Chambersaarup7318

Endoscopy has long been widely used to screen for esophageal varices (EV) in cirrhotic patients. Recurrent endoscopy is a significant burden for the healthcare system of the endoscopic unit as well as uncomfortable and high costs for patients. This study intended to prognosticate Right Liver Lobe Diameter/Serum Albumin Ratio (RLLD/Alb) as a non-invasive approach in the early diagnosis of EV among chronic liver disease (CLD) Bangladeshi patients enrolled in a specific hospital.

A total of 150 admitted patients with CLD were included in the study. Patients were subjected through a comprehensive biochemical checkup and upper digestive endoscopic or ultrasonographic inspection. The correlation was evaluated between the RLLD/Alb ratio and esophageal varices grades.

The upper digestive endoscopy demonstration among 150 patients resulted in no EV in 18%, while 24% of patients was identified as EV grade I, 20% as grade II, 20% as grade III, and 18% patients as grade IV. The mean value of the RLLD/Alb ratio was 4.89 ± 1.49 (range from 2.30 to 8.45). The RLLD/Alb ratio diagnosed the EV employing the cut-off value of 4.01 with 85.3% sensitivity and 68.8% specificity. Furthermore, it was positively correlated with the grading of EV, when this ratio increased the grading of EV increases and vice versa (r=0.630, p < 0.001).

The RLLD/Alb ratio is a non-invasive parameter giving exact guidance relevant to the ascertainment of the existence of EV and their grading in chronic liver disease patients.

The RLLD/Alb ratio is a non-invasive parameter giving exact guidance relevant to the ascertainment of the existence of EV and their grading in chronic liver disease patients.Nonselective beta-blockers are used as prophylaxis for variceal bleeding in patients with advanced chronic liver disease (ACLD). The acute hemodynamic response to intravenous propranolol (i.e., ≥10% reduction in hepatic venous pressure gradient [HVPG]) is linked to a decreased risk of variceal bleeding. In this study, we aimed to investigate the overall prognostic value of an acute response in compensated and decompensated ACLD. We analyzed the long-term outcome of prospectively recruited patients with ACLD following a baseline HVPG measurement with an intraprocedural assessment of the acute hemodynamic response to propranolol. Overall, we included 98 patients with ACLD (mean ± SD age, 56.4 ± 11.5 years; 72.4% decompensated; 88.8% varices; mean ± SD HVPG, 19.9 ± 4.4 mm Hg) who were followed for a median of 9.6 (interquartile range, 6.5-18.2) months. Fifty-seven patients (58.2%) demonstrated an acute hemodynamic response to propranolol that was associated with a decreased risk of variceal bleeding (at 12 months, 3.6% vs. 15% in nonresponder; log-rank, p = 0.038) and hepatic decompensation (at 12 months, 23% vs. 33% in nonresponder; log-rank, p = 0.096). On multivariate analysis, the acute response was an independent predictor of first/further hepatic decompensation (adjusted hazards ratio, 0.31; 95% confidence interval [CI], 0.13-0.70; p = 0.005). Importantly, there was a tendency toward a prolonged transplant-free survival in acute responders compared to nonresponders (34.2; 95% CI, 29.2-39.2 vs. 25.2; 95% CI, 19.8-30.6 months; log-rank, p = 0.191). Conclusions Patients with ACLD who achieve an acute hemodynamic response to intravenous propranolol experience a lower risk of variceal bleeding and nonbleeding hepatic decompensation events compared to nonresponders. An assessment of the acute hemodynamic response to intravenous propranolol provides important prognostic information in ACLD.Background There is recent renewed interest in the effect of hand dominance on distal radius fractures. Current studies focus on functional or patient-reported outcomes, with lack of studies pertaining to radiological outcomes. The primary aim of this study is to examine the effect of hand dominance on time to fracture healing following surgical fixation of distal radius fracture. We also looked at the effect of age, gender, fracture comminution and American Society of Anaesthesiologists (ASA) status on time to fracture healing. Methods Patients who underwent distal radius fracture fixation surgery in our department from 1 January 2015 to 31 December 2015 were included. Time to fracture healing was taken from the day of surgery to when radiographic union was present as evidence by bridging callus or osseous bone. We looked at the effect of hand dominance, age, gender, fracture comminution and ASA status on time to fracture healing. Results One hundred and forty-five consecutive patients (80 females and 65 males) had a mean period of 56.2 ± 41.8 days to fracture healing post-operatively. Patients with dominant hand injury had a shorter duration to fracture healing than patients with non-dominant hand injury (mean 47.3 ± 31.1 days versus 62.1 ± 46.8 days, p = 0.023). Patients ≥ 65 years and with pre-existing medical conditions (ASA Class II and above) had a longer duration to fracture healing (mean 63.7 ± 53.0 days versus 51.9 ± 33.4 days, p = 0.036 and mean 47.9 ± 30.0 days versus 62.0 ± 47.7 days, p = 0.016, respectively). In addition, patients with comminuted fractures took longer to heal than patients with non-comminuted fractures (mean 57.6 ± 33.4 days versus 48.3 ± 20.8 days, p = 0.038). Conclusion Time to fracture healing post distal radius fracture fixation surgery was significantly related to hand dominance, as well as age, ASA classification and fracture configuration. Dominant wrist injuries had shorter time to fracture healing. Level of Evidence Level IV (Therapeutic).Macrodactyly is a serious and rare disease and considered one of the most difficult pathologies to treat. There is no rule and the treatment for each patient must be tailor-made, depending on the location and degree of macrodactyly. Although amputation is a valid option for adult patients, nail preservation and reconstruction are important and has a direct impact on the treatment outcome, both aesthetically and on the patient's self-esteem. We have used a wide, z-shaped fingertip flap associated with the preservation of a nail quadrant, bone shortening and distal interphalangeal arthrodesis. We have obtained good functional and aesthetic outcomes with this 'quadrant flap' technique. The technique allows decreasing digit size and volume and reconstruction of the nail complex and finger pulp. Level of Evidence Level V (Therapeutic).Post-axial polydactyly (PAP) is almost always treated by ablation of the sixth ray since the ulnar duplicate is universally inadequate and the radial one is normal. We report a patient with bilateral PAP with skeletal abnormalities in both radial and ulnar duplicates. This unusual presentation cannot be classified according to previous classifications of PAP and precludes simple ablation as the treatment of choice. Both hands of this patient were treated by on-top plasty with excellent functional and cosmetic results. A modification of the previous classifications is recommended at the end of this article. Level of Evidence Level V (Therapeutic).The best treatment for mallet fingers is still a matter of debate. Numerous splints with different designs to keep the distal interphalangeal (DIP) joint in extension have been described in literature. The outcomes of splint treatment are generally good with occasional reports of minor skin complications. Percutaneous Kirschner-wire pinning of the DIP joint for closed tendinous mallet finger represents a alternative treatment modality that reliably immobilises the joint and does not need much patient compliance or use of an external splint. We report a rare but devastating complication of percutaneous pinning of the DIP joint for closed tendinous mallet finger. Level of Evidence Level V (Therapeutic).Locking of metacarpophalangeal (MCP) joints of the thumb may be a consequence of dorsal subluxation from hyperextension injury. The joint is locked in mild hyperextension and cannot flex actively or passively. We report four patients with locked MCP joint of the thumb due to radial sesamoid entrapment after hyperextension or forced flexion injury. All patients had a prominent radial condyle of the metacarpal bone. Three patients had a deformity of the longitudinal groove on which the sesamoid was overlaid. The radial sesamoid was entrapped proximal to the radial condyle which could result in limited extension and hinged flexion of the joint. Excision of the radial sesamoid could release the locked joint. The radial sesamoid should be assessed if the motion of the thumb MCP joint is limited after flexion or extension injury. Level of Evidence Level V (Therapeutic).Background Patients' individual interpretations of their own health outcomes are becoming increasingly important metrics in defining clinical success across all specialties, especially in hand surgery. However, there is a relative paucity of data using validated health-related quality of life (HR-QoL) assessments for carpal tunnel release (CTR). The purpose of this study was to review published outcomes on traditional open CTR to formally assess the current need for more accurate, validated assessment tools to evaluate CTR-specific HR-QoL. Methods PubMed, MEDLINE and Cochrane Library databases were queried according to PRISMA guidelines for all studies investigating patient-reported outcomes following traditional open CTR. Analysis focused on HR-QoL, symptomatic relief, functional status, overall satisfaction and return to work or activities of daily living (ADLs). Results In total, 588 unique articles were screened, and 30 studies met selection criteria. HR-QoL was formally assessed in only 3 studies using the validated 36-Item Short Form Survey. Symptomatic relief was measured in 29 (97%) studies, making it the most frequently reported item, whereas functional ability was reported by 19 (63%) studies. The Boston Carpal Tunnel Questionnaire was the most frequently utilised tool to assess symptomatic relief (13/30) and functional improvement (11/30). Using unvalidated custom surveys, 14 studies (47%) reported patient satisfaction and 12 studies (40%) documented time to return to work/ADLs. Conclusion There is a dearth of studies utilising HR-QoL assessment tools to evaluate outcomes following traditional open CTR. The creation and validation of new CTR-specific HR-QoL tools accounting for both physical and psychological health is warranted. Level of Evidence Level II (Therapeutic).Background Bony deformities and arthropathies have been noticed in thalassemia patients. The aim of this study is to compare the arc of motion and radiological parameters of the wrist and patient rated wrist evaluation (PRWE) between adult transfusion-dependent thalassemics and normal subjects. Methods An observational cross-sectional study was done in the department of orthopaedics over a period of 2 years where a total of 30 skeletally mature thalassemia major patients (group A) were assessed. selleck The data was then compared with the data of demographically matched 30 healthy adults (group B). Arc of motion of the dominant wrist that included flexion, extension, radial and ulnar deviation, pronation and supination was measured using a handheld goniometer for both groups. Radiographs of the dominant wrist were obtained in both groups and used to determine the radial height, radial articular angle and carpal slip. PRWE was used to assess the function of the wrist. A p-value of less then 0.05 was considered statistically significant.