Technological advances have helped to improve functional ability in spinal cord injury survivors. The aim of this study is to systematically review the evidence for functional electrical stimulation (FES) on functional tasks involving the upper limb in people with spinal cord injuries. The authors systematically searched from September 2009 to September 2014 in relevant databases using a combination of keywords covering spinal cord injury and FES. Studies were selected using pre-determined criteria. The search yielded 144 studies. Only five studies met the inclusion criteria. All five reported improvements immediately and at follow-up in functional ability as a result of FES or FES combined with conventional therapy. There is some preliminary evidence that FES may reduce disability due to upper limb-related activity limitations in tetraplegic spinal cord injury. Further work needs to examine the role of FES in more detail and in combination with other treatments.

ABSTRACT:Objective: To assesses the pattern of antibiotic utilization and outcome of patients with bacteremia in the hospital. METHODOLOGY: All positive blood cultures (BC) over a 12-months period from January-2012 to December-2012 were retrospectively review/ positive BC were recorded in 50patients received antibiotics before or soon after obtaining the BC and ceftriaxone was the most frequently-prescribed antibiotics (42.9%), either alone or in combination with other antibiotics. RESULTS: The bacteremia was due to gram-negative rods in 84.9% and gram-positive cocci in 15.1% cases. Most common gram-negative bacilli were E. coli, Klebsiella pneumoniae and Salmonella species while most common gram-positive cocci were Staphylococcus aureus. Antibiotics regimen was changed in 37% cases after BC results became available. Most frequent change was addition of meropenem in-case of gram-negative bacilli (29.6%) and vancomycin in gram-positive cocci (12.5%). Ten (18.5%) patients developed serious sepsis or septic shock; 3(30.0%) improved and 7 (70.0%0 had fatal outcome. CONCLUSION: Antibiotic selection needs to be tailor made for each patient. However, most bacteremia necessitating hospital admission is due to gram-negative bacilli and it should be considered in antibiotics selection prior to BC.

Introduction In 2012, 22 new major trauma centres were introduced in England. This followed evidence demonstrating that such units saved lives and reduced serious disability. Traumatic central cord syndrome is an example of spinal injury seen in major trauma centres. This condition occurs most frequently as a result of hyperextension to the neck in the presence of spondylosis or degenerative changes. These patients may suffer additional injuries during the initial trauma which may be missed, either due to lack of clinically apparent symptoms or due to the masking of symptoms as a result of neurological compromise.Case presentation We describe a case of a 56-year-old gentleman who sustained a traumatic central cord syndrome following a fall down a flight of stairs whilst disembarking an aeroplane. Following transfer from the major trauma centre to the regional spinal injuries centre it was discovered that he had bilateral radial head fractures which had been missed on the initial primary and secondary surveys. Discussion Radial head fractures are a significant injury in the context of traumatic central cord syndrome due to the potential impact on functional recovery and rehabilitation. The tertiary survey has been proposed as a method to detect subclinical injuries in trauma cases. This case highlights the importance of conducting the tertiary survey to avoid missing important subclinical injuries.

Undiagnosed and underlying medical co-morbidities are known to have a role in the causation of or contribution to injuries sustained in cases of polytrauma. Syncope provoked by valvular heart disease is one such example. Thorough clinical assessment is needed to ensure such diagnoses are detected and treated, whilst ensuring a patient’s ongoing rehabilitation needs are met. Here, the authors report a case of polytrauma, most likely secondary to severe aortic stenosis, causing syncope which was diagnosed at a later stage due to ongoing symptomatology. Delay in picking up such diagnoses can contribute to mortality in these patients or affect morbidity by having a detrimental impact on a patient’s functional recovery.