Disability and Quality of Life After Talectomy for Arthrogryposis Multiplex Congenita.

BACKGROUND: Arthrogryposis multiplex congenita (AMC) is one of the causes of rigid and resistant clubfoot. Talectomy is considered as a primary or salvage procedure for recurrent equinovarus deformity in these patients. We conducted this study to assess patients with AMC who underwent talectomy for the correction of foot and ankle deformities in terms of health-related quality of life and disability. METHODS: Patients under 10 years of age with a primary diagnosis of AMC who underwent talectomy and attended follow-up for at least 5 years were included in this study. We also formed an age- and gender-matched control group consisting of 20 individuals without any foot-ankle problem in order to compare the measurements between the AMC and healthy groups. Oxford Ankle Foot Questionnaire (OxAFQ) was administered as a health-related quality of life instrument to objectively measure the disability of the pediatric patients. RESULTS: Twenty patients (10 girls, 10 boys) who underwent a total of 35 talectomy operations with an average follow-up of 7.2 years and a control group of 20 similarly aged unaffected children were included in the study. The mean OxAFQ scores were significantly lower in the AMC group than in the controls for all domains (physical, emotional, and school and play), especially for the one concerning satisfaction with footwear The presence of plantigrade foot and absence of forefoot supination were significantly associated with the physical and footwear domains of the OxAFQ scores. The presence of hindfoot varus, midfoot adductus, dorsal bunion, and having less than 10 degrees of dorsiflexion had no effect on the OxAFQ scores. CONCLUSION: In this study, we found that the major driving factors for satisfaction after talectomy for AMC were plantigrade foot and absence of forefoot supination. The mean OxAFQ scores were universally lower in the AMC group than controls. Finding comfortable footwear is a major concern for the AMC patients. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Could serum S100B be a predictor of neuronal damage and clinical poor outcomes associated with the use of synthetic cannabinoids? S100B to predict neuronal damage of SC in the ED.

AIM: This study aims to evaluate the serum S100B levels to predict neuronal damage and poor clinical outcomes associated with the use of synthetic cannabinoids. METHOD: Thirty patients identified as synthetic cannabinoid users and 30 healthy controls were included in the study. S100B levels were compared between healthy controls and synthetic cannabinoid users. The following were considered to be composite outcomes: the need for endotracheal intubation, incidence of seizures, the need for intensive care unit admission, and in-hospital mortality. Clinical and laboratory findings associated with composite clinical outcomes were examined. RESULTS: The mean S100B level was 19.3 (95% CI: 17.7 to 21.4) pg/mL in patients who use synthetic cannabinoid, and 15.9 (95% CI: 15 to 16.9) pg/mL in the controls; mean df: -3.6 (95% CI: -5.6 to -1.6). In patients with and without composite clinical outcomes, the mean S100B level measured 24.5 (95% CI: 21.2 to 27.9) pg/mL and 17.4 (95% CI: 15.8 to 18.4) pg/mL, respectively; mean df: -7.4 (95% CI: -10.2 to -4.6). With the cut-off value for S100B set at 20pg/mL based on the highest sensitivity, the sensitivity, specificity, PPV, and NPV for S100B were 89.9%, 52.0%, 44.4%, and 91.9%, respectively; odds ratio: 13.2, 95% CI (2.1 to 28.1). CONCLUSION: Our data suggest that serum S100B levels are elevated in patients using synthetic cannabinoids. These results show that S100B can help clinicians stratify risk or may have a role in excluding those with neuronal damage.