technique, prosthetic design, and postoperative rehabilitation play a vital role in functional outcomes. More multicenter, large series and registries are required with long-term follow-up in the future to frame the clinical practice guidelines.
Ultrastructural Characteristics of Chronically Failed Reconstructed Anterior Cruciate Ligament
Authors: Jain Gunjar , Datt Rameshwar , Nag Hira Lal , Mahmood Asjad , Shekhar Shubhankar , Nag Tapas Chandra
Published: June 2022

Background

In the present study, we have examined the ultrastructure of chronically failed reconstructed anterior cruciate ligament (ACL). We aimed to investigate a faulty ligamentization process of a failed reconstructed anterior cruciate ligament. In other words, we want to study ultrastructural alterations a failed ACL graft undergoes.

Methods

Two patients who underwent revision ACL reconstruction for nontraumatic failure without discontinuity of the graft were included in the study. The first patient was a 40-year-old male who had undergone ACL reconstruction of his right knee 21 years back using the bone-patellar tendon-bone autograft. The second patient was a 23-year-old male who had sustained an ACL tear with a medial collateral ligament injury treated by isolated ACL reconstruction 3 years back using hamstring tendon autograft. We collected punch biopsy specimens from the failed ligaments of both the patients during revision ACL reconstruction. These specimens were examined for the density of collagen fibrils within a fascicle (per 1.5 mm2), cellular metabolism, and fibril diameter (nm) by transmission electron microscopy.

Results

Fibroblasts of both the ligaments showed features of increased metabolism, more so in the first patient. Compared to the second patient, the fascicles of the first specimen were more loosely arranged. Both ligaments had a unimodal distribution of collagen fibrils. The first patient had a mean fibril diameter of 45.2 (+/−8.5) nm and an average fibril density of 376.8 fibrils per 1.5 mm2. The second patient had an average fibril diameter of 64.1 nm (+/−7) and a mean fibril density of 152.9 fibrils/1.5 mm2. The difference in these parameters of the two patients was statistically significant (P < 0.001).

Conclusion

Our study suggests that the absence of thicker collagen fibrils with unimodal distribution, the altered density of the collagen fibrils within a fascicle, and ovoid fibroblasts with increased metabolism may symbolize bad ligamentization changes.
The Effects of Intra-Articular Hyaluronate Injections in Young (<55 years) Patients with Glenohumeral Joint Osteoarthritis
Authors: Oduoza Uche , Stoddart Michael , Majed Addie , Butt David , Falworth Mark , Rudge William
Published: June 2022

Purpose

Glenohumeral joint (GHJ) osteoarthritis (OA) in younger patients represents a challenging problem. This study assessed the efficacy of intra-articular hyaluronate injection in patients below the age of 55 years.

Methods

We reviewed our patient database from August 2013 to December 2016 for patients who received a fluoroscopic-guided intra-articular injection of hyaluronate. Those who had received interventional procedures within the preceding 12 months were excluded. We evaluated the response to the injection using the Oxford Shoulder Score (OSS). These scores were recorded before injection and at 6 weeks, 12 weeks, and 26 weeks postinjection. Radiographs were reviewed independently by two evaluators, and the severity of GHJ OA was categorized (mild, moderate, or severe) using the Samilson–Prieto classification.

Results

Fifty-five patients were identified, with a mean age of 43 years (18.6–54.6 years). These cases were classified as being mild in 11 (20%), moderate in 21 (38%), and severe in 23 (42%) using Samilson-Prieto classification. In the severe group, there was a statistically significant improvement in the OSS at all time points. In the moderate group, there were statistically significant improvements at 6 weeks and 12 weeks but not at 6 months. In the mild group, there were no statistically significant changes.

Conclusion

In patients under the age of 55 years with moderate-to-severe GHJ OA, there is a significant improvement in the OSS up to 12 weeks after intra-articular injection of hyaluronate, with improvements lasting up to 26 weeks in more severe cases. Hyaluronate is, therefore, a useful treatment option in younger patients and may potentially delay the need for arthroplasty.
Endoscopic Marginal Excision of Extraarticular Osteochondroma around the Knee
Authors: Wiratnaya I Gede Eka , Nugraha Hans Kristian , Kawiyana I Ketut Siki , Astawa Putu
Published: June 2022

We present three patients with pedunculated and sessile osteochondromas of distal femur and proximal tibia, ranging from a 15-year-old to a 30-year-old patient. All were removed due to esthetic concerns; therefore, we utilized a novel marginal excision using minimally invasive endoscopic tools. All patients had excellent functional and esthetic outcomes up until 1-year postoperative evaluation. Although technically challenging, endoscopic marginal excision is a viable alternative for the surgical management of osteochondroma of the knee and should be considered when esthetic is the primary concern of the patients.
Spinal cervical extradural hemangioblastoma
Authors: Mariniello Giuseppe , Corvino Sergio , Corazzelli Giuseppe , Franca Raduan Ahmed , Caro Marialaura Del Basso De , Maiuri Francesco
Published: June 2022

Spinal cervical extradural and intra-extradural hemangioblastomas are exceptional, with only nine reported cases. This study reviews the diagnostic and surgical problems of this rare entity. Two female patients, aged 80 years and 25 years, respectively, one with Von Hippel–Lindau disease (VHLD), experienced brachial pain and weakness. On magnetic resonance imaging, a dumbbell intra-extraspinal hemangioblastoma was evidenced. The surgical resection through posterior laminectomy resulted in clinical remission of brachial pain and weakness. The magnetic resonance aspect of a dumbbell lesion suggests a neurogenic tumor; the correct preoperative diagnosis is possible in individuals with VHLD. The surgical problems include high tumor vascularity, vertebral artery control, and nerve root preservation. However, the surgical excision results in clinical remission.
Case report
Authors: Gelinne Aaron , Abumoussa Andrew L. , Bhowmick Deb A.
Published: June 2022

Treatment of atlantoaxial pathology is often associated with significant morbidity and mortality. While surgical techniques for fixation are well established, approaches that minimize blood loss and muscle dissection are advantageous for expediting recovering and minimizing surgical risk. We present a 34-year-old female who presented with a Type III odontoid fracture requiring surgical fixation. She underwent a C1-2 fusion employing a novel minimally invasive modification of the Goel-Harms atlantoaxial fusion using percutaneous screws and intra-articular cage.
Cigarette smoking and complications in elective thoracolumbar fusions surgery
Authors: Sharfman Zachary T. , Gelfand Yaroslav , Hoang Henry , Ramos Rafael De La Garza , Gomez Jaime A. , Krystal Jonathan , Kramer David , Yassari Reza
Published: June 2022

Study Design:

This was retrospective cohort study.

Purpose:

The current investigation uses a large, multi-institutional dataset to compare short-term morbidity and mortality rates between current smokers and nonsmokers undergoing thoracolumbar fusion surgery.

Overview of Literature:

The few studies that have addressed perioperative complications following thoracolumbar fusion surgeries are each derived from small cohorts from single institutions.

Materials and Methods:

A retrospective study was conducted on thoracolumbar fusion patients in the American College of Surgeons National Surgical Quality Improvement Program database (2006–2016). The primary outcome compared the rates of overall morbidity, severe postoperative morbidity, infections, pneumonia, deep venous thrombosis (DVT), pulmonary embolism (PE), transfusions, and mortality in smokers and nonsmokers.

Results:

A total of 57,677 patients were identified. 45,952 (78.8%) were nonsmokers and 12,352 (21.2%) smoked within 1 year of surgery. Smokers had fewer severe complications (1.6% vs. 2.0%, P = 0.014) and decreased discharge to skilled nursing facilities (6.3% vs. 11.5%, P < 0.001) compared to nonsmokers. They had lower incidences of transfusions (odds ratio [OR] = 0.9, confidence interval [CI] = 0.8–1.0, P = 0.009) and DVT (OR = 0.7, CI = 0.5–0.9, P = 0.039) as well as shorter length of stay (LOS) (OR = 0.9, CI = 0.9–0.99, P < 0.001). They had a higher incidence of postoperative pneumonia (OR = 1.4, CI = 1.1–1.8, P = 0.002). There was no difference in the remaining primary outcomes between smoking and nonsmoking cohorts.

Conclusions:

There is a positive correlation between smoking and postoperative pneumonia after thoracolumbar fusion. The incidence of blood transfusions, DVT, and LOS was decreased in smokers. Early postoperative mortality, severe complications, discharge to subacute rehabilitation facilities, extubation failure, PE, SSI, and return to OR were not associated with smoking.
C1-C2 arthroplasty for craniovertebral junction instability
Authors: Salunke Pravin , Karthigeyan Madhivanan , Kodigudla Manoj Kumar , Kelkar Amey V. , Goel Vijay K.
Published: June 2022

Background:

The atlantoaxial complex contributes to significant neck movements, especially the axial rotation. Its instability is currently treated with various C1-C2 fusion techniques. This however, considerably hampers the neck movements and affects the quality of life; a C1-C2 motion preserving arthroplasty could potentially overcome this drawback.

Objectives:

We evaluate the range of motion (ROM) of lateral C1-C2 artificial joints in cadaveric models.

Materials and Methods:

This is an in vitro cadaveric biomechanical study. After C1-C2 arthroplasty through a posterior approach, the C1-C2 ROM was tested in 4 fresh-frozen human cadaveric specimens, before and after destabilization.

Results:

The mean axial rotation demonstrated after the placement of C1-C2 joint implants was 15.46 degrees on the right and 16.03 degrees on the left side; the prosthesis provided stability, with 46% of the baseline C1-C2 axial rotation on either side. The ROM achieved in the other axes was less compared with that of intact specimens. To initiate rotation, a higher moment of 1.5 Nm was required in the presence of joint implants compared to 0.5 NM in unimplanted specimens.

Conclusions:

In our preliminary ROM evaluation, the C1-C2 arthroplasty appears to be stable and provides about half of the range of atlantoaxial rotation. It has the potential for joint motion preservation in the treatment of atlantoaxial instability resulting from lateral C1-C2 joint pathologies.
Adjunct pelvic fixation in short-to-medium segment degenerative fusion constructs independently predicts readmission and morbidity
Authors: Katz Austen D. , Song Junho , Virk Sohrab , Silber Jeff Scott , Essig David
Published: June 2022

Context:

Despite increasing utilization of fusion to treat degenerative pathology, few studies have evaluated outcomes with pelvic fixation (PF). This is the first large-scale database study to compare multilevel fusion with and without PF for degenerative lumbar disease.

Aim:

The aim of this study was to compare the 30-day outcomes of multilevel lumbar fusion with and without PF.

Settings and Design:

This was a retrospective cohort study.

Subjects and Methods:

Lumbar fusion patients were identified using the National Surgical Quality Improvement Program database. Regression was utilized to analyze readmission, reoperation, morbidity, and specific complications and to evaluate for predictors thereof.

Statistical Analysis Used:

Student's t-test was used for continuous variables and Chi-squared or Fisher's exact test was used for categorical variables. Variables significant in the univariate analyses (P < 0.05) and PF were then evaluated for significance as independent predictors and control variables in a series of multivariate logistic regression analyses of primary outcomes.

Results:

We identified 38,413 patients. PF predicted 30-day readmission and morbidity. PF was associated with greater reoperation in univariate analysis, but not in multivariate analyses. PF predicted deep wound infections, organ-space infections, pulmonary complications, urinary tract infection, transfusion, deep venous thrombosis, and sepsis. PF was also associated with a longer hospital stay. Age, obesity, steroids, and American Society of Anesthesiologists (ASA) class ≥ 3 predicted readmission. Obesity, steroids, bleeding disorder, preoperative transfusion, ASA class ≥3, and levels fused predicted reoperation. Age, African American race, decreased hematocrit, obesity, hypertension, dyspnea, steroids, bleeding disorder, ASA class ≥3, levels fused, and interbody levels fused predicted morbidity. Male gender and inclusion of anterior lumbar interbody fusion (ALIF) were protective of reoperation. Hispanic ethnicity, ALIF, and computer-assisted surgery (CAS) were protective of morbidity.

Conclusions:

Adjunctive PF was associated with a 1.5-times and 2.7-times increased odds of readmission and morbidity, respectively. ASA class and specific comorbidities predicted poorer outcomes, while ALIF and CAS were protective. These findings can guide surgical solutions given specific patient factors.
Surgical management of os odontoideum
Authors: Berchiche Lakhdar , Khelifa Adel , Asfirane Nadjib , Yakoubi Becherki , Morsli Abdelhalim
Published: June 2022

Background:

Os odontoideum (OO) is a craniovertebral junction malformation of unknown origin. In most times, this lesion is highly unstable demanding surgical management. We present our series of OO surgical management and we discuss clinical, radiological, and management aspects of this pathology via our experience and literature opinions.

Methods:

This is a retrospective study of patients operated on at our department between May 2014 and May 2021 for OO. All patients were explored with plane X-rays and computed tomography (CT). In some cases, magnetic resonance imaging (MRI) was necessary. Posterior C1–C2 or C1-C3 fixation with polyaxial screws and rod fixation was used. In postoperative, the patient is asked to put Philadelphia collar for 3 months. Hospitalization periods vary between 3 and 7 days. After discharge, all our patients are followed up regularly in consultation. Control radiographs of the occipito cervical region were performed. After 3 months postoperatively, the CT scan is performed on all our patients to assess the quality of fusion. Patient's follow-up ranges from 4 months to 6 years.

Results:

Fifteen patients were included in this study; nine males (60%) and six females (40%); with mean age of 32.5 years old. Ten patients (67%) presented motor weakness, three patients (20%) with neck pain, one patient (6.5%) with torticollis, and one patient (6.5%) presented vertigo. No notable cervical trauma was present in six patients (40%) and in nine patients (60%), a remote history of traumatism was noted. All cases of our series presented mobile OO. Normal thickness of the C2 pedicle was noted in nine patients (60%). In two patients (13%), there was hypoplasia of one pedicle and in four patients (27%) both pedicles. MRI showed direct signs of spinal cord aggression: simple compression, myelomalacia, strangulation, or hypotrophy. C1 lateral mass screw fixation was performed in all patients; and according to C2 morphology: nine patients underwent C1-C2 pedicular fixation, in one patient, bilateral crossing C2 laminar screws technique, in three patients, we skipped C2 to perform a C1-C3 articular fixation, and in two patients, C1-C2-C3 fixations were performed. All patients improved clinically. In one patient, we noted an infection resulting in bad wound healing this infection was successfully treated with no complications. In the patient with bilateral crossing C2 laminar screws technique, CT control objectified 4 mm exceeding of one screw; the patient was reoperated and the screw was slightly pulled back. No other complications were noted.

Conclusion:

Congenital origin of OO is always evoked. C1-C2 fixation according to Goel and Harms technique with grafting proved its safety, providing high fixation quality with the acceptable biodynamic outcome. Once treated, the prognostic of OO is in general good, and improvement is observed in most patients with few complications.
C1 lateral mass reduction screws for treating atlantoaxial dislocations
Authors: Singh Deepak Kumar , Pathak Vipul , Singh Neha , Singh Rakesh Kumar , Kaif Mohammad , Yadav Kuldeep
Published: June 2022

Objective:

The C1-C2 fixation technique revolutionized the management of complex craniovertebral junction (CVJ) anomalies. Presently used polyaxial screw and rod systems have inadvertent technical difficulties in rod fitting and reduction of atlantoaxial dislocations (AAD) requiring forceful joint handling. The purpose of this study is to analyze the use of a specially designed “reduction screw” in C1 lateral mass in C1-C2 fixation for treating AAD with or without basilar invagination (BI).

Study Design:

This is a retrospective cohort study in which long lateral mass reduction screws were used for C1-C2 fixation.

Materials and Methods:

Eighteen patients diagnosed with congenital AAD with or without BI treated with C1-C2 fixations using C1 reduction lateral mass were included in the study. The outcome was measured clinically by the modified Japanese Orthopedic Association score and radiologically by conventional craniometric indices.

Results:

Among all cases included in the study, 72% (13/18) are males and 18% (5/18) are females with average age at presentation of 33.5 years. Among 18 cases of AAD, 84% (15/18) of patients have BI, 22% (4/18) have Chiari Type 1 malformation, and one patient has Klipple–Feil syndrome. Symptomatic improvement is noted in all patients following surgery. Adequate reduction of AAD with normalization of radiological indices was also achieved in all 18 (100%) patients.

Conclusion:

C1 lateral mass reduction screw in C1-C2 fixation helps in reduction of AAD and BI (Type A) even in difficult cases of CVJ anomalies with intraoperative technical ease, reduced operative time, no need for special instruments or complex maneuvers, and avoiding potential neurological injury.
A Scoping Review of Community-Based Geriatric Assessment and Screening Tools Used in South Asia
Authors: Panigraghi Sucharita , Bhoi Trilochan , Pati Sanghamitra , Kshatri Jaya Singh
Published: June 2022

Background:

Home-based comprehensive assessment and integrated care of the older people could be a key to relieve the pressure on the already overburdened health system. This review summarizes evidence on validated community-based geriatric assessment tools in South Asia.

Methods:

Guided by Arksey and O'Malley's five-stage scoping review framework, a total of 46 studies were included in the scoping review after searching from electronic databases and reference lists using the predefined eligibility criteria. Data were extracted on the main characteristics of included studies, identified instruments, and their psychometric properties of the tools. This review was reported in accordance with preferred reporting items for systematic reviews and meta-analyses-ScR guidelines.

Results:

Among the 46 included studies, 10 reported on instruments for medical assessment, 12 on tools for psychological conditions, 13 on tools for functional issues, 2 on social well-being, and 9 on tools with multiple domains of health. Most studies included participants from both gender and different social classes. Majority used measurements that were both self-reported or measured by the investigator, whereas only two instruments were designed to be used by clinicians. In the existing geriatric health assessment tools, environmental domain was neglected completely, and not a single tool considered in this review covered all 5 domains which influence regular life of the elderly.

Conclusion:

There are no validated tools available that can be used for comprehensive geriatric assessment in South Asia. There is a need to develop and validate culturally sensitive tools that can be used for assessing all the geriatric health domains.
Study the Co-relation between SpO2 and Radiological and Biochemical Markers with the Severity and Outcome in Geriatric COVID-19 Patients
Authors: Sumathi Selvanathan , Ramalingam Shanthimalar , Ramasamy Jayalakshmi , Banumathy Getrude , Solomon Sony , Veer Praveena
Published: June 2022

Background:

Pandemics are natural calamities, which humans have been encountering since time im-memorial. The world has witnessed and endured several pandemics like from Justinian Plague to Spanish Flu. The 21st century has already witnessed three major pandemics like Severe Acute Respiratory Syndrome in 2002, Middle East Respiratory syndrome in 2012 and at present COVID-19. The first case of COVID-19 was reported in Wuhan, Hubein Province in Dec 2019. The first case of COVID-19 was reported in Kerala on 30th January 2020. COVID-19 virus is a single stranded RNA Virus and resembles SARS -2 virus and hence the name SARS -COV 2. There has been a report of around 34 million cases with 1 million deaths. Majority of the deaths occur in the elderly population as they have immunosenescence and multiple comorbidities. Hence a study aiming at analysis of correlation between SpO2, radiological and biochemical markers is essential in management of COVID 19 in elderly.

Aims & Objectives:

To study the correlation between SpO2 and radiological features in X ray and CT Chest and biochemical markers with the severity and outcome in geriatric patients.

Study Period:

April 2020 to September 2020, Duration: 6 months. Study Centre: Chengalpattu Medical College, Tamilnadu. Inclusion Criteria: RT PCR positive Covid 19 patients more than 60 years of age. Exclusion Criteria: Covid 19 patients less than 60 years, RT PCR Negative patients.

Materials and Methods:

Retrospective analysis of records of 300 Covid 19 patients, aged more than 60 years hospitalized in Chengalpattu Medical College during April to September 2020 was done and biochemical parameters mentioned below were corelated with features in CXR and CT Chest RTPCR positive spo2 and analysis with severity of disease and outcome was done.

Results and Discussion:

On retrospective analysis of records of elderly Covid 19 patients, it was observed that the elderly could be graded as mild, moderate and severe based on clinical criteria. Radiological parameters co-relating in the same group classified as mild, moderate and severe could be derived and could be used for assessment of patients. Similarly, it was observed that the biochemical parameters of D- Dimer, C reactive protein, Neutrophil Lymphocyte Ratio correlated most significantly in that order with the clinical severity of disease and hence could be used as useful tools for assessment of severity of patients and the ranges corelating with severity could be derived.

Conclusion:

Analyzing SpO2, radiological features, biochemical parameters individually and in combination with clinical severity and outcome in elderly patients helps in deriving biochemical and radiological parameters to predict severity which in turn helps in a holistic approach and right management at the right time preventing or reducing mortality due to Covid 19 in the elderly.
Isolated Systolic Hypertension in Very Elderly
Authors: Sharda Meenaxi
Published: June 2022

Globally, hypertension is a common problem in the elderly, and its prevalence increases with increasing age. Isolated systolic hypertension (ISH) subset is more common in the very elderly population, and as the population ages, its prevalence will rise more and more. In the past, treatment of hypertension (HT) in the very elderly was controversial and either no treatment or complications of treatment risk overweigh the benefits observed. The inclusion of elders in various clinical trials has demonstrated a better understanding and rational approach toward optimal management of HT. Systolic blood pressure (BP) is more important in predicting adverse cerebrovascular outcomes and decline in renal function in elderly patients with ISH. Early detection, protection of target organs, correction of high BP will develop, promote, and corroborate healthy aging.
Management of Unstable Fractures of the Distal End Radius Using Bicolumnar Radius Plating
Authors: Sharma Ashok , Ali Nayyar , Vyas Umesh , Bohra Arvind Kumar , Sharma Shiv Bhagwan
Published: June 2022

Background:

Controversy still exists regarding the current treatment modalities for unstable distal radius fractures. A prospective study was performed to evaluate efficacy of bicolumnar plating (radial buttress and volar plating) technique, which is designed to providing sufficiently secure fixation treatment of distal radius fractures.

Materials and Methods:

The prospective randomized study was done under the department of orthopedics at SRG hospital Jhalawar. We operated 20 patients, with distal end radius fracture of type 23C2 and 23C3 with radial column fracture using bicolumnar plating between May 2019 to MAY 2021. All patients presented for follow-up till union. Patients belonged to age group 20-75 years with the mean age of 45 years. Twelve patients were male and eight were female. The duration of follow-up was 12-18 months.

Results:

Bicolumnar plating led to complete union of unstable distal radius fractures without additional procedures. The assessment of post-operative functional outcome was done using the MODIFIED MAYO WRIST SCORE. At the final follow-up, 15 patients had excellent score, 3 had good score and 2 had fair score.

Conclusions:

Bicolumnar plating is feasible option for the management of displaced distal radius fractures and can result in favorable surgical outcomes.
Evaluation of Functional and Radiological Outcome of Five-Pin Technique in Management of Distal End Radius Fractures
Authors: Solanki Mahendra , Sharma Dev Krishan , Prasad Rakesh , Jain Mitul
Published: June 2022

Introduction:

Distal end radius fractures are the most common fractures of the upper extremity. The most common mode of injury is a fall on outstretched hand. Closed reduction and percutaneous pinning with “the five-pin technique” improve the reliability of fixation. The current study aimed to assess the clinical and functional outcome of fixation of distal radius fractures using the five-pin technique.

Materials and Methods:

Thirty patients with fracture of distal end radius Frykman type 1 and 2 were subjected to close reduction and K-wire fixation by five-pin technique.

Results:

Functional outcome-using Obrien scoring system for functional outcome, there was 90%–100% score in 11 patients, 80%–89% in 18 patients, and <80 in one patient. Radiological outcome-using Sarmiento modification Lindstrom criteria for radiological outcome, 11 patients had excellent results, and 18 had good results, and one had fair results.

Conclusion:

“The five-pin technique” is a versatile tool which provides optimum functional and radiological outcomes.