Spontaneous bilateral femoral neck facture in a renal disease patient is not common. We report a case of 47-year-old female patient with chronic renal failure and on regular hemodialysis for the past 5 years who sustained bilateral impacted femoral neck fracture without history of trauma and injury and refused any surgical intervention. The patient was mobilised on wheel chair one year after the fractures. The cause of the fracture and the literature review of the bilateral femoral neck fracture in renal disease are discussed.
Intertrochanteric fractures of the femur in ankylosed hips are extremely rare. The aims of the operative management for elderly patients with intertrochanteric fractures are to prevent general complications, to maintain mobility, and to relieve pain. The optimal management to achieve these goals is not clear. The authors present a case of a 74-year-old man with an intertrochanteric fracture of the femur in an ankylosed hip. The fracture was managed surgically with dynamic hip screws and cannulated screws. Two years after the surgery, good union was observed at the fracture, and the patient was ambulating independently.
Hands are essential organs and their agility and dexterity are vital to our daily lives. In the present study, we analysed 107 patients who presented at the local hospital with hand injuries sustained in the oil fields, oil industries and related employment sectors from the surrounding regions. All the patients were male and the mean age was 37.89 years (range, 21-61y). Forty-seven (43.93%) patients had simple cut injuries, 14 patients (13.08%) had tendon injuries, 13 patients (12.14%) had amputation of the digit (30.84%) had bone fractures (including 20 (66.66%) open fractures). Only 19 (17.75%) patients were admitted in hospital for further treatment. Ninety-one (85.04%) patients injured within one year of employment and 57(53.27%) patients were not satisfied with instructions and orientation before starting their job. Hand injury is one of the most common injuries in the oil industry and overtime work further increases incidence of this injury.Key WordsHand injury, trauma, oil field, digital fractures
Background: Lower limbs ulcers and wounds, Charcot foot with the presence of peripheral neuropathy or peripheral vascular disease are common complications of the diabetes mellitus (DM). Major extremity amputations (below and above knee) are one of the common surgical procedures performed due to DM complications. Objective: To review the amputations performed due to diabetes mellitus (DM) complications with other associated illness, commonly isolated bacteria, and the demography of the patients in a public general hospital. Materials and Methods: We retrospectively reviewed the cases of above and below the knee amputations due to DM complications from January 2012 to December 2016. The age, gender, duration of DM anyone having, bacteria isolated, vascular condition of the lower limbs, other diseases anyone having, post-surgery wound conditions and status of the ambulation after surgery were analyzed. Results: A total of 53 amputations of the limbs of 51 patients were performed. Below knee amputations were performed on 43 (81.83%) limbs and male gender were 35(68.62%). The mean age of the patient was 57.6±12.01 years (range 31-91 years). The three most common bacteria isolated were Klebsiella pneumoniae, Staphylococcus aureus, Enterobacter cloacae. About 85% of these bacteria were sensitive to commonly used first line of antibiotics like co-amoxiclav and ciprofloxacin. Fifty cases (98.03%) had diabetes for more than five years. End stage renal disease (ESRD) and ischaemic heart disease (IHD) were the other common co-morbidities observed. Conclusion: Major lower limb amputations (below and above the knee) due to uncontrolled blood sugar are common surgical procedures performed on DM. Majority of the bacteria were sensitive to commonly used first line of antibiotics but still 15% were not sensitive and bacteria isolation, sensitivity with the drugs were also important for the treatment of the infection.
Funding Acknowledgements Type of funding sources: None. Coronary CT is a first line investigation according to NICE guidelines, yet there are still uncertainties in its ability to decrease adverse event rates. The high sensitivity and high negative predictive value of coronary CT only validates low to moderate pre-test probability of attaining significant CAD due to its low positive predictive value. Improving outcomes in coronary CT could avoid events and limit the use of invasive modalities such as invasive coronary angiography. Increased probability of MACE with presence of risk factors could also raise the merit of risk stratification utilization for better classification. This study provides insight into the effectiveness of CT as a first-line investigation for new onset angina referred to RACPC regardless of CAD probability and any further testing. Data differences on outcome probabilities in risk stratification utilization and different CT modalities, both coronary calcium scoring and coronary angiography, raised notion that the incremental value of these tools should not be overlooked. End-outcomes would compromise of MACE composites after a 6-month follow-up. We hypothesize that patients investigated with coronary CT as opposed to without, with presence or absence of functional testing, would grant better clinical outcomes. Data on 155 patients who registered in RACPC were identified and collected from Brunei Health Information Management Systems for a one-year period (August 2018- August 2019). Information on sociodemographic, risk factors, further diagnostic testing, CT reports and event follow-up at 6 months were extracted, subject to availability. Probability of CAD in patients were classified according to CCS and CTCA results. CAD was detected in 62 (40.0%) patients with non-obstructive or obstructive CAD in addition to low to high calcium scores. Over the 6-month follow-up period, MACE occurred in 8 patients in the CT group (6.3%) and 4 (13.8%) without CT. 126 (81.3%) patients with CT did not attain MACE (p = 0.19) and chances of getting CABG after adjustments with co- founding factors were significantly lower than without CT [HR = 2.654e-06; 95% CI = 2.204e-07-3.195e-05; p= <0.001]. A higher event probability was associated with a high CCS (41.1%) (p= <0.001) than abnormal CTCA (11.4%) (p = 0.018). MACE was also associated with multiple risk factors such as age (p= <0.001), hypertension (p = 0.001), diabetes (p= <0.001), high cholesterol(p = 0.027), and abnormal total cholesterol (0.010) and creatinine levels [serum creatinine, p= 0.017; creatinine clearance, p = 0.006]. Outcomes measured were not significantly better in those with cardiac CT however risk of coronary artery bypass graft was significantly lower. CCS is better than CTCA in event prospects but both possess promising prognostic values in healthy arteries. Multiple CAD risk factors associated with MACE were likely as a result of intense atherosclerosis, marking appeal for risk stratifications and preventive measures. Abstract Figure. Kaplan-Meier curves for MACE Abstract Figure. Multiple cox regression models
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.