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Acute pancreatitis is one of the most common conditions with high rates of morbidity and mortality. Different scoring systems are used to gauge the severity of this condition, which, in turn, estimates the complications and mortality rates. With the ever-evolving use of the acute-phase reactant protein, C-reactive protein (CRP), and an abundant circulating protein in plasma, albumin, in daily practice, this study aimed to assess the ratio of CRP and albumin for assessing the severity of acute pancreatitis. A systematic review of the literature was performed using the keywords CRP albumin ratio and acute pancreatitis in the PubMed and Cochrane databases. Studies reporting the use of the ratio of CRP and albumin in acute pancreatitis as well as the outcomes were included in this analysis. The quality of studies was assessed using the MINORS (methodological index for non-randomized studies) assessment tool. In our review, across these three studies, 956 patients with acute pancreatitis were identified and enrolled in studies that examined the relationship between the CRP/Albumin ratio and the severity of acute pancreatitis. Overall, a positive correlation was found between the CRP/albumin ratio at admission and the development of subsequent severe acute pancreatitis, increased hospital length of stay, and the higher rate of mortality in these studies.

Neurovascular problems are common in acute fracture. In the emergency room, a thorough clinical evaluation is required, when examined by an orthopedic specialist or emergency doctors.we registered our project with the audit department. In the first cycle, we looked at notes from 77 patients from November-December 2020, emphasis to neurovascular documentation from both ED and orthopedic Clerking notes. We submitted our findings at our audit meeting and implemented modifications. Two months later, we re-audited, this time with 82 patients as the sample size.77 patient notes were reviewed in the first cycle, 51% male and 49% female. In ED clerking notes, 22% patients had no neurovascular documentation, compared to 3.8% of patients in orthopedic clerking. 39% ED notes had acronyms written for the neurovascular status, such as NVI, to 20.7% of orthopedic notes. 82 notes were reviewed in the second cycle,44% male and 56% female.7% of ED clerking notes lacked any neurovascular comments, compared to 0% of orthopedic admission sheets. 10% of the ED sheets contained NVI abbreviation, while 4% of ortho notes had the same. There were specific notes on neurovascular state on 68 of the ED admission sheets evaluated, and 74 of the orthopedic notes did the same.In fracture patients, documentation of neurovascular condition was lacking. The documentation of the details of the neurovascular assessment was poor. Increased recording of neurovascular assessment and improved emergency department evaluation of patients presenting with upper and lower limb injuries were aided by the introduction of teachings.

Background Clavicle fractures are a common presentation to the Emergency Department following falls and sporting injuries. During 2020, the COVID-19 pandemic brought with it a long period of social isolation resulting in a change of behavior patterns and in return, the presentation of fractures to our local hospitals. The effects of this global pandemic on the presentation and management of clavicles were noted with particular interest to the change in mechanism and its future implications. Methods We performed a longitudinal observational study in 10 hospitals in the North West of England, reviewing all patients presenting with a clavicle fracture during six weeks in the first peak of COVID-19 pandemic and compared these with the same time period in 2019. Collection points included the patient demographics, fracture characteristics, mechanism of injury and management. Results A total of 427 clavicle fractures were assessed with lower numbers of patients presenting with a clavicle fracture during the COVID-2020 period (n=177) compared with 2019 (n=250). Cycling related clavicle fractures increased three fold during the pandemic compared to the 2019 control group. We also noted an overall increase in clavicle fractures resulting from higher energy trauma as opposed to low energy or fragility fracture. We also found a faster time to surgery in the COVID cohort by 2.7 days on average when compared to 2019. Conclusions Government restrictions and the encouragement of social distancing led to behavioral changes with a vast increase in cyclists on the road. This created a significant rise in clavicle fractures related to this activity. This is likely to be further driven by the Government pledge to double cyclists on the road by 2025 in the United Kingdom.5 We forecast that this increase in cyclists, a behavior change accelerated by the pandemic, is a reliable predictor for future trauma trends.

Since its first use as a bone void filler at the end of the 19th century, calcium sulphate products have been adapted in different ways to aid orthopaedic surgeons. Calcium sulphate local antibiotic delivery systems offer a promising solution in the delivery of high antibiotic concentrations locally for an extended period of time. Over the years, multiple centres have reported side effects such as wound drainage, heterotrophic ossification and hypercalcaemia. This study was carried out to assess the risk of wound drainage in prosthetic joints after implantation of antibiotic-impregnated calcium sulphate beads. Two reviewers searched the literature in three online databases using the Cochrane methodology for systematic reviews. The search of databases yielded 182 articles. The studies without reported post-operative complications, mainly drainage outcomes, were excluded. After screening, seven articles were deemed suitable and selected. Out of the 1,112 cases identified, 43 joints developed wound drainage after calcium sulphate bead placement. This complication was resolved in all these cases by either conservative or operative approaches. The factors implicated in the development of wound drainage include the volume of the product used, procedural placement and host factors. The result of this systematic review shows that calcium sulphate products can be used for treatment and prophylaxis in prosthetic joints with a risk of post-procedural wound drainage. This risk, however, is lesser with the use of synthetic calcium sulphate products as compared with conventional calcium sulphate products.

Novel oral anticoagulants (NOACs) are increasingly prescribed blood-thinning medication. Surpassing Warfarin, NOACs are more favored and extensively used in paroxysmal atrial fibrillation, acute coronary syndrome, and in elderly patients. Well-known benefits of novel oral anticoagulants include predictable pharmacokinetics, pharmacodynamics, and shorter half-life. However, as with any anticoagulant, there are bleeding risks with NOACs. There is a lack of evidence and consensus on the management of novel anticoagulants for intraarticular injections and arthrocentesis. This systematic review aims to analyze the risk of bleeding complications in patients on novel oral anticoagulants who underwent joint injections and arthrocentesis to help physicians in the decision-making and consenting process. A literature search of three online databases was completed using the Cochrane methodology for systematic reviews. Eligibility criteria included any study that reported bleeding complication rates in adult patients on novel oral anticoagulants that had a joint injection or aspiration whilst continuing their regular oral anticoagulation. All studies with any number of patients and published in any language were included. Review articles and systematic reviews were excluded. The search of databases resulted in a total of 310 articles. After screening, a total of four articles were deemed suitable to be included in the analysis. These described a total of 668 patients undergoing injections/aspiration procedures with patients on three different novel oral anticoagulants namely Rivaroxaban, Apixaban, and Dabigatran. Only one patient joint had a bleeding complication and the patient was on Dabigatran. The results of this systematic review show that it is relatively safe to perform joint injections and arthrocentesis whilst continuing on Novel oral anticoagulation.

Assessment of Diet and Physical Activity Correlation with BMI Objectives: • To evaluate the impact of long working hours on diet and physical activity • To find out the relationship between diets, physical activity and BMI of officials having long work hours. Methodology: It’s a Cross sectional study carried out over the period of 2 months in different private sector offices. The targeted population was officials of 20-45 years of age having more than 48 hr of work a week for last 5 year. Sample size of 100 officials was selected. Officials were selected through randomized sampling Officials more than 45 yrs of age with documented diagnosis of chronic diseases were excluded to avoid disparity in results. Data was collected from Allied Bank of Pakistan (Lahore), Faysal Bank Ltd. (Lahore), Nawa-i-Waqt Newspaper Office (Lahore) with the help of structured questionnaire and anthropometric indices were calculated using standard tools for measuring height, weight and body mass index. Informed consent was taken prior to asking questions from respondent. Anonymity of the respondents was also guaranteed. Data was analyzed by using SPSS version 17 and Microsoft Excel 2010. Result: Following results were obtained: Our sample comprises of 100 subjects 80 out of which are male and 20 females.80%of the population have a post-graduation degree, 15% are graduates and 5% are undergraduates.51%of the population has homemade meal for lunch while 49% eat bakery item and visit restaurants out of which 37% of the population go to restaurants more the twice a week.83% of the officials have no physical activity. While 9% have light physical activity. 32% of the population has a BMI greater than normal limits(18.50-24.99).60% of population who don’t have lunch has a BMI within normal limits(18.50-24.99).subject having homemade lunch 52% of them has BMI in normal limits (18.50- 24.99) while people having lunch at cafeteria and restaurants 41% of them has BMI above the normal limit. Population having junk food more than twice a week 32% of them has BMI above normal limits. Conclusion: Majority of the officials don’t indulged in any kind of physical activity and if done it is not up to the standard criteria leading to increased BMI. The BMI & dietary habits on other hand depict healthy life styles adopted by most of them.