Low radius of curvature growth-friendly rib-based implants increase the risk of developing clinically significant proximal junctional kyphosis.

BACKGROUND: Clinically significant proximal junctional kyphosis (PJK) occurs in 20% of children with scoliosis treated with posterior distraction-based growth-friendly surgery. In an effort to identify modifiable risk factors, it has been theorized biomechanically that low radius of curvature (ROC) implants (i.e., more curved rods) may increase post-operative thoracic kyphosis, and thus may pose a higher risk of developing PJK. We sought to test the hypothesis that early onset scoliosis (EOS) patients treated with low ROC distraction-based implants will have a greater risk of developing clinically significant PJK as compared to those treated with high ROC (straighter) implants. METHODS: We conducted a retrospective review of prospectively collected data obtained from a multi-centre EOS database on children treated with rib-based distraction with a minimum 2-year follow-up. Variables of interest included: implant ROC at index (220 mm or 500 mm), participant age, pre-operative scoliosis, pre-operative kyphosis, and scoliosis etiology. PJK was defined as clinically significant if revision surgery with a superior extension of the upper instrumented vertebrae was performed. RESULTS: In 148 participants with scoliosis, there was a higher risk of clinically significant PJK with low ROC (more curved) rods (OR: 2.6 (95% CI 1.09-5.99), χ2 (1, n = 148) = 4.8, p = 0.03). Participants had a mean pre-operative age of 5.3 years (4.6y 220 mm vs 6.2y 500 mm, p = 0.002). A logistic regression model was created with age as a confounding variable, but it was determined to be not significant (p = 0.6). Scoliosis etiologies included 52 neuromuscular, 52 congenital, 27 idiopathic, 17 syndromic with no significant differences in PJK risk between etiologies (p = 0.07). Overall, participants had pre-op scoliosis of 69° (67° 220 mm vs 72° 500 mm, p = 0.2), and kyphosis of 48° (45° 220 mm vs 51° 500 mm, p = 0.1). The change in thoracic kyphosis pre-operatively to final follow-up (mean 4.0 ± 0.2 years) was higher in participants treated with 220 mm implants compared to 500 mm implants (220 mm: 7.5 ± 2.6° vs 500 mm: - 4.0 ± 3.0°, p = 0.004). CONCLUSIONS: Use of low ROC (more curved) posterior distraction implants is associated with a significantly greater increase in thoracic kyphosis which likely led to a higher risk of developing clinically significant PJK in participants with EOS. LEVEL OF EVIDENCE: Level III - retrospective comparative study.

Prevalence and Predictive Factors of Female Sexual Dysfunction in a Sample of Saudi Women.

INTRODUCTION: Female sexual dysfunction (FSD) is a common health problem that is inadequately investigated in Saudi Arabia. AIM: To assess the prevalence and predictors of FSD in a sample of Saudi women attending the primary care and gynecology clinics. METHODS: A cross-sectional clinic-based survey involved Saudi women attending primary care and gynecology clinics in a teaching hospital in Riyadh during the period from January to June 2019. Data were collected using a structured interview questionnaire. Female sexual function has been evaluated by the Arabic version of the Female Sexual Function Index. MAIN OUTCOME MEASURES: The main outcome measure of this study was female sexual function using the Arabic version of the Female Sexual Function Index. RESULTS: 200 Saudi women were included in this study. Their age ranged from 18 to 50 years. Most of the participants (88.5%) were fairly satisfied or satisfied with their spouse's sexual ability and 120 (60%) had a risk of FSD. Participants with FSD reported the lowest scores for arousal and desire domains (3.03 ± 1.3 and 3.12 ± 1.1, respectively) followed by orgasm domain (3.48 ± 1.4). Predictive factors for risk of FSD in our participants were age greater than 40 years (P = .012), unemployment (P = .035), low/moderate family income (P = .014), dissatisfaction with the spouse's sexual ability (P = .005), and higher weight (P = .010) and height (P = .043). Only age greater than 40 years (P = .041), low family income (P = .007), and dissatisfaction with spouse's sexual ability (P = .011) sustained independent significance in a multivariate logistic regression analysis. CONCLUSION: A high prevalence of FSD was encountered in our sample of Saudi women. Desire and arousal were the most significantly affected domains followed by orgasmic problems. Age greater than 40 years, low socioeconomic level, and dissatisfaction with the spouse's sexual ability are the most significant predictors. Madbouly K, Al-Anazi M, Al-Anazi H, et al. Prevalence and Predictive Factors of Female Sexual Dysfunction in a Sample of Saudi Women. Sex Med 2021;9:100277.

Comparison of peri-implant clinical and radiographic inflammatory parameters and whole salivary destructive inflammatory cytokine profile among obese and non-obese men.

The aim of the present cross-sectional retrospective study was to compare the peri-implant clinical and radiographic inflammatory parameters and whole salivary destructive inflammatory cytokine profile among obese and non-obese men. Thirty-five obese and 37 non-obese men were included. Information regarding age, obesity, systemic health status, and habits was collected using a questionnaire. Clinical examination to evaluate peri-implant parameters and radiographic examination to assess marginal bone loss were conducted. Levels of interleukin (IL)-6 and IL-1ß in collected un-stimulated whole saliva were measured using enzyme-linked immunosorbent assay. Data was statistically analyzed using Kruskal Wallis test. The mean scores of peri-implant bleeding on probing (P<0.05) and peri-implant probing depth (P<0.05) were significantly higher among obese compared with non-obese individuals. The mean marginal bone loss was also statistically significantly higher among individuals in the test-group compared with the control-group (P<0.05). Whole salivary IL-1ß (P<0.001) and IL-6 (P<0.001) levels were significantly higher among individuals in the test-group compared with the control-group. Clinical and radiographic peri-implant inflammatory parameters were worse, and whole salivary IL-6 and IL-1ß were higher in obese than non-obese subjects. Obese patients are at greater risk of peri-implant inflammation than non-obese healthy subjects. It is highly recommended that clinicians should educate obese patients seeking implant treatment regarding the association between obesity and peri-implant inflammation. In addition, obese patients with osseointegrated implants must follow strict oral hygiene regimen to prevent inflammation and maintain optimum peri-implant tissue health.

T1 and T2 ADAM33 single nucleotide polymorphisms and the risk of childhood asthma in a Saudi Arabian population: a pilot study.

BACKGROUND AND OBJECTIVES: Genetic association studies have demonstrated that over 100 variants in target genes (including ADAM33) are associated with airway remodeling and hyper-responsiveness in different ethnic groups; however, this has never been evaluated in Arabic populations. The objective of this study was to determine whether ADAM33 polymorphisms that are associated with asthma in a population of asthmatic children from Saudi Arabia. DESIGN AND SETTING: A cross-sectional pilot study comparing the polymorphisms of normal subjects and asthmatic patients from Saudi Arabia over a period of 1 year. PATIENTS AND METHODS: One hundred and seven Saudi asthmatic children and 87 healthy Saudi children of 3-12 years old were assessed for allelic association of ADAM33 T1 (rs2280091), T2 (rs2280090), ST+4 (rs44707) and S1 (rs3918396) SNPs to asthma. Genotyping was done by real-time PCR, multiplex ARMS and PCR-RFLP. RESULTS: T1 and T2 SNP genotype frequencies in asthmatic children were significantly different compared to controls (P < .05), indicating allelic association with asthma. The T1 A/G and G/G and the T2 A/G and A/A genotypes (P=.0013 and P=.008, respectively) but not S1 and ST+4, increased the risk of asthma when using the best fit dominant model. Strong linkage disequilibrium between T1 (rs2280091) and T2 (rs2280090) was observed (r2=0.83; D'=0.95; P < .001). The haplotype G-A-A-C was significantly more frequent in asthmatics, thus supporting the association of T1 G-allele and T2 A-allele with increased predisposition to asthma (P=.007). CONCLUSIONS: T1 A/G and T2 G/A ADAM33 polymorphisms, but not S1 or ST+4, were significantly associated with asthma development in Saudi children, like those reported for white and Hispanic populations in the United States.