Mid-term outcome of arthroscopic TightRope fixation of displaced lateral end clavicular fractures: Average follow-up of 6.1 years / 中华创伤杂志(英文版)

PURPOSE@#Various surgical modalities are available to treat Neer types 2 and 5 unstable fractures of lateral end clavicle but none of them are standardized. Arthroscopic fixation of the displaced lateral end clavicle fractures provides good short-term results but mid- to long-term outcomes are not available. The purpose of this study was to show the mid- to long-term radiological and functional outcomes of these fractures treated arthroscopically by a TightRope device, and to show the complications associated with this procedure.@*METHODS@#A retrospective study was conducted over 2 years from January 2014 to December 2015 with a minimum 5-year follow-up. Active patients aged 18-50 years with acute (less than 3 weeks) displaced fracture of lateral end of the clavicle, with a minimum 5-year follow-up were included in the study. Patients with associated fractures of the proximal humerus, glenoid, scapula and acromioclavicular joint injuries were excluded from the study along with open fractures and neurovascular injuries. The outcomes were assessed by objective (complications and radiographic examination) and subjective criteria (quick disabilities of the arm, shoulder and hand score, the Constant-Murley score and the visual pain analogue scale). The data were analyzed by SPSS version 21.0.@*RESULTS@#Totally, 42 patients were operated during the study period and 37 were available with a minimum 5-year follow-up. Thirty were male and 7 were female with a mean age of 29.5 years and a mean follow-up of 6.1 years. The mean quick disabilities of the arm, shoulder and hand score was 68.2 ± 4.6 preoperatively and 1.27 ± 2.32 at final follow-up (p < 0.001); the mean visual pain analogue scale score was 6.85 ± 2.2 preoperatively and 0.86 ± 1.60 at final follow-up (p < 0.001). The average Constant-Murley score was 93.38 ± 3.25 at the end of the follow-up. There were 2 fixation failures, with established non-union and 3 patients developed radiographic acromioclavicular joint arthritis.@*CONCLUSIONS@#Arthroscopic TightRope fixation of displaced lateral end clavicular fractures provides good radiological and functional outcomes at mid- to long-term follow-up. With the low complication rates and high patient satisfaction, this technique can be considered as a primary option in the surgical treatment of these fractures.

Is Neck Circumference A Better Measure for Determining Obesity? A Cross-Sectional Analytical Study to Assess Its Validity in Type II Diabetes Mellitus Patient

Introduction: Several anthropometric measurements like Body mass index (BMI), skin fold thickness, Waist circumference (WC), waist-height ratio (WHtR), and Waist hip ratio (WHR) are available for diag-nosing obesity at the population level. But each of them has its disadvantage as well. Neck circumference, which has been the recent anthropometric tool of interest can be used as an alternative to these meas-urements. Objective: To determine the validity of neck circumference as an anthropometric parameter of obesity and to estimate the cut-off points for obesity in type II diabetes mellitus patients. Material & Methods: This analytical cross-sectional study was done among 141 Type II diabetes pa-tients attending rural and urban health training centre non-communicable disease clinic of Sri Rama-chandra Institute of higher education and research, Chennai. After obtaining informed consent, their an-thropometric measurements like NC, BMI, WC, HC, and WHR was measured. Results: Neck circumference ≥36.5cm in males and ≥33.2cm in females is conceivably the perfect cut-off point for diagnosing overweight/Obesity in Type II diabetes mellitus. Conclusion: This analytical study deduced that NC is a valid anthropometric measurement for diagnos-ing obesity among Type II diabetes mellitus with plausible sensitivity and specificity.

Anatomical study on sciatic nerve variations in Andhra Pradesh, India

Background: The sciatic nerve is the largest and widest nerve in the body and is derived from ventral rami of spinal nerves L2 to S3. Sciatic nerve appears in the Gluteal region below Piriformis from Pelvic cavity by passing through Greater Sciatic foramen. In between the Ischial tuberosity and greater trochanter of Femur, it reaches the back of the thigh. At the superior angle of Popliteal fossa, it divides into Tibial and common Peroneal (fibular) nerves. The division varies, and it may occur within the pelvis, Gluteal, upper, mid and lower part of thigh. The anatomical variations of the level at which the Sciatic nerve divides is considered important by Neurosurgeons, Anaesthetists, Orthopaedicians and Surgeons.Methods: This study was conducted on 52 lower limbs to determine the level of sciatic nerve bifurcation and its variations on 26 embalmed human cadavers. The data was analyzed manually using numbers, frequencies and percentages.Results: The findings of this study states that in 2 limbs (3.84%) the nerve divided in the gluteal region; in 4 limbs (7.69%) in the pelvic region; in 10 limbs (19.23%) at the junction between upper and middle thigh. The highest incidence of division occurs in 36 limbs (69.23%) at the superior angle of the popliteal fossa.Conclusions: The findings of this study revealed that the majority of sciatic nerve divisions occur   at the superior angle of popliteal fossa while some divided into other regions such as Pelvis, Gluteal and thigh regions.

Hand-made Cloning: A Guide for Cloning Water Buffaloes.

The present review is a detailed discussion on comparable benefits of hand-made cloning (HMC) technique than micro-manipulation based conventional cloning and developed in the author’s laboratory. Hand-made cloning technique does not require micromanipulators, because the manipulations required for both enucleation and nucleus transfer are performed by hand. The HMC technique includes manual bisection of zona-free oocytes and the simultaneous fusion of the somatic cell with two cytoplasts to produce a cloned embryo. The benefits of HMC include low setup costs for limited equipment, no requirement of highly trained expertise and in vitro effciency comparable to traditional somatic cell nuclear transfer technology. Embryos produced by HMC can be cryopreserved and capable of producing live births. The HMC technique is now applied to different species and can be used in large scale nuclear transfer programs.

Prevalence of impacted canines among sudanese university students / Prevalência de caninos impactados em estudantes universitários sudaneses

Objective: To determine the prevalence of impacted canines among 17-25 year old Sudanese University students. Material and Methods: Descriptive crosssectional study in University of Khartoum, Sudan. 2401 students were selected according to random stratified sampling technique and screened under natural day light. All students with un erupted permanent canines were referred to the Orthodontic Department for clinical examination and radiographic investigations. Results: Forty nine students (2%), 10 males and 39 females out of 2401 students were reported to have at least one impacted canine. Males to females ratio was approximately 1:4. Impacted canines were more common in the maxilla (1.6%) than in the mandible (0.33%). Majority of the cases with impacted canines (73.5%) had unilateral impaction p < 0.05, whereas 24.5% had bilateral impactions and only 2% had three impacted canines. Location of the impaction either: palatal, buccal or in the line of arch and the palatal impactions were the most common one (45%), whereas buccal and in the line of arch impaction were found in 20% and 35% respectively. Retained deciduous canines were observed in most of the cases with impacted canines (81.6%). Conclusion: Prevalence of impacted canines was noticeable and comparable to the findings reported in other populations. The study gives a clue about the magnitude of the problem. However, strong conclusion can not be drawn since the sample is not representative to the whole Sudanese population. Further study is essential for a great sample from different provinces of the Sudan in order to draw a real conclusion...

Objetivo: Determinar a prevalência de caninos impactados em universitários sudaneses com idade entre 17 - 25 anos. Material e Métodos: Este é um estudo transversal descritivo realizado na Universidade de Cartum, Sudão. Dois mil, quatrocentos e um estudantes foram selecionados de acordo com técnica de amostragem aleatória estratificada e avaliados sob a luz natural do dia. Todos os alunos com caninos permanentes não irrompidos foram encaminhados para o Departamento de Ortodontia para investigações por meio de exames clínico e radiográfico. Resultados: Quarenta e nove alunos (2%), 10 do sexo masculino e 39 do sexo feminino, dentre os 2.401 estudantes avaliados, apresentaram pelo menos um canino não irrompido. A relação deste episódio entre homens e mulheres foi de aproximadamente 1: 4. Caninos não irrompidos foram mais frequentes na maxila (1,6%) do que na mandíbula (0,33%). A maioria dos casos de caninos não irrompidos (73,5%) eram impacções unilaterais (p < 0,05), enquanto que 24,5% apresentavam impação bilateral e somente 2% dos pacientes apresentavam três caninos não irrompidos. A localização da impacção foi por palatino, vestibular ou na linha média; sendo que impacções por palatino foram mais frequentes (45%), enquanto que 20% e 35% estavam por vestibular ou na linha média, respectivamente. Caninos decíduos retidos foram observados na maioria dos casos de caninos não irrompidos (81,6%). Conclusão: A prevalência de caninos não irrompidos foi relevante e comparável com os achados em outras populações. Este estudo fornece noções sobre a magnitude do problema, no entanto, conclusões generalizadas não podem ser tomadas, pois a amostra não é representativa de toda a população sudanesa. Um estudo mais aprofundado é essencial para uma conclusão real, considerando-se amostras de diferentes províncias do Sudão...

Unsafe injection practices in Hodeidah governorate, Yemen

Unsafe injection practices are a major public health problem and can lead to the transmission of blood borne pathogens, including hepatitis B virus [HBV], hepatitis C virus [HCV] and human immunodeficiency virus [HIV]. The present study was conducted to determine the nature and magnitude of unsafe injection practices in healthcare facilities in Hodeidah governorate, Yemen. The study was conducted in two hospitals and a representative sample of the governorate's health centers. A total of 1600 injections were observed in these facilities. This study revealed several unsafe practices, particularly the recapping of needles after use, which occurred in 61.1% and 36.8% of the observations in the hospitals and the health centers, respectively. This study showed that most healthcare workers [HCWs] followed the proper injection protocols but performed some procedures that exposed themselves and the community to the risk of needlestick injuries [NSIs] and blood borne infections

Costs associated with tuberculosis diagnosis and treatment in Yemen for patients and public health services

This study determined the costs associated with tuberculosis [TB] diagnosis and treatment for the public health services and patients in Sana'a, Yemen. Data were collected prospectively from 320 pulmonary and extrapulmonary TB patients [160 each] who were followed until completion of treatment. Direct medical and nonmedical costs and indirect costs were calculated. The proportionate cost to the patients for pulmonary TB and extrapulmonary TB was 76.1% and 89.4% respectively of the total for treatment. The mean cost to patients for pulmonary and extrapulmonary TB treatment was US$ 108.4 and US$ 328.0 respectively. The mean cost per patient to the health services for pulmonary and extrapulmonary TB treatment was US$ 34.0 and US$ 38.8 respectively. For pulmonary and extrapulmonary TB, drug treatment represented 59.3% and 77.9% respectively of the total cost to the health services. The greatest proportionate cost to patients for pulmonary TB treatment was time away from work [67.5% of the total cost], and for extrapulmonary TB was laboratory and X-ray costs [55.5%] followed by transportation [28.6%]

Development of process dental nursing care standards

Assessing the needs and determining health priorities are essential to focus the attention in the right direction and use the scarce resources in the most efficient way that would positively affect the oral health status of the population, and help in maximizing the oral health results and enforcing equity. The present study was aimed at developing process dental nursing care standards based on literature review and eliciting participant's opinions regarding the importance of proposed standards. A methodological research design was used to determine the importance of proposed standards from point view of participants. The study was conducted in [34] governmental and nongovernmental dental clinics in Jenin district West Bank in Palestine. Subjects of the study included two groups consisted of [128] participants. Nursing group divided into two categories included [53] dental nurses, and [22] nurse managers, while dentistry group included [53]dentists. Data collection included Arabic questionnaire sheet aimed at determining the importance of tasks by eliciting participant's opinions. Results showed that majority of participants agreed upon importance of most proposed standards related to process dental nursing care, followed by development of these standards. As a conclusion, the developed standards are ready for application in study settings where they are urgently needed. It is recommended to apply developed standards in study settings and also in similar settings in other districts in Palestine. Training sessions about dental nursing care plan steps should be conducted for dental nurses to increase their knowledge

Good outcome of neuromyelitis optica: a case report / 国际眼科杂志(Guoji Yanke Zazhi)

A 26 year-old Malay man presented with first attack of left eye optic neuritis that recovered fully with intravenous methylprednisolone after 3 weeks. He developed a second attack of optic neuritis in the right eye the following week. Lhermitte sign as well as Uthoff phenomenon were also positive. On day-3, he developed bilateral paraplegia and sensory loss at T8 level, which progressively worsen and became bedridden on day-5. MRI showed bilateral enhance-ment of the optic nerve with the presence of long multisegmental demyelinating plaque in the thoracic to lumbar spinal cord and the brainstem, sparing the brain hemisphere. He was promptly given high dose intravenous methylprednisolone followed by oral predni-solone. He was also assigned on intensive neuro-phy-siotherapy. He recovered after 3 months and was able to walk with walking aids. He recovered completely after 7 months and resumed working as site contactor. There was no relapse during the last 1 year follow-up. His final visual acuity improved to 6/9 in the right eye and 6/6 in the left eye. The visual field of the right eye showed per-sistent mild cecocentral scotoma. And diffuse depression.

[Identification of effective biotherapy for bacterial otitis media in children presenting to private clinics in Sanaa city]

To identify the causative agents of otitis media of children aged up to 15 years, and determine the proper antibiotics and compare them with those empirically prescribed by Yemeni pediatricians. A total of 429 bacteriology results of middle ear swabs, agent microorganisms, and their susceptibility to antibiotics of children aged up to 15 years old with otitis media resistant to prescribed antibiotics were collected from three main microbiology lab in Sana 'a city during the period from June 2006 till June 2007. Fifty pediatricians were asked to list their 5 antibiotics of choice in treatment of otitis media to compare empirical prescription with microbiology A total of 429 children were enrolled in this study, 145 [33.8%] of them aged 2 year or less, 101 between 3-5 years [23.5%], while 183 aged 6 years old and above [42.7%]. Males were 266 [62.0%] while 163 [38.0%] were females. The most common pathogens were Staphylococcus aureus [41.7%], Pseudomonas aeruginosa [17.7%], Proteus spp [11.2%] and Hemophilus influenza [7.7%]. Concerning antibiotics, pathogens were more sensitive to ceftriaxone [77.7%] followed by cefotaxime [72.0%], cefuroxime [69.1%], amoxil/clavulanic [57.3%]. Most common empirically prescribed antibiotics were amoxil/clavulanic [92%]. Practicing pediatricians used to prescribe amoxil/ davulanic first and a considerable proportion are prescribing amoxil which is not effective. Staphylococcus aureus, Pseudomonas aeruginosa and Proteus spp. are the most common pathogens associated with otitis media in Yemeni children. Otitis media pathogens are sensitive to ceftriaxone, cefotaxime and amoxil/clavulanic respectively

Quality of management for acute respiratory tract infections and diarrhoeal diseases in rural Yemen

To evaluate the performance of health workers with respect to diagnosis and treatment of acute respiratory infection [ARI] and acute diarrhoea [AD] in children < 5 years in 11 rural heath facilities in Yemen, we carried out a cross-sectional study on 219 cases of ARI and 93 cases of AD. Mean score for performance was 30.04 [range 21-39]. The quality of care provided was fair in 89.4% and poor in 4.5% of cases. A "well done" performance of 6.3% was achieved by medical doctors but only 3.6% of medical assistants and 25% of medical assistants scored "poor" for performance, but only 2.5% of medical doctors. Health workers who had received training courses in ARI and AD performed slightly better than those who had not

Toxoplasma granuloma of brainstem: A rare case.

Toxoplasmosis is a common opportunistic infection in patients with AIDS in whom it frequently presents as intracranial space-occupying lesions. In the immunocompetent patient the most common manifestation is as asymptomatic cervical lymphadenopathy which may be associated with vague systemic manifestations such as fever or myalgia. In very rare cases people with normal immunity may present with meningoencephalitis polymyositis or myocarditis. It is very rare to encounter a brainstem granuloma due to toxoplasma infection in such patients. We report a non-immunocompromised man who presented with multiple cranial nerve palsies due to a brainstem lesion, which turned out to be a toxoplasma granuloma. He recovered completely after a four-week course of Pyrimethamine and Sulphadoxine. An extensive search of the literature failed to reveal any prior reports of a similar nature. This case is being reported because of its rarity and the complete recovery made by the patient.

Profile of paediatric emergency cases in Yemen: the need for evidence-based guidelines

This study describes the status and characteristics of children presenting to emergency services in hospitals and health centres in Yemen in order to inform the development of guidelines for paediatric emergency services. Information was collected from 7 hospitals and 2 health centres in 5 governorates about 3454 cases, mostly aged < 2 years old. The majority of paediatric emergency cases were due to respiratory system problems [28.6%] and gastrointestinal problems [25.5%]; 36.4% of children presented with a duration of complaint exceeding 4 days. One-third of cases [33.2%] were treated with 3rd generation cephalosporins alone or in combination with other antibiotics. The mortality rate was 1.9%. The most important causes of death were cardiac and respiratory failure

Prevalence of malaria and types of plasmodium in patients presenting with fever to the health center in Hajer Valley, Hadromout, Yemen

To determine the prevalence of malaria and the species of Plasmodium causing the disease in patients presenting with fever to the health center in Hajer Valley, Hadramout, Yemen. A record-based descriptive study was done in the health center in Hajer Valley, Hadramout Governorate during a one year period from January 2000 to December 2000. The 3653 patients presenting with fever were investigated in the laboratory unit for malaria using thick and thin blood films additionally, information about age and gender were collected. A range of the patients was from 0-65. There were 3653 febrile cases [males 1886, females 1767] submitted for malaria examinations. Of these, 1212 [33.2%] were malaria parasite positive, 691 [57%] of them were males and 521 [43%] were females. Infants constituted 8%, those 1-4 years 27% and those 5-14 years 27% Plasmodium falciparum represented 97% of the positive malaria cases and Plasmodium vivax 3%. Hajer Valley is a high-risk area for malaria transmission, and the predominant species was Plasmodium falciparum. The majority of the patients were males. Malaria infected all ages, but it was more common in the age groups from 0-14 years. We strongly recommend all febrile cases, in this area, to be treated with anitmalarial drugs. More effort are needed to control for this problem in Hajer Valley in order to reduce the rate of infection with malaria parasites

Effect of breastfeeding on growth in Ifemeni infants

To estimate the prevalence of effective breastfeeding [EBF] practice and its association with weight of young infants, mothers education, employment status, and parity. The study is a cross-sectional, conducted in Dula Health Center in Sanaa city, the capital of Yemen during the year 2003. Six hundred and twenty-one mothers and their exclusively breastfed apparently healthy infants attended to the health center for immunization were enrolled in the study. Effective breastfeeding was evaluated according to the World Health Organization integrated management of childhood illnesses literature. Weight was measured using Seca scale. We conducted interview to investigate the age of the child, parity, employment status, and education of the mother. The mean age of infants was 49.7 +/- 16.8 days. The prevalence of EBF was 16.9% [n = 105]. Good positioning was observed in 26.7% [n=l66], followed by good suckling in 23.7% [n=l47] and finally by good attachment in 20.3% [n=126]. The mean weight of EBF infants was 3.9 +/- 0.5 kg, whereas that of the ineffectively breastfed gtoutp was 3.5 +/- 0.5 kg [P<0.000l]. The 2 groups were compared with gender and age matched. The mean weight of well-attached infants was 3.8 +/- 0.55 kg and for those with good suckling was 3.8 +/- 0.55 kg and for those with good positioning was 3.7 +/- 0.59 kg. No association was found between EBF with mother's education and employment status while parity was positively related to EBF rate. Prevalence of EBF is low. Infants with EBF are heavier than the ineffectively breast-fed infants

Malaria signs and infection rate among asymptomatic schoolchildren in Hajr valley, Yemen

This study recorded malaria signs and the rate of parasitaemia among asymptomatic schoolchildren in Hajr valley, Hadhramout governorate, Yemen. Tests were made for malaria parasites and anaemia in 469 randomly selected primary-school children aged 6-11 years, together with clinical examination to determine spleen size, and interviews to study sociodemographic factors. Of the children, 12.8% had positive malaria blood films and 11.3% had spleen enlargement. There were significant associations between malaria infection, anaemia and splenomegaly and fever. Children with malaria parasitaemia were more often absent from school

Peripheral neuropathy in thalasemia

Patients with thalassemia may complain of numbness and weakness of the lower extremities. The aim of the study was to document whether these patients suffer from a polyneuropathy and to determine any contributing factors for the development of neuropathy. We examined 30 patients with thalassemia major and intermedia, clinically and electrophysiologically. We corre_lated these findings with demographics, blood status, and treatment and compared electrophysiologic data with 30 age- and sex-matched normal subjects or historical controls. We found that 78% of thalassemic patients suffered from a mild sensory polyneuropathy. The neuropathy seemed to be worse in the intermedia type. Thalassemic patients who received blood transfusions and deferoxamine had better nerve function than those who did not, irrespective of the dose of deferoxamine. The neuropathy was worse for older patients, irrespective of sex. The hemoglobin level, and the fact that some patients underwent splenectomy, did not affect the status of the patients' nerves. Patients with thalassemia may suffer from a sensory polyneuropathy especially as they grow older and if they are not opti_mally treated

Etiology of hearing in loss in children attended al thawra teaching hospital in sana'a, yemen

To determine the etiology of hearing loss among children presenting at Al-Thawra teaching Hospital in Sana'a, Yemen A total of 580 children with hearing loss attended the ENT out-patient clinic in Al-Thawra Teaching Hospital during the period from January 2003 to December 2004. Patients were examined clinically and investigated by pure tone audiometry, tympanometry and auditory brain stem response [ABR] when indicated. A proportion of 68.3% of children with hearing loss were aged between 5-15 years at presentation. Males were 337 [58.1%] and females were 243 [41.9%]. Of the 385 [66.4%] children who were subjected to pure tone audiometry 282 [73.2%] had profound hearing loss, 71 [18.4%] had severe hearing loss and 32 [8.3%] had moderately severe hearing loss. Causes of hearing loss were: unknown in 238 [41.0%], meningitis in 122 [21.0%], hereditary in 76 [13.1%], ototoxicity in 47 [8.1%] and febrile convulsion in 3.5 [6.0%]. Consanguinity was recorded in the parents of 309 [53.3%] children. Of them 192 [62.1%] married to their first cousins and 117 [37.9%] to their relatives. The highest range of presentation of children with hearing loss was between 5-15 years old. The most common causes were unknown, meningitis, hereditary and ototoxicity. Consanguinity was reported by more than half of the parents. Majority of the children were with profound type of hearing loss

Frequency of intestinal parasites in children presenting with diarrhea and/or abdominal pain to Sam hospital, Sana'a, Republic of Yemen

To detect the frequency of intestinal parasites in children presenting with diarrhea and/or abdominal pain to Sam Hospital, Sana'a, Republic of Yemen. A record-based study was performed during a one year period from January 1, 2003 to December 31, 2003. The total number of patients seen for differnt causes through that period was 24100. The charts of those children with diarrhea and/or abdominal pain or discomfort who were referred to the laboratory unit for stool examination were analyzed. A normal saline sedimentation technique was adopted for stool examination. Normal ethyl acetate sedimentation or direct smear methods were also used when necessary. Data about age and sex were collected. The ages of the patients ranged from 2 months to 15 years. Stool examination was carried out in 2824 patients; 1703 [60.3%] of them were males and 1121 [39.7%] were females. Six hundred sixty [23.4%] specimens were parasite positive. Of these, 286 [10.1%] were Entamoeba histolytica, 266 [9.4%] Giardia lamblia, 52 [[1.8%] Hymenolepis nana, 27 [1%] Schistsoma mansoni, 20 [0.7%] Ascaris, 5 [0.2%] Enterobius, and 4 [0.1%] Trichuris trichiura. The majority of the patients were males. The most frequently found found intestinal parasites in children were Entamoeba histolytica followed by Giardia, H. nana, Schistosoma mansoni, and Ascaris