Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

Tumors and tumorous conditions of the bones and joints

Arsenic contamination of groundwater in different parts of the world is an outcome of natural and/or anthropogenic sources, leading to adverse effects on human health and ecosystem. Millions of people from different countries are heavily dependent on groundwater containing elevated level of As for drinking purposes. As contamination of groundwater, poses a serious risk to human health. Excessive and prolonged exposure of inorganic As with drinking water is causing arsenicosis, a deteriorating and disabling disease characterized by skin lesions and pigmentation of the skin, patches on palm of the hands and soles of the feet. Arsenic poisoning culminates into potentially fatal diseases like skin and internal cancers. This paper reviews sources, speciation, and mobility of As and global overview of groundwater As contamination. The paper also critically reviews the As led human health risks, its uptake, metabolism, and toxicity mechanisms. The paper provides an overview of the state-of-the-art knowledge on the alternative As free drinking water and various technologies (oxidation, coagulation flocculation, adsorption, and microbial) for mitigation of the problem of As contamination of groundwater.

/pdf/arsenic-contamination-of-groundwater-a-review-of-sources-23jz4vlejd.pdf

Arsenic contamination of groundwater: a review of sources, prevalence, health risks, and strategies for mitigation.

Spinal cord injury (SCI) is a serious medical condition that causes functional, psychological and socioeconomic disorder. Therefore, patients with SCI experience significant impairments in various aspects of their life. The goals of rehabilitation and other treatment approaches in SCI are to improve functional level, decrease secondary morbidity and enhance health-related quality of life. Acute and long-term secondary medical complications are common in patients with SCI. However, chronic complications especially further negatively impact on patients' functional independence and quality of life. Therefore, prevention, early diagnosis and treatment of chronic secondary complications in patients with SCI is critical for limiting these complications, improving survival, community participation and health-related quality of life. The management of secondary chronic complications of SCI is also important for SCI specialists, families and caregivers as well as patients. In this paper, we review data about common secondary long-term complications after SCI, including respiratory complications, cardiovascular complications, urinary and bowel complications, spasticity, pain syndromes, pressure ulcers, osteoporosis and bone fractures. The purpose of this review is to provide an overview of risk factors, signs, symptoms, prevention and treatment approaches for secondary long-term complications in patients with SCI.

Chronic complications of spinal cord injury.

Purpose: Technique for the fixation of two, three, and four part proximal humerus fractures has rapidly shifted towards the use of specially contoured proximal humerus locking plates. The purpose of this study is to evaluate the short to medium term functional results and common complications associated with the fixation of proximal humerus fractures with locking plates. Methods: The PubMed and EMBASE databases were used to perform a systematic review of the English literature to assess the functional results and complications associated with proximal humerus locking plates. Our inclusion criteria were proximal humerus fracture due to trauma (excluding pathologic fractures), patients greater than 18 years of age, more than 15 patients in the study or subgroup of interest, at least 18 months follow-up, at least one relevant functional outcome score, and quality outcome score of at least 5/10. Studies that did not meet these criteria were excluded. All institutional, author, and journal information was concealed to minimize reviewer bias. Results: Twelve studies including 514 patients met the inclusion criteria. At most recent follow-up patients achieved a mean Constant score of 74 and a mean DASH score of 27. The overall rate of complications was 49% including varus malunion, 33% excluding varus malunion, and reoperation rate was 14%. The most common complications included varus malunion 16%, AVN 10%, screw perforation of the humeral head into the joint 8%, subacromial impingement 6%, and infection 4%. Discussion: Fixation of proximal humerus fractures with proximal humerus locking plates is associated with a high rate of complications and reoperation. Further study is needed to determine what technical errors and patient characteristics are risk factors for failure of this now common fixation technique.

A systematic review of locking plate fixation of proximal humerus fractures

Research question: What are the preventable risk factors in traumatic spinal cord injury (SCI)? Objectives: 1. To study the risk factors in traumatic spinal cord injuries. 2. To identify preventable risk factors. Study design: Prospective study. Setting: Accident and emergency services and department of Orthopaedic Surgery and Rehabilitation of Pt. B.D. Sharma PGIMS, Rohtak. Participants: New traumatic SCI patients. Study variables: Age, sex, mode of injury, SCI level, seasonal variation, associated trauma, duration of hospital stay, socio-economic status. Results: Four hundred and eighty three new traumatic SCI cases reported in 2000-2001. Male to female ratio was 2.96:1 and the average age at injury was 35.4 years. Fall from height was most common cause of trauma (44.5%), followed by motor vehicle accidents (34.7%). One hundred and sixty four patients were tetraplegics and 283 patients were paraplegics, while 36 patients had no neurological deficit. Most common level of injury was first lumbar vertebra among paraplegics and fifth cervical vertebra among tetraplegics. There was increase in incidence of SCI during summer and rainy season. Average hospital stay was 39.5 days. Conclusions: Certain preventable risk factors in traumatic SCI (falls, vehicular accidents, improper pre hospital care and improper transportation) need to be addressed in order to reduce the frequency and morbidity of SCI, burden on meagre financial and health resources.

Traumatic spinal cord injuries in Haryana: An epidemiological study

Different operative techniques used for treating displaced proximal humeral fractures could result in malunion, non-union, osteonecrosis of humeral head, loosening of screw and loss of reduction particularly in comminuted and osteoporotic fractures. Locking compression plate (LPHP) has been proposed for open reduction and internal fixation of these fractures and is associated with less complication rate. We prospectively assessed the functional outcome and the complications after an average follow-up of 24.9 months in 25 patients of proximal humeral fractures with osteoporosis. Mean age was 62 years. Using AO classification, 48% were type A and 52% type B. Mean constant score was 80 points. According to constant score, 28% had excellent outcome, 64% had good functional outcome, and 8% had moderate outcome. When the results were related to grades of osteoporosis, grade IV osteoporotic fractures had highest average Constant–Murley score (83 points, range 78–88 points), followed by grade III osteoporotic fractures (80 points, range 71–92 points), followed by grade II osteoporotic fractures (78 points, range 66–88 points). Varus malalignment and subacromial impingement were observed in 8% patients. Loosening of implant and loss of reduction were observed in 4% patients. Superficial infection was observed in 4% patients. Locking compression plate (LPHP) is an advantageous implant in proximal humeral fractures due to angular stability, particularly in comminuted fractures and in osteoporotic bones in elderly patients, thus allowing early mobilization.

/pdf/internal-fixation-of-proximal-humeral-fractures-with-locking-26ylin8hw2.pdf

Internal fixation of proximal humeral fractures with locking proximal humeral plate (LPHP) in elderly patients with osteoporosis

Women with spinal cord injury (SCI) have unique concerns and problems related to their sexuality. The purpose of this study is to assess sexual issues in women with SCI, for 
better management and rehabilitation of such patients. Consequently, 40 such women were interviewed based on a standardized questionnaire. Evaluation of sexual activity, medical problems most significantly interfering with sexual activity, menstruation, pregnancy, child bearing and relationships was done. Interest in sex and importance of sex in lives did not change significantly after SCI. The key concerns after SCI were sexual, 
bladder and bowel dysfunctions, bed sores, pain, spasticity and satisfaction of partner and cultural taboos. Only, 30% women had received information on sexual matters, that too to isolated problems. There is a distinctive need for clinical attention, education, research and development around gynaecological/reproductive, sexual and urogenital issues unique to women with SCI in India.

Sexuality and Women with Spinal Cord Injury

Aims This is a prospective randomised study which compares the radiological
and functional outcomes of ring and rail fixators in patients with
an infected gap (> 3 cm) nonunion of the tibia. Patients and Methods Between May 2008 and February 2013, 70 patients were treated
at our Institute for a posttraumatic osseocutaneous defect of the
tibia measuring at least 3 cm. These were randomised into two groups
of 35 patients using the lottery method. Group I patients were treated
with a ring fixator and group II patients with a rail fixator. The
mean age was 33.2 years (18 to 64) in group I and 29.3 years (18
to 65) in group II. The mean bone gap was 5.84 cm in group I and 5.78
cm in group II. The mean followup was 33.8 months in group I and 32.6 months
in group II. Bone and functional results were assessed using the
classification of the Association for the Study and Application
of the Method of Ilizarov (ASAMI). Functional results were also
assessed at six months using the short musculoskeletal functional
assessment (SMFA) score. Results The bone result was excellent, good, fair and poor in 21, 12,
0 and 2 in group I; and 14, 15, 3, and 3 in group II, respectively.
The functional results were excellent, good, fair, poor and failure
in 16, 17, 1, 0 and 1 in group I; and 22, 10, 0, 3 and 0 in group
II, respectively. Both fixator systems achieved comparable rates
of union and functional outcomes. The rate of deep 
pintract infection was significantly higher in the rail fixator
group but patients found it more comfortable. Conclusion We recommend the use of a ring fixator in patients with a bone
gap of more than 6 cm. Patients with a bone gap up to 6 cm can be
managed with either a ring or rail fixator. Cite this article: Bone Joint J 2016;98B:1399–1405.

Prospective randomised comparison of ring versus rail fixator in infected gap nonunion of tibia treated with distraction osteogenesis

Out of 11234 patients reporting to our outdoor during June 2001 to June 2002, 2594 patients (23.09%) had low back pain. 4358 roentgenograms were done in these patients, a mean of 1.68 per patient. These patients were interviewed and their psychosocial and demographic details were compared with 1000 controls who did not have back pain but attended outdoor for other reasons. In the low back pain group, 67% had psychosocial issues, 57% were in blue-collar jobs, 26% had to change/leave their profession, and 38% did not enjoy their present job. All patients had used NSAIDS at some stage of illness and 64% were advised exercises for the back. The comparative figures in control group were 19% with psychosocial issues, 34% in blue-collar jobs (heavy manual workers), 7% had to switch over to new job, 6% did not relish their present job. Hence, it is concluded that along with exercises and NSAIDS, sufficient consideration should be given to short centre-based intensive rehabilitation program followed by a home-based program for chronic low back pain patients.

Incidence of low back pain in workage adults in rural North India.

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