[Medial discoid meniscus in a pediatric patient. Case report and review of the literature]. / Menisco discoide medial en paciente pediátrico. Presentación de un caso y revisión de la literatura.

Discoid meniscus is a congenital morphological variant of the meniscus, which tends to occur more frequently in its lateral form than in the medial form. This anomaly is characterized by central hypertrophy of the meniscus and a larger diameter than the normal meniscus, resulting in an abnormal shape and greater coverage of the tibial plateau. The clinical presentation of this condition varies depending on the stability of the meniscus. In pediatric patients, in particular, it is common to experience progressive and atraumatic symptoms, such as pain and limited mobility. Diagnosis is based on imaging studies, with magnetic resonance imaging being the preferred tool, where the "bowtie sign" is a classic finding. Surgery is recommended for symptomatic patients, with a focus on preserving the peripheral portion of the meniscus. Saucerization is the most commonly used technique, followed by stability assessment to determine if additional procedures are required. In this case, a 9-year-old patient with a medial discoid meniscus presented symptoms following trauma. Despite this atypical presentation, a successful outcome was achieved through arthroscopic surgery, underscoring the importance of accurate diagnosis and proper management of this condition in pediatric patients. Understanding the anatomical and pathophysiological characteristics of the discoid meniscus is essential for an effective therapeutic approach.

El menisco discoide es una variante morfológica congénita del menisco, que suele presentarse con mayor frecuencia en su forma lateral que en la medial. Esta anomalía se caracteriza por la hipertrofia central del menisco y un diámetro mayor que el menisco normal, lo que resulta en una forma anormal y una mayor cobertura del platillo tibial. La presentación clínica de esta condición varía según la estabilidad del menisco. En pacientes pediátricos, en particular, es común experimentar síntomas progresivos y atraumáticos, como dolor y limitación de la movilidad. El diagnóstico se basa en estudios de imagen, siendo la resonancia magnética la herramienta preferida, donde el "signo del corbatín" es un hallazgo clásico. Se recomienda la cirugía para pacientes sintomáticos, con un enfoque en preservar la porción periférica del menisco. La saucerización es la técnica más utilizada, seguida de la evaluación de la estabilidad para determinar si se requiere un procedimiento adicional. En el presente caso, se describe a un paciente de nueve años con un menisco discoide medial que manifestó síntomas después de un traumatismo. A pesar de esta presentación atípica, se logró un resultado exitoso mediante una cirugía artroscópica, lo que resalta la importancia de un diagnóstico preciso y un manejo adecuado de esta condición en pacientes pediátricos. La comprensión de las características anatómicas y patofisiológicas del menisco discoide es esencial para un enfoque terapéutico efectivo.

Levels of support for legislative bans to end physical punishment in schools and homes in a national sample.

OBJECTIVES: Physical punishment of children remains quite common and yet has only negative effects on children's health, making it an important public health problem. This study was designed to assess positive attitudes about and perceived normative support for the use of physical punishment with children, as well as attitudes regarding prohibition of physical punishment in homes and schools. STUDY DESIGN: This was a cross-sectional national survey of a diverse sample of US adults (N = 3049). METHODS: This survey, conducted in Fall 2020, assessed attitudes and perceived norms regarding physical punishment use using continuous measures as well as support and perceived support for policies prohibiting physical punishment in homes and schools in the United States. RESULTS: Respondents who had positive attitudes toward physical punishment (39%) and who perceived normative support for physical punishment (41%) were not in the majority. While 65% agreed that there should be a federal ban on physical punishment in public schools, only 18% perceived that most US adults would support such a ban. Persons who were older (aged ≥55 years), men, living in the southern United States, or who themselves were hit more frequently as children were significantly less likely than their counterparts to support a federal ban in schools. CONCLUSIONS: Based on a national sample, there is strong support for a federal ban on physical punishment in US schools; yet this normative belief is unrecognized. Social norms campaigns should capitalize on this pluralistic ignorance to increase mobilization toward policy reform and reduction of harm to children through bans of physical punishment in public schools.

The 2022 monkeypox outbreak: A UK military perspective.

With the emergence of SARS-CoV-2 and now monkeypox, the UK Defence Medical Services have been required to provide rapid advice in the management of patients with airborne high consequence infectious diseases (A-HCID). The Defence Public Health Network (DPHN) cadre, consisting of closely aligned uniformed and civilian public health specialists have worked at pace to provide evidence-based recommendations on the clinical management, public health response and policy for monkeypox, with military medicine and pathology clinicians (primarily infectious disease physicians and medical microbiologists). Military environments can be complicated and nuanced requiring specialist input and advice to non-specialists as well as unit commanders both in the UK and overseas. DPHN and military infection clinicians have close links with the UK National Health Service (NHS) and the UK Health Security Agency (UKHSA), allowing for a dynamic two-way relationship that encompasses patient management, public health response, research and development of both UK military and national guidelines. This is further demonstrated with the Royal Air Force (RAF) Air Transport Isolator (ATI) capability, provided by Defence to support the UK Government and UKHSA. Military infectious disease clinicians are also embedded within NHS A-HCID units. In this manuscript we provide examples of the close interdisciplinary working of the DPHN and Defence clinicians in managing military monkeypox patients, co-ordinating the public health response, advising the Command and developing monkeypox policy for Defence through cross-government partnership. We also highlight the co-operation between civilian and military medical authorities in managing the current outbreak.

Fracturas de húmero proximal: valoración clínica y resultado funcional en pacientes con osteonecrosis de la cabeza humeral / Proximal humerus fractures: clinical assessment and functional outcome in patients with osteonecrosis of the humeral head

Introducción: Las fracturas de húmero proximal de tres o más fragmentos presentan riesgo elevado de necrosis, siendo éste el segundo sitio más frecuente sólo después del fémur, presentándose causas traumáticas y no traumáticas, siendo las traumáticas las más comunes, presentando una incidencia de 13 a 34% en fracturas de más de cuatro fragmentos. El propósito de este estudio es valorar el resultado funcional de pacientes con antecedente de fractura humeral proximal y osteonecrosis con manejo conservador. Material y métodos: Se presenta un estudio descriptivo, retrospectivo, observacional con seguimiento de 6 a 12 meses de pacientes mayores de 60 años con diagnóstico de fractura de húmero proximal con manejo conservador, en el período comprendido de Enero de 2004 a Noviembre de 2009, se seleccionaron 122 pacientes que cumplían los criterios de inclusión, perdiendo el seguimiento de 12 de ellos, con edad promedio de 71.02 años con rango de 60 a 92 años, 41 hombres y 69 mujeres, realizándose escalas de DASH y CONSTANT. Resultados: Posterior a la realización de las escalas de valoración funcional se realiza la validación de dichos resultados obteniendo un coeficiente de correlación de 0.80 siendo estadísticamente significativo. Conclusión: El tratamiento conservador debe ser reservado sólo en pacientes que cumplan con las características necesarias. Dependiendo del tipo de fractura y las características del individuo, el tratamiento siempre está enfocado a la estabilización y a la movilización temprana y en la obtención de la recuperación funcional precoz. Encontrando en este estudio que las fracturas tratadas de forma conservadora, desarrollan algún estadio de osteonecrosis de la cabeza pero con adecuada función casi similar a la extremidad sana.

Introduction: Fractures of the proximal humerus resulting in three or more fragments represent a high risk of necrosis. The former is the second most frequent site of necrosis, only after the femur, due to either traumatic or nontraumatic causes. The former are the most common, with an incidence rate of necrosis of 13-34% in fractures with more than four fragments. The purpose of this study is to assess the functional outcome of patients with a history of fracture of the proximal humerus and osteonecrosis treated conservatively. Material and methods: This is a descriptive, retrospective, observational study with a 6-12 month follow-up of patients older than 60 years of age with a diagnosis of fracture of the proximal humerus managed conservatively between January 2004 and November 2009. One hundred and twenty-two patients met the inclusion criteria and 12 were lost to follow-up. Mean age was 71.02 years with a range between 60 and 92 years; 41 males and 69 females. The DASH and CONSTANT scales were applied. Results: After applying the functional assessment scales and validating the results, the correlation coefficient obtained was 0.80, and it was statistically significant. Conclusion: Conservative treatment should be used only in patients who meet the necessary criteria. Depending on the type of fracture and the patient's characteristics, treatment should always be aimed at stabilization, early mobilization, and early functional recovery. This study found that fractures treated conservatively eventually develop some degree of osteonecrosis of the head, but they have proper function, similar to that of a healthy limb.

[Proximal humerus fractures: clinical assessment and functional outcome in patients with osteonecrosis of the humeral head]. / Fracturas de húmero proximal: valoración clínica y resultado funcional en pacientes con osteonecrosis de la cabeza humeral.

INTRODUCTION: Fractures of the proximal humerus resulting in three or more fragments represent a high risk of necrosis. The former is the second most frequent site of necrosis, only after the femur, due to either traumatic or nontraumatic causes. The former are the most common, with an incidence rate of necrosis of 13-34% in fractures with more than four fragments. The purpose of this study is to assess the functional outcome of patients with a history of fracture of the proximal humerus and osteonecrosis treated conservatively. MATERIAL AND METHODS: This is a descriptive, retrospective, observational study with a 6-12 month follow-up of patients older than 60 years of age with a diagnosis of fracture of the proximal humerus managed conservatively between January 2004 and November 2009. One hundred and twenty-two patients met the inclusion criteria and 12 were lost to follow-up. Mean age was 71.02 years with a range between 60 and 92 years; 41 males and 69 females. The DASH and CONSTANT scales were applied. RESULTS: After applying the functional assessment scales and validating the results, the correlation coefficient obtained was 0.80, and it was statistically significant. CONCLUSION: Conservative treatment should be used only in patients who meet the necessary criteria. Depending on the type of fracture and the patient's characteristics, treatment should always be aimed at stabilization, early mobilization, and early functional recovery. This study found that fractures treated conservatively eventually develop some degree of osteonecrosis of the head, but they have proper function, similar to that of a healthy limb.

Pertussis -- a case finding study amongst returnees from Op Herrick.

We present a case finding study of serologically confirmed Pertussis amongst BFG-based returnees from Op HERRICK. The role of Pertussis in the aetiology of the commonplace "Kabul Cough" is discussed. It is recommended that enhanced health surveillance for Pertussis takes place both during and after future deployments to Afghanistan, to prevent the potential onward transmission of a potentially fatal illness to unimmunised children.

Improvement in efficacy of chemoradiotherapy by addition of an antiangiogenic agent in a murine tumor model.

BACKGROUND: Chemoradiotherapy improves survival for some cancer patients. Methods of enhancing treatment response would further enhance survival rates. The effect of the addition of an antiangiogenic agent to a chemoradiotherapy regime has not previously been examined. MATERIALS AND METHODS: C57B16 mice were inoculated with 1 x 10(6) Lewis lung carcinoma cells into the flank and randomized to 1 of 10 treatment groups when tumor volume approached 1000 mm(3). Animals received combinations of standard doses of intraperitoneal cisplatin, 5-fluorouracil, and the antiangiogenic agent genistein, together with 10 or 20 Gy of external beam radiotherapy. Animals were sacrificed at day 6 when tumor volume, microvessel density, and serum VEGF were determined. RESULTS: Mean (SEM) tumor volume in the chemoradiotherapy group was 762 (212) mm(3) versus 565 (79) mm(3) in the chemoradiotherapy plus genistein group (P = 0.04, unpaired t-test). The addition of genistein produced a significant reduction in tumor microvessel density (P = 0.01) as well as serum VEGF levels (P < 0.05) compared to those animals receiving chemoradiation alone. CONCLUSIONS: This study provides proof of principle that chemoradiation can be enhanced by the addition of an antiangiogenic agent to the regime and suggests that further examination of such regimes is warranted.

Local anaesthetic for transrectal ultrasound-guided prostate biopsy: a prospective, randomized, double blind, placebo-controlled study.

OBJECTIVE: To evaluate the efficacy of local anaesthetic (LA) infiltration in decreasing the discomfort experienced by patients undergoing transrectal ultrasound (TRUS)-guided biopsy of prostate. PATIENTS AND METHODS: 98 patients were randomized to receive 3x3ml of 1% lidocaine (n=55) or saline (n=43). The injection sites were basolaterally on each side to infiltrate the neuro-vascular bundle and one at the apex. Generally 12 systematic random biopsies were performed after which patients were asked to grade the pain of the whole procedure using a visual analogue scale ranging from 0 to 10. RESULTS: The LA group had a significantly lower pain score compared with placebo. The mean pain scores were 3.0 and 4.3 (p<0.001), respectively. Using an unpaired t-test, the difference between means was -1.96 to -0.51 with 95% confidence interval. There were no significant problems associated with the infiltration of either saline or LA. CONCLUSION: Local anaesthesia for TRUS biopsy is simple and well tolerated. It significantly reduces the pain associated with the procedure. We recommend its usage as a part of standard TRUS biopsy of the prostate.

Psychology, religion, and the family: it's time for a revival.

Despite some occasional efforts to link psychology, religion, and the family, psychological research has largely ignored the topic. Three fundamental psychological questions about the role of religion in the family are raised. The publication of the 4 studies in this issue represents a watershed in this area, and these articles provide a model for future research. However, several pitfalls in this area of research are identified. These pitfalls are primarily due to the complexity of religion and heterogeneity associated with it. Four research directions are then recommended. It is concluded that this area is ripe for a research revival.

BB-10010, an analog of macrophage inflammatory protein-1alpha, protects murine small intestine against radiation.

Irradiation of the small intestine can result in depletion of the epithelial stem cell compartment and is often the dose-limiting factor for radiotherapeutic treatment of tumors in the abdominal and pelvic region. Since mitotic cells are most sensitive to radiation, significant radioprotection can be achieved by reducing the number of cells in mitosis at the time of irradiation. We have previously shown that administration of macrophage inflammatory protein (MIP) -1alpha induces a transient 50% reduction in the number of mitotic cells in small intestinal crypts, including the stem cell region, and therefore, MIP-1alpha pretreatment before radiation exposure could result in a substantial reduction of the side effects associated with radiotherapy. Groups of adult mice were exposed to different doses of radiation (6, 8, 10, or 12 Gy), with or without prior administration of 200 microg BB-10010/kg 3 hr before irradiation and radiation damage was assessed by means of the microcolony survival assay. MIP-1alpha pretreatment resulted in significantly increased numbers of surviving crypts (10%) when compared to untreated irradiated animals. The observed radioprotective effects of MIP-1alpha in the small intestine should translate into reduced side effects in a clinically relevant radiotherapy context and could allow larger doses of radiation to be delivered to patients with tumors in the abdominal or pelvic region.

Cognitive-behavioral predictors of asthma morbidity in inner-city children.

Asthma is a growing health problem among children in the United States, particularly in urban, inner-city areas. This article examines the relationship between cognitive-behavioral aspects of asthma management (caretaker asthma knowledge, expectations, and problem-solving) and asthma morbidity in a sample of 1,376 inner-city children with physician-diagnosed asthma. In the analyses, baseline symptom severity served as a covariate, and the average of the 3-, 6-, and 9-month follow-up data served as the outcome measure. Children of caregivers with ineffective problem-solving strategies had significantly more days of wheezing over a 14-day period. Ineffective problem-solving capabilities were also associated with poorer functional status; however, positive caregiver expectations were associated with better functional status. Of the cognitive-behavioral factors studied in a high-risk urban population, caregiver problem-solving skills and expectations emerged as meriting further investigation and possible intervention.

Division of responsibility for asthma management tasks between caregivers and children in the inner city.

This investigation examined caregiver and child perceptions of the division of responsibility for asthma management tasks in families. The study sample included 789 children with asthma, aged 6 to 9 years, who lived in the inner city. These children and their primary caregivers completed the Asthma Responsibility Interview. The correlation between the caregiver's and child's ratings of the child's responsibility was low (.19), with children rating themselves as more responsible than their caregivers rated them. Caregiver and child ratings of the child's responsibility increased with the child's age; however, caregivers' ratings of their own responsibility remained constant over the age range studied. Kappa statistics ranged from -.03 to .12, with up to 16% of children reporting less responsibility for self-care than was indicated by the caregiver. More than one third of families reported four or more asthma caregivers. The discrepancy between the caregiver's and child's perceptions and the involvement of multiple caregivers raise the possibility of unintentional nonadherence.

Enduring and different: a meta-analysis of the similarity in parents' child rearing.

The assessment of child-rearing beliefs and behavior has predominantly focused on qualities and characteristics believed to reflect consistent, enduring qualities of parenting--the similarity in child rearing. This review evaluates the evidence for similarity and differences among 3 types of child-rearing data and includes comparisons across time, children, and situations. Both relative stability and mean level differences were found in all 3 domains. The most similarity was found in the across-time and across-children domains, although it depended on the child-rearing construct and methodology used. It is argued that attention to the variability and change in child rearing must be incorporated into theoretical models of parenting to better understand the nature of child rearing and, in turn, parental influence on children's development.

The hospital social work self-efficacy scale: a partial replication and extension.

The Hospital Social Work Self-Efficacy Scale (HSWSE) was developed to assess social workers' confidence about their ability to perform hospital social work. The scale was originally tested with master's-level social work students. This partial replication and extension included both students and professional social workers. In addition, we used a new scale to assess construct validity and added another hospital to assess external validity. In general, findings continue to support the use of the HSWSE. In addition, anecdotal evidence suggests that this is an outcome measure that practitioners see as easy to use, specific, and highly relevant.

Psychosocial characteristics of inner-city children with asthma: a description of the NCICAS psychosocial protocol. National Cooperative Inner-City Asthma Study.

Previous research has demonstrated a significant reciprocal relationship between psychosocial factors and asthma morbidity in children. The National Cooperative Inner-City Asthma Study investigated both asthma-specific and non-specific psychosocial variables, including asthma knowledge beliefs and management behavior, caregiver and child adjustment, life stress, and social support. This article presents these psychosocial characteristics in 1,528 4-9-year-old asthmatic urban children and their caretakers. Caretakers demonstrated considerable asthma knowledge, averaging 84% correct responses on the Asthma Information Quiz. However, respondents provided less than one helpful response for each hypothetical problem situation involving asthma care, and most respondents had more than one undesirable response, indicating a potentially dangerous or maladaptive action. Both adults and children reported multiple caretakers responsible for asthma management (adult report: average 3.4, including the child); in addition, children rated their responsibility for self-care significantly higher than did adults. Scores on the Child Behavior Checklist indicated increased problems compared to normative samples (57.3 vs. 50, respectively), and 35% of children met the criteria for problems of clinical severity. On the Brief Symptom Inventory, adults reported elevated levels of psychological distress (56.02 vs norm of 50); 50% of caretakers had symptoms of clinical severity. Caretakers also experienced an average of 8.13 undesirable life events in the 12 months preceding the baseline interview. These findings suggest that limited asthma problem-solving skills, multiple asthma managers, child and adult adjustment problems, and high levels of life stress are significant concerns for this group and may place the inner-city children in this study population at increased risk for problems related to adherence to asthma management regimens and for asthma morbidity.