efficacy of Pavlik harness as a treatment of developmental dislocation of the hip

Objective: To evaluate the efficacy of using a Pavlik harness Orthosis in reducing dislocated hips in patients with developmental dislocation of the hip

Methods: This is a prospective study done on patients who visited the pediatric orthopedics clinic in the Royal Medical Services in the period between October 2010 and June 2015. Each patient diagnosed by radiography and fulfilled the inclusion criteria was examined prior to the application of a dynamic flexion abduction orthosis [Pavlik Harness orthosis] and then the Orthosis application is checked by one of the authors whom are a senior consultant pediatric orthopedic surgeon and four pediatric orthopedic specialists. After that, a follow up period of two weeks is given to those patients who present with a dislocated hip in the age between three to six months. The patients were reevaluated after two weeks by clinical examination of both hips and by radiography while maintaining the Pavlik harness orthosis applied on the patient

Results: In this study 133 patients had fulfilled the inclusion criteria. The number of dislocated hips was 184. We found that there were 82 patients 61.6% who presented with unilateral hip dislocation and 51 patients 38.4% who presented with bilateral hip dislocation. Female:Male ratio of 6.4:1 . 128 hips 69.7% achieved reduction after the application of a pavlik harness orthosis at two weeks follow up. And 56 hips 30.3% diagnosed as a case of failed hip reduction and underwent closed reduction under general anesthesia with or without Adductor tendon tenotomy and static hip spica cast application. 3 patients 2.2% developed femoral Nerve palsy that fully recovered after discontinuity of Orthosis application

Conclusion: The use of Pavlik Harness Orthosis is an effective method of treating patients who present with a dislocated of hip in the age between three to six months. The younger the patient the better the outcome

Shoulder functional outcome after latissimus dorsi muscle transfer and subscapularis muscle release in children with obstetrical brachial plexus palsy

To evaluate the shoulder functional outcome in children with obstetrical brachial plexus palsy after performing latissimus dorsi muscle transfer and subscapularis muscle release. This is a retrospective analysis to fifty patients with 52 shoulders underwent latissimus dorsi muscle transfer and subscapularis muscle release for obstetrical brachial plexus palsy, between June 2008 and April 2012. Reviewing patient's files and pre-operative videos. Mallet scoring system was used to evaluate the shoulder functional changes. Fifty children with fifty two shoulders with a ranging age between 18 months up to 13 years were involved in this study, 1:1 male to female ratio, the average birth weight was 3.89KG, the brachial plexus extent of injury were ranging from upper injury 80% to total palsy 20%. Regarding the affected limb the right side involvement was 60% the left side 36% and bilateral involvement was 4%.there is significant difference in the global upper limb function between younger age group[below five years] when compare to older age group[above five years of age]. Five active ranges of motion around the shoulder joint involved in the injury were analyzed with the following functional outcome improvement: Global Abduction 46.6%, Global External Rotation 62.9%, Hand to neck 49%, Hand to spine 53.3%, Hand to mouth 57.2%. We found that this type of surgery improves the global function of the upper limb in patients with obstetrical brachial plexus palsy, this improvement become less remarkable in older children[>5years of age]. And the majority of patients and their families were satisfied by the achieved results

Tuberculosis awareness in Gezira, Sudan: knowledge, attitude and practice case-control survey

This case control study aimed to assess tuberculosis [TB] awareness and its associatedsociodemographic characteristics in Gezira, Sudan. New smear-positive TB patients registered in Gezira in 2010 [n - 425] and age-matched controls who attended the same health facilities for other reasons [n = 850] formed the study sample. Awareness was measured using a modified standard World Health Organization TB knowledge, attitude and practice instrument. There was no significant difference between TB cases and the controls in overall levels of TB awareness. About two-thirds of TB cases and controls had good TB awareness. Respondents' sex was associated with awareness among the controls. Age, level of education, type of residence and type of occupation were significantly associated with TB awareness, whereas marital status had no effect. The good level of TB awareness found among TB cases and controls is a baseline for further TB awareness-raising among the Gezira population

message from the past: splenectomy and devascularisation with salvage sclerotherapy in the treatment of bleeding schistosomal oesophageal varices

To study the short and long term results of splenectomy and esophagogastric devascularisation in the prevention of bleeding from esophageal varices secondary to schistosomal portal hypertension. This is a retrospective prospective study of patients, who underwent splenectomy and devascularisation for schistosomal bleeding varices during the period 1980 to 1990 at Soba university hospital. They had clinical, laboratory, and endoscopic evaluation. They were followed up for a period of 10 years [mean 4.5 years]. At follow up special emphasis was laid on recurrence of variceal hemorrhage and, or mortality. Patients with recurrent variceal bleeding received emergency treatment in the form of resuscitation, balloon tamponade when necessary, and flexible endoscopic sclerotherapy. Splenectomy and oesophagogastric devascularisation was performed in 185 patients, and devascularisation only in 5 patients. Early postoperative mortality occurred in 8 patients [4.2%]. Early recurrence of variceal bleeding occurred in 4 patients who responded to emergency treatment. Transient of treatable ascitis developed in 21% of patients, transient jaundice in 12.6%, and liver failure in 1.6%. Major postoperative septic complications occurred in 6.4%. The rate of recurrence of variceal bleeding was 18.1% within the first 5 years, and 23.6% by 10 years follow-up. Late mortality occurred in 8 patients [4.4%]. The overall mortality of the procedure was 8.4%. Splenectomy and oesophagogastric devascularisation for the treatment of schistosomal portal hypertension can be associated with a high rate of variceal rebleeding. However, when coupled with sclerotherapy for recurrence, it carries an acceptable mortality rate

sensitivity and specificity of the conventional symptoms and signs in making a diagnosis of acute appendicitis

Simple appendicitis can progress to perforation, which is associated with a much higher morbidity and mortality. So, surgeons have therefore been inclined to operate when the diagnosis is probable rather than wait until it is certain. This study is designed to evaluate the sensitivity and specificity of clinical examination in the diagnosis of acute appendicitis. The study included 866 patients of acute appendicitis who had undergone appendicectomy with preoperative diagnosis of acute appendicitis. They were analyzed retrospectively. The parameters evaluated were age/gender, clinical presentation [signs and symptoms] and total white blood cell counts. The operative findings were recorded and the inflammation of the appendix was graded into normal, acutely inflamed and gangrenous. Clinical diagnosis was made correctly in 807 [93.2%] of the patients. White blood cells count ranged from 3.70 to 45.30 /mm[3] [mean 17.5353 /mm[3]]. It was <10.000/mm[3] in 133 [15.4%] patients. Clinical assessment is the best criterion to reach a confident diagnosis. Investigations may supplement the diagnosis but are never a substitute for it

Factors affecting satisfaction of patients after orthognathic surgery at a university hospital

To analyze factors that influence patient's satisfaction with orthognathic treatment and evaluate patient's perception of changes in physical and psychosocial aspects. In a retrospective clinical study conducted at Jordan University Hospital, Amman, Jordan between December 2006 and December 2007, we examined 38 patients who had orthognathic surgery after an average follow-up of 20 months. Examination included evaluation of nerve function and temporomandibular function with Helkimo index. Patients filled out a questionnaire on treatment satisfaction, and perception of physical and psychosocial changes after treatment. Patients were generally satisfied with the result, 82% agreed they would undergo treatment again. They were divided into very satisfied n=25 and less satisfied n=13 groups according to satisfaction score, with statistically significant differences found between them concerning diagnosis, and follow-up period, with all vertical maxillary excess patients very satisfied and 75% of asymmetrical deformities patients less satisfied, and less satisfaction by patients more than one year postoperatively p=0.006. Patients perceived improvement in oral function, general health, appearance and interpersonal skills. Lower rates of joint and muscular pain, and increased mobility of lower jaw correlated with better patients' perception of health and appearance. Although patients' report high satisfaction levels, several factors such as the temporomandibular joint function could affect patients' psychosocial adjustment after treatment. Sufficient information for patients on the treatment course is required to improve satisfaction. Controlling these factors could improve patients' quality of life

Prevalence of vitamin-mineral supplement use among Jordan University students

To determine the prevalence, reasons, source of information of vitamin-mineral supplement uses, and their relationship with selected demographic and lifestyle characteristics among Jordan University students. A cross-sectional survey was carried out at Jordan University, Amman, Jordan from March to September 2005. The survey included 1187 students aged 17-28 years. A multistage stratified sampling technique was used to recruit the participants from different majors at Jordan University. A self-administered questionnaire containing questions on use of vitamin-mineral supplement during the last year, demographic, and lifestyle characteristics was completed. The overall prevalence of vitamin-mineral supplement use during the last year reported by students was 27.4% [males 22%, and females 30.2%]. Vitamin-mineral supplement use among university students was significantly [p<0.05] associated with age, gender, family monthly income, smoking status, physical activity, vegetarian status, and body mass index. The most frequently used supplements were multivitamins [10.4%] and multivitamins-multi minerals [10%]. The most frequently given reason for supplement use was for treatment. The main frequently reported source of information was a physician [45.8%]. The overall prevalence rate of vitamin-mineral supplement use is very low. Supplement users are more likely to be: females, nonsmokers, of higher income, physically active, vegetarians, and of normal body mass index. The main reason for supplement use is for treatment, and the major source of information on supplements is by physicians and pharmacists

Do doctors in north-western Somalia follow the national guidelines for tuberculosis management?

A cross-sectional study assessed the knowledge and practices of registered practitioners in management of tuberculosis [TB] in north-western Somalia. Of 100 registered doctors, 53 were interviewed. Of these, 32 [64%] had treated TB patients during the previous year, but only 1 had notified the authorities, 33 [66%] knew the most important symptoms and 32 [64%] identified sputum smear microscopy as the most important diagnostic test. Only 4 doctors prescribed the correct regimen and only 7 advocated direct observation. Suboptimal knowledge was more common among doctors working in private practice [relative risk: 2.1; 95% CI: 1.1-4.3]. Patients are being treated in the private sector, but few doctors follow national treatment guidelines. Training in diagnosis and case management is needed to improve TB control in Somalia

Substance use among university and college students in Jordan

A random survey of 5064 university and community college Jordanian students aged between 18-25 years was conducted in early 2001 to investigate the extent of the impact of common substances of abuse among this population and the subjects' emotional and attitudinal stance toward illicit drugs. Participants completed a questionnaire of 72 questions relating to emotions, behaviors, relationship with family and friends and substance use behavior during the previous month. Results showed the following self-reported substance use: 2.5% cannabis; 3.3% sedatives; 0.9% opiates, with the most common method of opiate consumption being burning and inhaling; 2.8% Benzhexol; 2.6% stimulants; 12% alcohol; and 29% tobacco. None of the sample reported using cocaine. Throughout, substance abuse was significantly higher in male students. Some risk factors were identified for substance abuse in the group as seeking acceptance, encouragement by friends, having friends involved in substance abuse and poor communication with the family

Ultrasound assessment of normal splenic length and spleen-to-kidney ratio in children

Splenic lengths in 184 normal Jordanian children were measured through the hilum by ultrasound and compared with data from Hong Kong and the United States of America. The spleen to left kidney ratio was calculated to determine whether it was constant and to establish a ratio above which splenomegaly can be diagnosed. Up to age 15 years, little variation in splenic length was observed, but over 15 years splenic length was slightly lower in Jordanian males. Spleen to left kidney ratio was constant at around 1; splenomegaly is highly probable in ratios > / = 1.25

Presence of panic disorder among medical patient referred to psychiatry

A retrospective application of the panic questionnaire and the life stressors questionnaire on 50 patients with unexplained somatic symptoms referred for psychiatric consultation by other medical disciplines. The most common presenting symptoms were related to, head, chest, heart, and abdomen. Analysis revealed two groups of patients, panic disorder patients [N = 32] and non - panic patients [N = 18]. Panic group presented more frequent and severe somatic symptoms and they were associated with different life stressors. The results also indicate that the panic patients had utilized more frequently the health services