Sixteen patients underwent tendon repair or reconstruction of the hand using barbed sutures. Fifteen patients were followed up for 3 to 8 months, with no reported complications of adhesions or ruptures. Barbed sutures provide advantages over traditional sutures as they are knotless and distribute tension uniformly. While early outcomes are favorable, further long-term studies are still needed to evaluate barbed sutures compared to traditional sutures for tendon repair.
The cpr process and role of medical expert evidence in court v2Vaikunthan Rajaratnam
Understand the accepted definition, role and responsibility of the experts within the legal framework
Understand the current changes and development of the Civil Procedure Processes globally
To describe and determine the reliability, validity and credibility of an expert opinion
Comparison of Modified Kessler Technique versus Four Strand Cruciate Techniqu...Crimsonpublisherssmoaj
Introduction: Hand Tendon injuries are not uncommon. Achieving a satisfactory range of motion and preventing tendon rupture after repair of flexor tendon injuries remains a challenge to hand surgeons.
Objectives: To compare functional outcome of tendon repair with Modified Kessler and four strand cruciate techniques.
Material and Methods: Randomized control trial was conducted from July 2013 to June 2015. Both male and female patients of age 18 to 60 years who had clean lacerated injury proximal to wrist crease (Zone V) were eligible for inclusion in the study. Patients with dirty or infected wounds, or those having multiple injuries other than tendons, having injury to extensor tendons were excluded from the study. Arm A comprised of patients who underwent modified Kessler repair and Arm B included patients whose repair was done via four strand cruciate repair technique. The final outcome at 8 weeks was compared by using Strickland’s evaluation system.
Results: A total of 140 fingers of 44 patients with sharp wrist laceration injury of long flexor tendons of fingers were included in this study. The average age of patients was 28.05 ± 10.42 years. Out of 44 patients, 28 (63.64%) were males and 16 (36.36%) females. At 8th week, satisfactory functional outcome (excellent group according to Strickland evaluation) was observed in 65.7% (46/70) fingers in four strand cruciate repair technique and in 28.6% (20/70) fingers in standard modified Kessler repair technique and the difference was statistically significant (P< 0.001).
Conclusion: Four strand cruciate repair technique is better than standard modified Kessler method for repair of long flexor tendons of fingers.
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Comparison of Modified Kessler Technique versus Four Strand Cruciate Techniqu...Crimsonpublisherssmoaj
Introduction: : Hand Tendon injuries are not uncommon. Achieving a satisfactory range of motion and preventing tendon rupture after repair of flexor tendon injuries remains a challenge to hand surgeons..Objectives: To compare functional outcome of tendon repair with Modified Kessler and four strand cruciate techniques.Material and Methods: Randomized control trial was conducted from July 2013 to June 2015. Both male and female patients of age 18 to 60 years who had clean lacerated injury proximal to wrist crease (Zone V) were eligible for inclusion in the study. Patients with dirty or infected wounds, or those having multiple injuries other than tendons, having injury to extensor tendons were excluded from the study. Arm A comprised of patients who underwent modified Kessler repair and Arm B included patients whose repair was done via four strand cruciate repair technique. The final outcome at 8 weeks was compared by using Strickland’s evaluation system. Results: A total of 140 fingers of 44 patients with sharp wrist laceration injury of long flexor tendons of fingers were included in this study. The average age of patients was 28.05 ± 10.42 years. Out of 44 patients, 28 (63.64%) were males and 16 (36.36%) females. At 8th week, satisfactory functional outcome (excellent group according to Strickland evaluation) was observed in 65.7% (46/70) fingers in four strand cruciate repair technique and in 28.6% (20/70) fingers in standard modified Kessler repair technique and the difference was statistically significant (P<0.001). Conclusion: Four strand cruciate repair technique is better than standard modified Kessler method for repair of long flexor tendons of fingers.
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
Tunnel Enlargement in Single Bundle ACL Reconstruction Using Bio-Interference...TheRightDoctors
Tunnel Enlargement in Single Bundle ACL Reconstruction Using Bio-Interference Screw, Transfix and Tight Rope RT: A Comparitive Study Using Computed Tomography-Dr. Ankit Goyal
Arthroscopic Anterior Cruciate Ligament Reconstruction Using Four-Strand Hams...Apollo Hospitals
In this study, we analyzed the clinical outcomes at two years following reconstruction of the anterior cruciate ligament with use of a four-strand hamstring tendon autograft in patients who had presented with a symptomatic torn anterior cruciate ligament.
Functional outcome of Arthroscopic reconstruction of single bundle anterior c...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Fixation of the mesh in laparoscopic hernia is an important step .I presented about different meshes used in hernia surgery along with the fixation devices.
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
AI in Healthcare APU Using AI in Healthcare for clinical Application research...Vaikunthan Rajaratnam
Discover how generative AI is transforming the face of healthcare. From accelerating drug discovery to empowering personalized treatment, this technology is reshaping the way we deliver and experience care."
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
A scoping review of the literature, its impact and challenges in healthcare, and a personal experience of its application in practice, teaching, and research.
COMPARATIVE ANALYSIS OF CHATGPT-4 AND CO-PILOT IN CLINICAL EDUCATION: INSIGHT...Vaikunthan Rajaratnam
This research investigates the potential of two advanced AI language models, ChatGPT-4 and Co-Pilot, to transform medical education through clinical scenario generation. Focusing on scenarios for Diabetic Neuropathy, Acute Myocardial Infarction, and Pediatric Asthma, the study compares the accuracy, depth, and practical teaching utility of content generated by each platform. A panel of medical experts assessed the AI-generated scenarios, and healthcare professionals provided feedback on their perceived usefulness in educational settings. Results suggest that ChatGPT-4 excels in providing structured foundational knowledge, while Co-Pilot offers greater depth through realistic patient narratives and a focus on holistic care. This indicates that both platforms have value, with their suitability depending on specific educational objectives – ChatGPT-4 aligns better with introductory learning, and Co-Pilot better serves advanced applications emphasizing practical clinical reasoning.
This workshop is a comprehensive introduction to the application of Generative AI in healthcare. It provides healthcare professionals, educators, and researchers with practical experience in using Generative AI for data analysis, predictive modeling, and personalized treatment planning. The workshop also explores the use of Generative AI in medical education and research. No prior AI experience is required, making this a unique opportunity to learn about the latest advancements in Generative AI and its healthcare applications.
This workshop will empower healthcare professionals with the knowledge and skills to leverage artificial intelligence (AI) in their practice. It aims to bridge the gap between cutting-edge technology and everyday clinical, research, and educational practice. The platforms covered in the workshop include Elicit.org, Scholarcy.com, Typeset.io, ChatGPT, Botpress.com, InVideo.io, and Genie.io.
The objectives of this specialised workshop are to:
• Explore the core principles of AI, emphasising its applications and significance in modern healthcare.
• Examine the role of AI in enhancing clinical judgment and patient management, with live demonstrations of relevant tools.
• Uncover the potential of AI in revolutionising teaching and learning experiences for healthcare professionals and students.
• Illustrate the integration of AI in healthcare research, focusing on tasks such as literature review, data analytics, and manuscript development.
• Provide a hands-on experience with various AI platforms tailored to healthcare professionals' unique needs and demands
A one day workshop on the use of AI in Healthcare for practice, teaching and research.
The Resource Material for the "AI in Healthcare" workshop serves as an essential guide for healthcare professionals who aim to harness the transformative power of Artificial Intelligence (AI) in clinical practice, medical education, and research. Developed under the expertise of Dr Vaikunthan Rajaratnam, this comprehensive package is designed to complement the workshop, providing both foundational knowledge and practical tools for immediate application.
The slide deck for the "AI for Learning Design" workshop, hosted at Asia Pacific University, serves as a comprehensive guide to integrating Artificial Intelligence into educational settings. Designed to empower educators and instructional designers, the presentation offers actionable strategies for curriculum integration, insights into personalized learning through AI, and a deep dive into the ethical considerations that accompany AI adoption in education. The deck is structured to facilitate an interactive and engaging workshop experience, featuring real-world examples, hands-on activities, and spaces for thought-provoking discussions. Don't miss this invaluable resource for transforming your teaching practices and enhancing educational impact through AI.
empowereing practice in healthcare with generative AI. How to use vairous AI tools to enhance and empowere healthc are practice inlcuidng teaching and research
Academic writing is the backbone of scholarly communication and is vital in knowledge dissemination. However, it can often be challenging and time-consuming, requiring meticulous attention to detail and adherence to established conventions. This is where AI comes into play, offering innovative solutions to streamline and enhance the writing process.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Barbed sutures
1. Early Outcomes of Tendon Repair and
Reconstruction in the Hand using Barbed
Sutures
Daniel Hap, R Vaikunthan
Department of Orthopaedic Surgery
Khoo Teck Puat Hospital
2. Introduction
Tendon repair and reconstruction an integral part of Hand
Surgery
Advancements in suture material, suture techniques1
Conventional sutures pose problems of 2
Knot rupture, unravelling
Bulky knot material inhibit tendon gliding
Barbed sutures may be the solution
Knotless
1Thurman RT, Trumble TE, Hanel DP, Tencer AF, Kiser PK. Two-,four-, and six-strand zone II flexor tendon repairs:
an in situ biomechanical comparison using a cadaver model. J Hand Surg. 1998;23: 261–5.
2 A Shah, M Rowlands. Barbed Sutures and Tendon Repair—a Review; HAND (2015) 10:6–15
3. Objectives
To examine the early outcomes of tendon repair and
reconstruction in the hand using barbed sutures
Identify potential complications
4. Methods
Retrospective study
Conducted in KTPH from August 2015 to July 2016
‘OT Sys’ used as search tool
All patients who underwent tendon repair and reconstruction
of the hand using barbed sutures included
Case-notes reviewed for
Patient demographics
Diagnosis
Surgery performed
Surgical technique
Type of suture used
5. Methods
Clinic notes and records from Hand Occupational Therapist
reviewed
Range of motion
Complications
Revision surgery
6. Results
16 patients underwent repair or reconstruction of tendon of hand
using barbed sutures.
1 patient with repaired EPL laceration lost to follow-up
15 patients with of 18 operated hand tendons
• 3 patients with concomitant injuries to 2 tendons on the same hand
9 females and 6 males
Age ranged from 23 to 80 years old,
Follow-up duration ranged from 3 to 8 months
7. Results – Surgical technique
All repairs performed using V-LOC 3-0 non-absorbable sutures
Standard tendon repair techniques employed
Post-op care: Standard flexor / extensor tendon repair protocol
by Hand OT.
9. Results – Nature of surgery
Pt
No.
Surgery Type Complications
Adhesions Rupture
1 Trapeziectomy and APL
suspensioplasty
Tendon transfer Nil Nil
2 PL to APB Camitz Transfer Tendon Transfer Nil Nil
3 FDS repair (MF) Flexor repair Nil Nil
FDP repair (MF) Flexor repair Nil Nil
4 EPL repair Extensor repair Nil Nil
5 Trapeziectomy and APL
suspensioplasty
Tendon transfer Nil Nil
6 PL to APB Camitz Transfer Tendon transfer Nil Nil
7 APB to EPL graft Tendon transfer Nil Nil
8 Trapeziectomy and APL
suspensioplasty
Tendon transfer Nil Nil
10. Results – Nature of surgery
Pt
No.
Surgery Type Complications
Adhesions Rupture
9 FPL repair Flexor repair Nil Nil
10 FDP repair (MF) Flexor repair Nil Nil
FDP repair (LF) Flexor repair Nil Nil
11 EIP to EPL tendon graft Tendon transfer
12 EPL repair Extensor repair Nil Nil
13 EPL repair Extensor repair Nil Nil
14 FDP repair Flexor repair Nil Nil
15 FDP repair (LF) Flexor repair Nil Nil
FDS repair (LF) Flexor repair Nil Nil
11. Results – Pt #10
LF FDP rupture LF FDP Post-repair
MF FDP rupture MF FDP post-repair
14. Discussion
Barbed suture repair described since 1960s1
Advantages:
1. Barbs provide multiple anchoring points, uniform
distribution of tissue-holding forces
2. Knotless suturing
1 McKenzie AR. An experimental multiple barbed suture for the long flexor tendons of the palm and fingers. Preliminary report. J
Bone Joint Surg 1967;49B:440–447.
Source:
http://mms.businesswire.com/bwapps/mediaserv
er/ViewMedia?mgid=229832&vid=5
15. Discussion
24 studies identified in MEDLINE, EMBASE, Google Scholar
2 meta-analysis, 21 biomechanical studies, 1 in-vivo study (chickens)
No in-vivo study with human subjects.
16. Discussion
Studies showing biomechanically comparable, if not superior
results in barbed sutures.
Greater or equivalent load to failure1,2
Smaller cross-sectional area3
Friction between exposed barbs and flexor tendon sheath4.
Adhesions
1 Joyce CW, Whately KE, Chan JC, Murphy M, O’Brien FJ, Carroll SM. Flexor tendon repair: a comparative study between a
knotless barbed suture repair and a traditional four-strand monofilament suture repair. J Hand Surg Eur Vol. 2014;39:40–5
2 Parikh PM, Davison SP, Higgins JP. Barbed suture tenorrhaphy: an ex vivo biomechanical analysis. Plast Reconstr Surg.
2009;124: 1551–8.
3 McClellan WT, Schessler MJ, Ruch DS, Levin LS, Goldner RD. A knotless flexor tendon repair technique using a bidirectional
barbed suture: an ex vivo comparison of three methods. Plast Reconstr Surg. 2011;128:322e–7e
4 Oded BA, J Kargel, B Mailey. The Effect of Barbed Suture Tendon Repair on Work of Flexion. J Hand Surg Am.
2015;40(5):969-974
18. Conclusion
Early outcomes of using barbed sutures for tendon repair
and reconstruction in the hand favourable.
Viable alternative to traditional sutures
Advantages – less suture material and faster repair.
Further studies required to ascertain long term results
Prospective study to compare barbed sutures and
traditional sutures.