Background: The initial presentation of sepsis in the emergency department (ED) is difficult to distinguish from other acute illnesses based upon similar clinical presentations. A new blood parameter, a measurement of increased monocyte volume distribution width (MDW), may be used in combination with other clinical parameters to improve early sepsis detection. We sought to determine if MDW, when combined with other available clinical parameters at the time of ED presentation, improves the early detection of sepsis. Methods: A retrospective analysis of prospectively collected clinical data available during the initial ED encounter of 2158 adult patients who were enrolled from emergency departments of three major academic centers, of which 385 fulfilled Sepsis-2 criteria, and 243 fulfilled Sepsis-3 criteria within 12 h of admission. Sepsis probabilities were determined based on MDW values, alone or in combination with components of systemic inflammatory response syndrome (SIRS) or quick sepsis-related organ failure assessment (qSOFA) score obtained during the initial patient presentation (i.e., within 2 h of ED admission). Results: Abnormal MDW (> 20.0) consistently increased sepsis probability, and normal MDW consistently reduced sepsis probability when used in combination with SIRS criteria (tachycardia, tachypnea, abnormal white blood count, or body temperature) or qSOFA criteria (tachypnea, altered mental status, but not hypotension). Overall, and regardless of other SIRS or qSOFA variables, MDW > 20.0 (vs. MDW ≤ 20.0) at the time of the initial ED encounter was associated with an approximately 6-fold increase in the odds of Sepsis-2, and an approximately 4-fold increase in the odds of Sepsis-3. Conclusions: MDW improves the early detection of sepsis during the initial ED encounter and is complementary to SIRS and qSOFA parameters that are currently used for this purpose. This study supports the incorporation of MDW with other readily available clinical parameters during the initial ED encounter for the early detection of sepsis.
Introduction: Distal tibial fractures are common orthopedic injury. These fractures involve distal tibia, sometimes with ankle joint. Distal tibial fracture may range from injuries with little or no displacement to complex fractures with significant associated injuries. Stability of these injuries depends on a combination of boney and associated ligamentous injuries. Surgical management includes MIPO/Open procedure by distal tibial locking plate and screw, this may include distal fibula fracture. The surgical management steps far superior in different aspects of outcome for the patient as the patient needs early mobilization. Methods: This prospective study was conducted in Dept. of Orthopaedic and Trauma Surgery, Shaheed Monsur Ali Medical College and Hospital, Dhaka, Bangladesh from January 2021 to December-2022. During this study we have operated on total of seven patients with distal tibial fracture sometimes involving distal fibula. All of these patients came to ER with acute injuries following RTA, fall from height etc. All of these patients were assessed pre and post operatively. All of these cases were classified according to AO classification. Results: Total seven patients included. The mean age of the patients was 32.62± 2.24 years. Maximum study patient were injured from RTA. All of them were treated by minimally invasive and open procedure. Patients were kept on follow up at regular interval. All of the patient’s plasters were removed at around after 28th POD. On consequent follow up patients could walk after brief period of physiotherapy and active exercise. There was no significant difference in the distribution of AO/OTA classification, age, gender, AOFAS score, time from injury to operation, follow-up, bone union time, delayed union, malunion and infection (p>0.05). The operation time was significantly longer in the open group than in the MIPO group: 69.59±7.21 min. for the ORIF, and 61.14±5.61 for the MIPO group (p<0.01). The hospitalization .....
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