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Free metatarsophalangeal joint to metacarpophalangeal joint transfer - a unique surgical technique
No full textGiant cell tumors of metacarpal bones is a rare occurrence. The tumor particularly exhibits an aggressive behavior in small bones of the extremities. Different techniques such as curettage with or without bone grafting, en bloc resection (more commonly preferred) and reconstruction have been discussed but a unique way of reconstruction is using the metatarsal for substitution. Other options include the fibular graft or using a portion of the iliac crest. We report the case of a young female with a giant cell tumor of the fourth metacarpal bone where we reconstructed the diseased joint with the metatarsal bone while achieving good local control, preserving lower limb and hand function along with cosmesis. The transfer of osteoarticular ligamentous complexes of the metatarsal bone for reconstruction of metacarpal bone defects is a technique that provides good cosmetic outcomes, excellent function with minimum effects to the donor site function
Smokeless tobacco: knowledge, attitudes and usage in Pakistan
No full textBackground: Smokeless tobacco (SLT) encompasses products that are not burnt but instead consumed orally or nasally. One-third of tobacco is consumed in the smokeless form in South Asia. Despite its widespread usage, there has been limited empirical research on the prevalence and factors influencing SLT consumption in Pakistan. This study aimed to provide an assessment of SLT knowledge, attitudes, and usage in Pakistan.Methods: Using an online questionnaire, a cross-sectional survey was conducted across Pakistan. Convenience sampling was used to disseminate, and expert approval was sought followed by a pilot study to validate the questionnaire. A comprehensive questionnaire was developed using elements from the Global Adult Tobacco Survey and other tools which had previously been utilized within Pakistan. Participants\u27 responses were described using descriptive statistics, and SPSS version 26 was used to perform linear and logistic regression. A p-value of less than 0.05 was considered statistically significant.Results: Data was collected from 1,195 participants among which 85.86% of participants had heard of SLTs prior to the survey. Sex, province, household income and previous doctor visits were significant determinants to product knowledge through which 72.55% agreed that these products can lead to serious illnesses but 30% noted a lack of knowledge on legality. General attitudes agreed that it makes one feel unwell (44.1%), gives a sense of guilt (43.85%) and more research is needed on it (54.39%). Negative health effects were the biggest deterrent from pursuing these products for 60.33% of participants. Among significant factors influencing the use of SLTs, the greatest odds of use were found with use as an alternative to cigarettes (OR 4.45) and secondly, due to its availability in a liked flavor (OR 2.27). About 31% reported to have used the product once, with 69.82% of current users expressing a desire to quit.Conclusions: Although adequate knowledge and aligning attitudes exist for SLTs, light is shed in the face of a sustaining public health problem. We offer important insights that can guide the creation of focused interventions meant to lower SLT use, and the health hazards associated with it in the Pakistani community by highlighting important myths, incentives, and deterrents
Enhancing surgical curriculum: trainees\u27 perspectives on laparoscopic simulation and assessment
No full textIntroduction Laparoscopic simulation has been used in many curricula. The United Kingdom (UK) surgical curriculum lacks summative assessment for laparoscopic skills. This study explores surgical trainees\u27 perceptions of using simulated laparoscopic assessment as a summative tool in the UK. Methodology This was a semi-structured interview study conducted in person for 10 higher surgical trainees recruited voluntarily in the northern region of England. A thematic analysis was used to analyse the data. Results The findings generally showed positive perceptions among the trainees for simulated laparoscopic assessment. The trainees highlighted that the current assessments are formative and often subjective. Trainees suggested introducing summative assessment might fit with current changes in the national curriculum. The interviews also showed that simulated laparoscopic assessment would positively affect the trainees, curriculum, and patients. In addition, trainees expressed that the introduction of such a change should be staged and tailored to the training grade. However, the majority did not support making it part of CCT requirements. The trainees emphasised that implementing such a change can face challenges such as cost, tension between training and service provision, and culture change. The practicality of introducing simulated laparoscopic assessment was discussed in terms of skills to be assessed, fidelity, and progression signposting. Conclusion The study highlighted the trainees\u27 perceptions about simulated laparoscopic assessment, which was generally positive, and raised issues regarding challenges in its implementation. Further discussion in surgical societies is required and in-depth research is needed before implementating simulated laparoscopic assessment for trainee certification
Reducing extreme heat impacts on health in pregnant women and Infants: a community based intervention in Kilifi, Kenya
Full text linkHigh ambient temperatures affect maternal and newborn health outcomes and wellbeing. The Climate Heat and Maternal and Neonatal Health in Africa (CHAMNHA) consortium conducted formative qualitative research in rural Kilifi, Kenya, to examine perceptions of heat risks among women, household members and community stakeholders. An intervention was co-designed together with community members. This paper presents the development, implementation, and evaluation of a behavior-change intervention aimed at reducing the burden of heat on maternal and newborn health. The intervention used Digital Audio-Visual (DAV) storytelling (encompassing short videos and a set of photographs) and facilitated group discussions. Intervention groups included pregnant and postpartum women (n=10), mothers-in-law (n=10), male spouses (n=10), and community influencers (n=40). Researchers and local community health volunteers supported pregnant and postpartum women and their household networks weekly for four months. At month five, a structured interview, originally administered at baseline, was repeated to evaluate understandings of heat risks and changes in behaviour (reducing exposure to heat by changing daily schedules, reducing heavy workload, and increasing spousal support). Pregnant and postpartum women reported a better understanding of the effects of heat on their health and the newborn, including the importance of staying hydrated, breastfeeding frequently, and avoiding heavy clothing for newborns. They also reported an increase in mothers-in-law and male spouses assisting with household chores and disseminating heat-health messaging to families. However, women noted that male spouses who supported them with chores sometimes reported being stigmatized by their peers. Community approaches to support pregnant and postpartum women during heat periods are feasible and key community influencers can be trained to include heat-health messaging in their daily routines. Additional research is needed to examine whether repeated training is required to ensure sustainability. Future heat interventions focusing on maternal and neonatal health should consider factors such as employment, age, and depth of support networks
Treating juvenile dermatomyositis to target: paediatric rheumatology European society/childhood arthritis and rheumatology research alliance-endorsed recommendations from an international task force
No full textObjectives: Despite the recent prognostic improvement, a sizeable proportion of patients with juvenile dermatomyositis (JDM) respond suboptimally to contemporary therapies. This study aimed to develop recommendations for treating JDM to target.
Methods: A Steering Committee formulated a set of provisional recommendations based on evidence derived from a systematic literature review and a retrospective chart review of patients. These were discussed, amended, and voted on by an international Task Force, including 28 paediatric rheumatologists, 2 specialists in neuromuscular diseases, 1 dermatologist, 1 physical therapist, 1 research nurse, 2 patients with JDM, and 1 parent of a patient with JDM. Items that achieved at least an 80% majority vote were accepted as final recommendations.
Results: Although the literature review did not reveal trials that compared a treat-to-target strategy with a nonsteered approach, it provided indirect evidence about specific end points that could serve as targets that facilitated development of recommendations. The group reached consensus on 7 overarching principles and 12 recommendations. It was agreed that both patients/parents and treaters should share decisions in setting treatment targets and therapeutic strategies, with inactive disease as the preferred target and minimal disease activity an alternative one. Inactive disease is targeted to be achieved within 12 months after treatment start. Interim targets include minimal and moderate clinical improvement within 6 weeks and 3 months, respectively, and normalisation of muscle strength within 6 months. High-dose glucocorticoids remain fundamental in the initial management, but progressive tapering and discontinuation within 12 months through optimization of concomitant immunomodulatory therapy was advised. A research agenda was formulated.
Conclusions: The Task Force developed recommendations for treating JDM to target, being aware that the evidence is not strong and needs to be expanded by future research. Implementation of the recommendations in clinical practice will help to reach optimal outcomes for JDM
What did Jan Hjärpe choose from the Islamic basket? A study of the dominant voice on Islam in Sweden, 1980–2000
No full textThis chapter analyses the non-Muslim Islam of a Swedish academic, Professor Jan Hjärpe, who was the most prominent voice in the public sphere of Sweden from 1979 until the first years of the twenty-first century.While Hjärpe was always nuanced when writing about Islam, he produced – mainly as side-effect of choices – certain normalities and interpretations of Islam. I argue that these can be seen as expressions of non-Muslim Islam. This chapter is not a critique of Hjärpe’s writing, which has by and large stood the test of time, but a case-study aiming to discuss researchers’ awareness and control of the logical consequences of choices of words and topics. It addresses non-Muslim Islam as an often-unintended by-product of scholarly writing
Lamotrigine overdose: A case report
No full textMetoclopramide, a common antiemetic, is associated with extrapyramidal side effects. This case report describes a 19-year-old male with dengue fever who developed involuntary muscle contractions and respiratory distress two hours after receiving intravenous metoclopramide for nausea. Despite the rare incidence (0.2% of users), the patient exhibited severe extrapyramidal symptoms, which were managed with procyclidine. The case emphasizes the need for vigilance in monitoring patients receiving metoclopramide, as early recognition and treatment of such reactions are critical to prevent complications. Clinicians should be aware of these potential side effects when prescribing metoclopramide, especially in vulnerable population