Retrograde intramedullary nailing or locked plating for stabilisation of distal femoral fractures? A comparative study of 193 patients

PURPOSE

The aim of this study was to evaluate the results of distal femoral fracture fixation of two different methods, lateral locking plate (LP) or an Intra-medullary nail (IMN), in patients managed in our institution. More specifically, to assess: (a) if there was a difference in functional outcomes between the LP and IMN groups; (b) whether the rate of complications was different between the two groups.

METHODS

Between January 2009 and December 2018 adult patients with distal femoral fractures managed in our unit with either LP or IMN for extra and intra-articular fractures were eligible to participate. Demographic details, fracture type, procedures performed, time to union, complications and functional scores (Oxford Knee Score) were recorded and analysed. The mean follow up was 4 years (12-120 months).

RESULTS

Out of 193 patients who met the inclusion criteria, 93 received an IMN whereas 100 patients were treated with LP. Mean age was 64.2 (18-99) and 70.1 (18-100) for the IMN and LP groups respectively. Overall, the two groups had similar demographics and there was no significant difference in the type of fractures sustained (p > 0.05). The Oxford Knee Score was highest for patients fixed with LP, mean 37.3 (6-48, SD 7.3) versus 28.4 (3-48, SD 14.4), (p =  < 0.02) compared to the IMN group. In terms of complications, the rate of non-union was higher in the LP group 8.6% versus 4% in those patients treated with an IMN, p value < 0.01.

CONCLUSION

While the rate of non-union was higher in the LP group and the functional results were superior in the plating group.

Duty of candour: encouraging a culture of openness and honesty

In a climate where there is a fear of blame and litigation associated with medical practice, this editorial discusses the current guidance within the UK on the duty of candour, both professional and statutory, highlighting cases where action has been taken.

528 EVALUATING THE PRESCRIPTION OF OPIATES IN PATIENTS WITH NECK OF FEMUR FRACTURES IN OUT OF HOSPITAL AND EMERGENCY CARE SETTING

Introduction

Opiate based analgesia forms a key component of Hip Fracture management. If prescribed inappropriately, opiate based analgesia can lead to respiratory depression, nephrotoxicity, and delayed recovery. The aim of this project was to evaluate opiate prescription in NOF patients in both out of hospital (OOH) and Emergency Department (ED).

Methods

100 consecutive patients were identified from National Hip Fracture Database between January and August 2019. Medical records were reviewed in both care settings, reviewing dose of morphine in comparison to body weight and renal function. Outcomes measured include constipation, acute kidney injury, respiratory compromise, and mortality. Statistical tests (t-test and chi square) were used to discern significance. Following the first cycle of results, results were disseminated to paramedics and at local governance meetings. Teaching was undertaken to increase awareness of harms associated with inappropriate opiate prescribing. A second cycle evaluated 30 consecutive NOFs from July 2020.

Results

In our study population, 74% were female and the average age was 84. The range of morphine doses given OOH ranged from 2-40 mg, in comparison to 2.5-20 mg in ED. 18% of patient suffered from Respiratory depression with 48 hours of their admission with a further 7% suffering from an acute kidney injury. After intervention, OOH morphine doses ranged between 5-10 mg, a reduction of 75% on maximum dose, with increased use of adjuvants as guided by the WHO pain ladder. No adverse outcomes were noted within 48 hours of admission.

Conclusion

Patient safety should be high on the agenda whilst caring for frail patients with Hip Fractures and opiate prescription is one of the most critical in the patient’s journey. Reducing harm by prescribing the optimal opiates helps to reduce mortality, morbidity, improve rehabilitation and patient flow within the NHS pathways. A guideline has been published to aid opiate prescription in elderly patients.

Nanoscale Mapping Reveals Functional Differences in Ion Channels Populating the Membrane of Primary Cilia

BACKGROUND/AIMS

The primary cilium is a nanoscale membrane protrusion believed to act as a mechano-chemical sensor in a range of different cell types. Disruptions in its structure and signalling have been linked to a number of medical conditions, referred to as ciliopathies, but remain poorly understood due to lack of techniques capable of investigating signal transduction in cilia at nanoscale. Here we set out to use latest advances in nanopipette technology to address the question of ion channel distribution along the structure of primary cilium.

METHODS

We used glass nanopipettes and Scanning Ion Conductance Microscopy (SICM) to image 3D topography of intact primary cilia in inner medullary collecting duct (IMCD) cells with nanoscale resolution. The high-resolution topographical images were then used to navigate the nanopipette along the structure of each cilium and perform spatially resolved single-channel recordings under precisely controlled mechanical and chemical stimulation.

RESULTS

We have successfully obtained first single-channel recordings at specific locations of intact primary cilia. Our experiments revealed significant differences between the populations of channels present at the ciliary base, tip and within extra-ciliary regions in terms of mean conductance and sensitivity to membrane displacement as small as 100 nm. Ion channels at the base of cilium, where mechanical strain is expected to be the highest, appeared particularly sensitive to the mechanical displacement.

CONCLUSION

Our results suggest the distribution of ion channels in the membrane of primary cilia is non-homogeneous. The relationship between the location and function of ciliary ion channels could be key to understanding signal transduction in primary cilia.

Insecticide susceptibility status and major detoxifying enzymes activity in Anopheles subpictus from Kasur, Pakistan

Anopheles subpictus s.l. Grassi (Diptera: Culicidae) is a malaria vector in South Asia, where insecticides are the mainstay for vector control interventions. Information on any variation in metabolic enzyme levels in mosquitoes is helpful with respect to adapting alternative strategies for vector control. The scarce data on the biochemical basis of insecticide resistance in malaria vectors of Pakistan limit the available information for vector control interventions within the country. The insecticide susceptibility status and its biochemical basis against dichlorodiphenyltrichloroethane (DDT) (4%), deltamethrin (0.05%) and permethrin (0.75%) in An. subpictus s.l. collected from all Tehsils of district Kasur were evaluated. For this purpose, a World Health Organization susceptibility bioassay was performed followed by the detection of altered metabolic enzyme activity using biochemical assays. Similarly, a significant difference in knock-down effect was observed among field collected and susceptible strain against all insecticides 24 h post exposure. The overall mean mortality rates of DDT, deltamethrin and permethrin were 27.86% [95% confidence interval (CI) = 29.65-26.06], 44.89% (95% CI = 46.23-43.54) and 78.82% (95% CI = 80.16-77.47), respectively. The biochemical assays revealed an elevated level of metabolic enzymes in the field population. The results provide evidence of resistance against organochlorine and pyrethroid groups in a field population of An. subpictus s.l. from district Kasur mediated by multiple metabolic mechanisms, including acetylcholinesterases, esterases, cytochrome P450 and glutathione S-transferases.

Synthesis and characterization of graphene oxide sheets integrated with gold nanoparticles and their applications to adsorptive removal and catalytic reduction of water contaminants

Here, we report the facile synthesis of graphene oxide–gold (GO–Au) nanocomposites and their use as adsorbents for the removal of toxic industrial dyes from water and as catalysts for the individual and simultaneous reduction of a dye and a nitro compound in aqueous medium. GO sheets were prepared using a modified Hummers method while Au nanoparticles were integrated on GO sheets by reducing Au(iii) ions on the surfaces of GO sheets using sodium citrate as a reducing agent. The prepared composite was characterized with field emission scanning electron microscopy (FESEM), transmission electron microscopy (TEM), elemental dispersive X-ray analysis (EDX), X-ray diffraction (XRD), Fourier transform infra-red (FT-IR) spectroscopy and thermal gravimetric analysis (TGA). The GO–Au nanocomposite demonstrated efficient adsorption capacities and recyclability for malachite green (MG) and ethyl violet (EV) dyes. The effects of various experimental parameters including temperature, pH, contact time, and adsorbent dose were studied. From the simulation of experimental data with different adsorption isotherms and kinetic models it was found that the adsorption of both the dyes followed the Freundlich adsorption model and a pseudo-second order kinetic model, respectively. Moreover, the adsorbent showed better recyclability for both dyes without any compromise on the removal efficiency. Similarly, the catalytic performance for the reduction of 2-nitroaniline (2-NA) has been investigated in detail by using the prepared nanocomposite as a catalyst. Most importantly, we reported the simultaneous adsorption of cationic and anionic dyes from water using the prepared nanocomposite as well as the simultaneous catalytic reduction of a mixture of EV and 2-NA. So, considering the facile synthesis process and the efficient removal of a variety of dyes and the catalytic performance this work opens up a tremendous opportunity to bring GO based nanocomposites from experimental research to practically applied materials for wastewater treatment.

Preparation of graphene oxide–gold (GO–Au) nanocomposites as adsorbents and catalysts for decontamination of water.