Vitamin D has been the focus of much scientific literature in recent years owing to various studies showing its association with a wide variety of pathological conditions 1,2 . Sun exposure, diet and fortified supplementation account for a bulk of Vitamin D intake in humans. Activation of vitamin D is sequential and requires sun exposure for conversion of 7- dehydrocholesterol to Vitamin D3. Further metabolism in the liver converts Vitamin D3 to 25 –hydroxyvitamin D3. Conversion to its active form 1,25 dihydroxyvitamin D3 (Calcitriol) occurs in the kidneys 2 . The importance of Vitamin D in calcium metabolism and bone health is well known and documented. Controversies exist regarding the true prevalence of hypovitaminosis, however in developing countries the prevalence of vitamin D deficiency in all age groups is probably higher 3 . Adding to this the burden and morbidity of skeletal trauma, persistent deficiency may have a deleterious effect in the injured 4, 5 . Vitamin D, with its positive effect on bone health does play a role in the biology of fracture repair and remodelling 6 . The role of Vitamin D replacement as sole biological effectors in fracture repair may be difficult to quantify and confounded by other variables at play in bone healing. Studies looking at vitamin D levels in orthopaedic patients have also shown significant levels of deficiency and have put forward recommendations for evaluation and supplementation
Vitamin D Deficiency

OBJECTIVES: To identify the factors that can potentially affect the ability of electrodiagnostic tests such as sural/radial amplitude ratio or SRAR and the presence of carpal tunnel syndrome or CTS to detect early subclinical neuropathy in diabetes mellitus (DM). Likewise, to investigate the likelihood of developing subclinical neuropathy that can be detected by a positive CTS or SRAR abnormalities, because of the presence of anthropometric factors and sugar levels, in addition to DM duration
METHODOLOGY: A retrospective cohort study was undertaken among 144 DM type 2 patients with confirmed subclinical neuropathy. Demographic data such as age, height and age, body mass index (BMI) and blood glucose profiles were obtained. Nerve conduction findings (SRAR and CTS protocols) were statistically analyzed using two sample t-test and multiple logistic regression ratios
RESULTS: Patients who were positive in the CTS protocols were taller and had lower BMI. They had shorter duration of DM but with extreme elevations in blood glucose. Variables that are independently associated with a (+) CTS are duration of DM, FBS, BMI, height and weight. Patients with SRAR abnormalities were older and obese, with longer duration of DM and less marked elevations in blood glucose. Variables that are independently associated with SRAR abnormalities are age, duration of DM, weight and BMI
CONCLUSION: Factors such as age, duration of DM, weight and height, BMI as well as glucose control can potentially affect the ability of various electrodiagnostic tests (SRAR and the presence of CTS) to detect early subclinical neuropathy. Since confounding factors was different between CTS and SRAR, the pathogenesis of these conditions may be different. The likelihood of developing subclinical neuropathy that can be detected by a (+) CTS or SRAR abnormalities because of the presence of certain factors, were documented.

Human ; Male ; Female ; Middle Aged ; Blood Glucose ; Carpal Tunnel Syndrome ; Body Mass Index ; Body Weight ; Obesity ; Anthropometry ; Diabetes Mellitus ; Demography ; Neural Conduction

BACKGROUND: The practice of Unang Yakap or Essential Intrapartum and Newborn Care (EINC) during the COVID-19 pandemic poses a safety concern with regards to a newborn’s exposure to their COVID-19 suspected mother. OBJECTIVES: This study aims to describe the experiences of COVID-19-suspected mothers and explore the factors influencing their decision to allow healthcare professionals to practice full EINC. Specifically, it aims to: 1) describe the experiences of mothers prior to, during, and immediately after delivery, and during postpartum care leading to their decision; and 2) explore the factors that influence the participant’s decision to practice EINC amidst the pandemic. METHODOLOGY: For this phenomenological case study, online interviews with nine (9) participants were conducted using a 13-item questionnaire describing their experience. Thematic analysis using the inductive and semantic approach was conducted to identify the common themes or factors. RESULTS: Of the nine (9) participants, five (5) experienced EINC, while four (4) did not. The COVID-19 status and the choice to undergo Unang Yakap were not a causal relationship. Two main influences, mother-related factors, and hospital-related factors, were identified and were found to have weight in decision-making. The mother-related factors include prior knowledge and perception towards EINC, COVID-19 status, personal beliefs, and information from social media; while the hospital-related factors are hospital facilities, hospital protocols, and HCW-patient relationship. CONCLUSION By delineating the different factors that influence mothers’ decisions, this study allows for the identification of possible bottlenecks in the practice of EINC, as well as effective and efficient means to encourage its practice.
COVID-19

Methods: Seven human lumbopelvic spines were used, each affixed to six-degrees-of-freedom testing apparatus; 8.5-Nm pure unconstrained bending moments applied in flexion-extension, lateral bending, and axial rotation. The ROM of left and right SIJ was measured using a motion analysis system. Each specimen tested as (1) intact, (2) injury (left), (3) L5–S1 fixation, (4) unilateral stabilization (left), (5) unilateral stabilization+L5–S1 fixation, (6) bilateral stabilization, and (7) bilateral stabilization+L5–S1 fixation. Both left-sided iliosacral and posterior ligaments were cut for injury condition to model SIJ instability before surgery. Results: There were no statistical differences between fixated and contralateral nonfixated SIJ ROM following unilateral stabilization with/without L5–S1 fixation for all loading directions (p>0.930). Injured condition and L5–S1 fixation provided the largest motion increases across both joints; no significant differences were recorded between SIJs in any loading direction (p>0.850). Unilateral and bilateral stabilization with/without L5–S1 fixation reduced ROM compared with the injured condition for both SIJs, with bilateral stabilization providing maximum stability. Conclusions In the cadaveric model, unilateral SIJ stabilization with/without lumbosacral fixation did not lead to significant contralateral SIJ hypermobility; long-term changes and in vivo response may differ.

PURPOSE: This study was performed to compare outcomes of the Trochanteric Fixation Nail (TFN®) with a helical blade versus TFN® with a femoral neck screw for the treatment of intertrochanteric femoral fractures. MATERIALS AND METHODS: A single center, retrospective cohort study. Patients (>18 years of age) with an intertrochanteric femoral fracture, who were operated on between January 1, 2012 and December 31, 2016 were included. Primary and secondary outcome measures were cut-out rate and intervention variables, respectively. Data from X-ray examinations and patient medical files were collected and analyzed. The chi-square test or Student's t-test were used for statistical analysis. RESULTS: A total of 631 patients were surgically treated for an intertrochanteric femoral fracture. Of this group, 239 patients (37.9%) were treated with a TFN® with helical blade and 392 patients (62.1%) with a TFN® with femoral neck screw. There were no statistically significant differences between the baseline characteristics of both groups. A total of 17 (2.7%) cut-outs were recorded, with no statistically significant difference between the two groups (P=0.19). Additionally, there were no statistically significant differences in the secondary outcome measures between the two groups. CONCLUSION: There are no statistically significant differences in primary and secondary outcomes following treatment of intertrochanteric femur fracture with the TFN® helical blade or TFN® femoral neck screw. These findings suggest that the choice of collum implant for the surgical treatment of intertrochanteric femur fractures cannot be made based on the surgical outcomes of the two implants evaluated here.
Cohort Studies ; Femoral Fractures ; Femur Neck ; Femur ; Hip Fractures ; Humans ; Outcome Assessment (Health Care) ; Retrospective Studies

INTRODUCTIONThe 2005 American Association for Study of Liver Diseases (AASLD) diagnostic criteria allow non-invasive diagnosis of hepatocellular carcinoma (HCC) based on their enhancement pattern but we have observed a high incidence of atypical enhancement characteristics in HCC associated with portal vein thrombosis. This study seeks to examine the radiological features of this particular subgroup.

MATERIALS AND METHODSPatients with HCC and portal vein thrombosis who underwent pre-treatment multiphasic CT imaging were drawn from a surgical database. The arterial, portal venous and delayed phase images were assessed qualitatively and quantitatively (with region of interest [ROI] analysis) for lesion hypervascularity and washout. The background enhancement of the left and right lobes of the liver was also quantifi ed by ROI analysis.

RESULTSTwenty-fi ve lesions in 25 patients were selected for analysis. Qualitative analysis showed that 10/25 (40%) lesions demonstrated arterial hypervascularity while 16/25 (64%) lesions showed washout. Ten out of 25 (40%) lesions demonstrated both arterial hypervascularity and washout. Quantitative analysis showed that the average absolute lesion enhancement from precontrast to arterial phases was 49.1 (± 17.1) HU for hypervascular lesions compared to 23.8 (± 16.6) HU for non-hypervascular lesions (P <0.01). The mean absolute enhancement of the background liver parenchyma in the arterial phase was 13.79 (± 7.9) HU for hypervascular lesions compared to 36.6 (± 30.6) HU for non-hypervascular lesions (P = 0.03).

CONCLUSIONA large proportion of HCC with portal vein thrombosis lack characteristic arterial hypervascularity, which may be secondary to compensatory increased arterial supply to the background liver. This is a potential pitfall when applying imaging criteria for diagnosis of HCC.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular ; complications ; diagnostic imaging ; Female ; Humans ; Liver Neoplasms ; complications ; diagnostic imaging ; Male ; Middle Aged ; Pattern Recognition, Automated ; Portal Vein ; diagnostic imaging ; physiopathology ; Retrospective Studies ; Tomography, X-Ray Computed ; methods ; Venous Thrombosis ; diagnostic imaging ; etiology

OBJECTIVETo evaluate serum cytokine concentrations in children with and without obstructive sleep apnoea (OSA) and to investigate the effects of OSA treatment on cytokines.

MATERIALS AND METHODSConsecutive children with habitual snoring and symptoms suggestive of OSA were recruited. They completed a sleep apnoea symptom questionnaire, underwent physical examination and overnight polysomnography (PSG). OSA was diagnosed if obstructive apnoea index (OAI) >1. A blood sample was collected for analysis of IL-6, IL-8, and TNF-alpha after PSG.

RESULTSOne hundred forty-two children (97 males) with a median (IQR) age of 11.1 years (9.0-12.8) were recruited. The commonest presenting symptoms were nocturnal mouth breathing, prone sleeping position and poor attention at school. Forty-seven children were found to have OSA and they had higher serum IL-6 [0.1 (0.1-0.4) vs 0.1 (0.1-0.1) pg/mL, P = 0.001] and IL-8 [1.7 (1.0-2.3) vs 1.3 (0.9-1.7) pg/mL, P = 0.029] concentrations compared to their non-OSA counterparts. Multiple regression analysis indicated that OAI was significantly associated with both IL-6 (r = 0.351, P <0.001) and IL-8 (r = 0.266, P = 0.002). Sixteen children underwent treatment and there was significant reduction in mean (SD) serum IL-8 after intervention [pre vs post levels of 1.9 (1.0) vs 1.1 (0.6) pg/mL, P = 0.001] independent of weight loss.

CONCLUSIONChildren with OSA had elevated levels of pro-inflammatory cytokines that normalised following treatment suggesting that the inflammatory response is potentially reversible. Early detection and intervention may be beneficial.

Child ; Cytokines ; blood ; Female ; Humans ; Interleukin-6 ; blood ; Interleukin-8 ; blood ; Male ; Polysomnography ; Sleep Apnea, Obstructive ; blood ; therapy ; Tumor Necrosis Factor-alpha ; blood

BACKGROUND/AIMS: Screening for hepatitis B virus (HBV) is recommended in populations with anticipated prevalence > or =2%. This study surveyed HBV screening and vaccination practices of Asian American primary care providers (PCPs). METHODS: Approximately 15,000 PCPs with Asian surnames in the New York, Los Angeles, San Francisco, Houston, and Chicago areas were invited to participate in a web-based survey. Asian American PCPs with > or =25% Asian patients in their practice were eligible. RESULTS: Of 430 (2.9%) survey respondents, 217 completed the survey. Greater than 50% followed > or =200 Asian patients. Although 95% of PCPs claimed to have screened patients for HBV, 41% estimated that < or =25% of their adult Asian patients had ever been screened, and 50% did not routinely screen all Asian patients. In a multivariable analysis, the proportion of Asian patients in the practice, provider geographic origin and the number of liver cancers diagnosed in the preceding 12 months were significantly associated with a higher likelihood of screening for HBV. Over 80% of respondents reported that < or =50% of their adult Asian patients had received the HBV vaccine. CONCLUSIONS: Screening and vaccination for HBV in Asian American patients is inadequate. Measures to improve HBV knowledge and care by primary-care physicians are critically needed.
Adult ; Asian Americans ; Asian Continental Ancestry Group ; Chicago ; Data Collection ; Hepatitis ; Hepatitis B ; Hepatitis B virus ; Hepatitis B, Chronic ; Humans ; Liver Neoplasms ; Los Angeles ; Mass Screening ; New York ; Prevalence ; Primary Health Care ; San Francisco ; Vaccination

A 63-year-old man presented with painless jaundice, loss of appetite and significant weight loss. Cross-sectional imaging showed a diffusely enlarged pancreas, with no significant fat stranding and a hypodense rim on computed tomography, which appeared hypointense on T2-weighted magnetic resonance imaging. There was a narrowed pancreatic duct and features of common bile duct narrowing in the region of the pancreatic head. However, there was no obvious mass seen in the pancreatic head region. These features were classical of autoimmune pancreatitis with diffuse involvement of the gland. Laboratory investigation showed abnormal liver function and the classical sign of raised immunoglobulin G class 4 antibodies. The patient showed dramatic response to high-dose steroids, with resolution of both the laboratory and imaging abnormalities within one month. We discuss the classical imaging features of Type 1 autoimmune pancreatitis, an uncommon condition that needs to be differentiated from pancreatic malignancy.
Autoimmune Diseases ; diagnostic imaging ; pathology ; Diagnostic Imaging ; Humans ; Jaundice ; complications ; diagnosis ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pancreas ; diagnostic imaging ; pathology ; Pancreatitis ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed

INTRODUCTIONAcute pancreatitis appears to be less prevalent in multi-ethnic Southeast Asia, where the aetiology also appears to be influenced by ethnicity. As with acute pancreatitis elsewhere, however, pancreatic necrosis is a cause of significant mortality and the aim of this study was to review our institutional experience with pancreatic necrosectomy.

MATERIALS AND METHODSThe records of all patients who underwent pancreatic necrosectomy from January 2000 to December 2004 were analysed. Indications for surgery were the presence of infected necrosis, unresolving sepsis attributable to ongoing pancreatitis or the presence of gas in the pancreatic bed on imaging. Surgical debridement was achieved by debridement with closure over drains or by debridement with open packing.

RESULTSThe cohort comprised 14 of 373 patients admitted for acute pancreatitis (3.8%), with an overall mortality rate of 29%. All patients had infected necrosis with positive bacteriological cultures. Eight patients (57%) underwent debridement with closure over drains and 6 patients (43%) underwent debridement with open packing. All mortalities occurred in patients who underwent open packing, who were also associated with a higher mean Acute Physiology and Chronic Health Evaluation (APACHE) II score. The mortality rate in patients who underwent debridement less than 4 weeks after admission was 33% (2 of 6), compared with 25% (2 of 8) in patients who underwent debridement after 4 weeks. There were no mortalities in patients operated on after 6 weeks.

CONCLUSIONSurgical debridement with closure of drains and a policy of performing delayed necrosectomy are viable in our population.

APACHE ; Adult ; Aged ; Asia, Southeastern ; epidemiology ; Cohort Studies ; Debridement ; methods ; Drainage ; Female ; Humans ; Male ; Middle Aged ; Pancreatectomy ; methods ; Pancreatitis, Acute Necrotizing ; diagnosis ; mortality ; surgery ; Time Factors ; Tomography, X-Ray Computed