Simultaneous bilateral fractures of the femoral necks are rare injuries, especially when there is no underlying pathological condition. We report a 20-year-old man who sustained bilateral femoral neck fractures resulting from an accidental electric shock with 440 V direct current. Simultaneous bilateral femoral neck fractures after electrical shock injury without falling from a height are rather uncommon in clinic. The main cause of the fracture may be muscle contraction. This case highlights that even in the absence of primary and secondary bone disease, bilateral fractures of the femoral necks can occur following electric shock injury. We successfully managed this case with bilateral cannulated screw fixation without bone grafting. Surgeons caring for patients with electrical injury should be aware of the possibility of skeletal injuries which can go unnoticed, leading to delay in diagnosis and increased risk of complications.
Adult ; Electric Injuries ; complications ; Femoral Neck Fractures ; etiology ; surgery ; Humans ; Male

Chemical industry is one of the important industries in the world. However, incidents happened due to the release of hazardous materials, toxic and poisonous chemicals in the chemical industries can cause fatal to human and destruction of the environment. Learning from the Bhopal disaster's experience, chemical industries have developed a program - Responsible Care, aiming to regain public trust through improving the environment, health and safety performances. Malaysia has adopted Responsible Care program since 1994 under the stewardship of the Chemical Industries Council of Malaysia (CICM). Six codes of management practices have been developed by the CICM, covering distribution, community awareness and emergency response, pollution prevention, process safety, employee health & safety and product stewardship. It has been more than 20 years since its inception. However, to date, there are only 125 companies have signed the pledge to adopt Responsible Care program. The CICM has also conducted several initiatives to encourage participation of chemical companies to adopt Responsible Care program in Malaysia. Therefore, it is the aim of this paper to review the current status of Responsible Care program in Malaysia and also deliberate the way forward of this program
Responsible Care ; chemical industries ; environment ; health ; safety

Chemical industry is one of the important industries in the world. However, incidents happened due to the release of hazardous materials, toxic and poisonous chemicals in the chemical industries can cause fatal to human and destruction of the environment. Learning from the Bhopal disaster's experience, chemical industries have developed a program - Responsible Care, aiming to regain public trust through improving the environment, health and safety performances. Malaysia has adopted Responsible Care program since 1994 under the stewardship of the Chemical Industries Council of Malaysia (CICM). Six codes of management practices have been developed by the CICM, covering distribution, community awareness and emergency response, pollution prevention, process safety, employee health & safety and product stewardship. It has been more than 20 years since its inception. However, to date, there are only 125 companies have signed the pledge to adopt Responsible Care program. The CICM has also conducted several initiatives to encourage participation of chemical companies to adopt Responsible Care program in Malaysia. Therefore, it is the aim of this paper to review the current status of Responsible Care program in Malaysia and also deliberate the way forward of this program.

Objectives: Type 2 Diabetics have elevated risk for acute coronary syndrome (ACS). The current management algorithm focuses on atherosclerotic cardiovascular (ASCVD) risk score to stratify this risk. However, in medically managed subjects, this algorithm may not be accurate. This study compares the ASCVD risk score in an Indian population with T2DM under medical supervision and the actual incidence of ACS. It also compared the ASCVD risk scores in cases with T2DM who developed ACS to controls and tried to estimate whether the ASCVD risk score is different in the two subsets, evaluating the utility of the ASCVD risk score in predicting ACS. Methodology: This is an electronic medical record (EMR) based case-control study. Only records of subjects with T2DM where details of age, sex, body mass index, blood pressure, duration of diabetes, family history of ACS, lipid profile, renal and liver function tests were included. The incidence of ACS was calculated in the selected records, and the records of subjects with ACS were compared with age and sex-matched subjects without ACS. Data are summarized as median and interquartile range (IQR). Wilcoxon rank-sum test was used for checking differences in continuous variables and Pearson’s Chi-squared test for categorical data. Univariate and multivariate logistic regression analyses were used to check the effect of ASCVD scores and other variables on the occurrence of ACS. Statistical data analyses were performed using JASP, version 0.16.4 (JASP Team [2022]) for MS Windows. Results: Of the 1226 EMRs included in the analysis, 207 had ACS. The actual incidence of ACS was 16.85% in 6 years, higher than the mean predicted 10-year incidence of 14.56 percent (p <0.05). The cases were age and sex-matched with controls and the ASCVD incidence was estimated in the two groups. The mean ASCVD score in the cases was 14.565 ± 8.709 (Min: 1.5, Max: 38.3) and controls 13.114 ± 8.247 (Min: 1.4, Max: 45). The chance of development of ACS increases with elevated systolic blood pressure (per mmHg rise OR: 1.04, 95% CI: 1.03, 1.06; p <0.001), positive family history (OR: 5.70, 95% CI: 3.41, 9.77; p <0.001), statin use (OR: 2.26, 95% CI: 1.46, 3.52; p <0.001), and longer duration of diabetes (for every year increase OR: 1.19, 95% CI: 1.13, 1.25; p <0.001) Conclusion The ASCVD risk score underestimates the ACS risk in subjects with T2DM under medical supervision and may not differ in those who developed and did not develop ACS. We also conclude that factors like a negative family history (30% less risk), longer duration of diabetes, and higher SBP are relevant in those who developed ACS.
Acute Coronary Syndrome