The Association Between Gonarthrosis Pain Severity and Radiographic Findings on X-Ray: A Cross-Sectional Study.

INTRODUCTION: Knee osteoarthritis (KOA) is a degenerative joint disease that progresses over time due to articular cartilage loss. Orthopedic surgeons use plain radiography (X-ray) with an anteroposterior (AP) standing (weight-bearing) view, which is currently considered the gold standard modality, to diagnose KOA. They base this diagnosis on the clinical history and physical examination of the knee joint. However, many previous studies have reported a weak correlation between knee-joint structural abnormalities on X-rays and described pain. Therefore, our study aimed to assess the incompatibility between patients' pain-severity complaints and radiographic findings on standing AP view. No similar study has been recently published in the Middle East. METHODS: 158 participants were selected for the study from King Abdulaziz University Hospital, Jeddah, between March 2022 and August 2022. We graded the patients' AP knee radiographs using the Kellgren-Lawrence (KL) grading scale and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, by which we made phone calls to assess pain severity on a 0-10 pain subscale. RESULTS: We found a significant association between the 0-10 pain subscale and WOMAC questions describing difficulty in sitting (p < 0.05). Comparing KL scores on X-ray on a 0-10 pain subscale, we found a significant association between mild pain and severe radiological findings on X-ray and vice versa. In addition, the comparison between KL scores on X-ray and WOMAC questions describing difficulty in sitting showed a significant association between moderate difficulty in sitting and severe radiological findings and vice versa. CONCLUSION: Our results indicated that there was a significant relationship between mild pain and severe radiological findings on X-rays and vice versa. Additionally, there was a significant relationship, based on the KL score and the WOMAC item that assessed sitting difficulty, between moderate sitting difficulty and severe radiological findings and vice versa. This may suggest that central and peripheral sensitization could be one factor in the causes of pain.

The Frequency of Vitamin D and Calcium Deficiencies Among Women of Reproductive Age in Wadi Etba, Southern Region of Libya.

Background Vitamin D (VD) is the sunshine vitamin. Its deficiency is widely spread worldwide and is implicated in various health problems that have serious financial, mental, and physical health burdens. In Libya, it also has a high incidence as many studies have been conducted on this issue, but the exact situation of VD deficiency in the southern region of Libya remains unclear. Aim  The aim of this study is to investigate the frequency of VD deficiency and calcium status among females of reproductive age in Wadi Etba (located in the southern region of Libya). Material and methods This study included 622 females aged 20-40 years attending the Rural Hospital and Private Clinics in Wadi Etba for various health issues during the last five years. The study population was further subdivided into two age groups; 20-30 years and 31-40 years. VD and calcium were measured to determine the VD status among the study population. Results In general, 489 females had sub-optimal VD (<30 ng/mL), representing 78.6% of the total subjects. Normal VD levels were represented only by 133 subjects (21.4%). VD deficiency was represented by 354 subjects (57%) of the total subjects. A total of 232 (37%) subjects were VD-deficient females (18.3 ± 5.5 ng/ml), 122 subjects (20%) were considered poor (severe deficient, VD <10 ng/ml) represented with a mean serum VD of 8.2 ± 0.6. Furthermore, deficiency cases dominated the older age group. Regarding calcium (Ca+2) levels, 31% had lower than the normal range, 68% had normal range, and only 1% showed high Ca+2 levels. On the other hand, there was no correlation between serum levels of VD and Ca+2 levels. Conclusion VD deficiency has become a widespread condition in the southern region of Libya. Therefore, we recommended making lifestyle changes, including extending the exposure time to the sunlight radiation, fortifying foods and drinks with VD, and taking supplementary doses of VD to reduce the high incidence of VD deficiency.

Environmental risk assessment associated with acidic volcanics in Egypt.

The present work aims to study gamma rays emitted by radionuclides such as 238U, 232Th and 40K from acidic Monqul volcanics. The studied volcanics are represented by a thick stratified lava flows interbanded with their pyroclastics. They are composed of thick lava flows of andesite and, to a lesser extent of basalt, and acidic volcanics including rhyolite and dacite. The average values of 238U, 232Th and 40K are (46 ± 24 Bq kg-1), (62 ± 11 Bq kg-1) and (1227 ± 318 Bq kg-1) in the rhyolite-dacite samples are greater than the worldwide average. The variation of radioactive bearing minerals observed inside granite faults produced the great amounts of radioactivity perceived in the samples. Calculating radiological risks is used to assess the public's radioactive risk from radionuclides revealed in the studied Rhyolite-dacite samples. The acceptable limit for excess lifetime cancer (ELCR) evaluations has been exceeded. As a result, Rhyolite-dacite are inappropriate for apply in building materials.

Potentially harmful elements in urban surface deposited sediment of Ekaterinburg, Russia: Occurrence, source appointment and risk assessment.

In this study, the human health risks of potentially harmful elements (PHEs) in urban surface deposited sediments (USDS) were examined by collecting urban dust samples, measuring their PHE concentrations, and using index evaluation. About 35, 12 and 16 samples are represented a green zones, roads, driveways and sidewalks in residential areas of Ekaterinburg, respectively. The dust fraction (0.002-0.1 mm) was obtained by sieving, filtration, and decantation process. Total concentrations of 10 PHEs were measured using inductively coupled plasma mass spectrometry. The highest concentrations of Pb were found in USDS from green zones, while Fe, V, Mn, Co, Ni, Sn, and Sb on roads, Cu and Zn on driveways and sidewalks. The contamination levels in the investigated land-use areas were studied, where the highest contamination was contributed from Sb in the driveways and sidewalk. Moreover, the pollution in the studied zones was a high load, contributing to anthropogenic activities and traffic emissions. No non-cancerogenic risk was attributed from the PHEs based on the results of health indices (HI < 1) for both adult and children, except Co and Ni which has HI > 1 for children. The total carcinogenic risk (TLCR) in all urban landscape areas is defined as a high potential inhalation exposure and a low potential ingestion and dermal exposure.

Prevalence and Risk Factors for Acute Kidney Injury Among Adults Undergoing Cardiac Interventions in King Abdulaziz University Hospital: A Retrospective Review.

Background Acute kidney injury (AKI) is a syndrome that has been receiving considerable attention as a common risk in cardiac surgeries, which has consequences for short- and long-term survival implications, even for those who do not progress to renal failure. There have been limited studies in the Middle East, and specifically in the Kingdom of Saudi Arabia (KSA). Therefore, our study aimed to identify the prevalence of and risk factors for AKIs following adult cardiac interventions during 2010-2020 at the King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. Methods Setting and Design: A retrospective medical record review was conducted among all the adult patients who underwent cardiac interventions and developed AKIs between 2010 and 2020. Google forms were used to extract the data from the hospital records. About statistical analysis binary logistic regression analyses, relative risks (RRs), and confidence intervals (CI) were used to determine the associations among the variables. Results After applying the inclusion and exclusion criteria, 564 patients were included. Their baseline demographic, clinical, biological, and operative characteristics were analyzed. AKIs developed in 110 (19.5%) patients and patients with diabetes were more likely to develop AKIs (P < 0.012, RR = 2.280, CI = 1.198-4.339). Hypertension showed a strong effect in the development of AKIs (P < 0.004, RR = 2.865, CI = 1.391-5.900). Moreover, patients who suffered from chronic heart failure were more prone to the development of AKIs (P < 0.008, RR = 4.189, CI =1.452-12.087). Furthermore, anemia with significant P-values (<0.002), and CIs of 1.509-6.822, indicated that these patients were more likely to develop AKIs (3.209 times). Conclusion We demonstrated that AKIs are frequent complications in adults after cardiac interventions and were associated with poor outcomes. Risk factors for the development of AKIs were identified to be diabetes mellitus, hypertension, chronic heart failure, and anemia. Further investigation of this cohort is necessary to better understand the problem of kidney injuries.

Antibiotic resistance in patients with urinary tract infections in Pakistan.

BACKGROUND: The level of antibiotic resistance of pathogens causing uncomplicated urinary tract infections (UTIs) is increasing. The 2017-2018 GLASS (Global Antimicrobial Resistance and Use Surveillance System) report indicated >70% resistance to ceftriaxone and ciprofloxacin in Escherichia coli in Pakistan. METHODS: A prospective study was conducted in the Médecins Sans Frontières (MSF) supported Timurgara District Hospital, Timurgara, Pakistan, from September 2017 to December 2018. Women aged 18-65 years presenting to the Emergency Department with symptoms of uncomplicated UTI (cystitis/pyelonephritis) were invited to participate. We conducted microbiological culture and sensitivity testing for samples with positive dipstick or nitrite test. RESULTS: Of the 200 patients who participated, 109 (54.5%) were diagnosed with pyelonephritis and 91 (45.5%) with cystitis. Forty-three samples (21.5%) were culture-positive: E. coli was isolated in 27 samples, Enterococcus spp. in 7 and Klebsiella pneumoniae in 6. Overall resistance to ciprofloxacin was observed in 51.8% of E. coli isolates, and ceftriaxone resistance in 66.7% of E. coli isolates and in 33.3% of K. pneumoniae. Resistance to fosfomycin was low (one E. coli isolate). CONCLUSIONS: This study found resistance to first- and second-line antibiotics for treating UTIs as per the MSF protocol. Heightened awareness and potential changes to local prescription practices are necessary to curb the spread of antimicrobial resistance pathogens causing UTIs.

OBJECTIF: Le taux de résistance aux antibiotiques des pathogènes responsables d'infections urinaires non compliquées (UTI) est en hausse. Le rapport GLASS (Global Antimicrobial Resistance and Use Surveillance System) 2017­2018 a indiqué un taux de résistance >70% à la ceftriaxone et à la ciprofloxacine chez Escherichia coli (Pakistan). MÉTHODES: Une étude prospective a été réalisée dans l'hôpital du district de Timurgara géré par Médecins Sans Frontières (MSF), de septembre 2017 à décembre 2018. Les femmes de 18­65 ans consultant aux Urgences avec des symptômes d'UTI non compliquée (cystite/pyélonéphrite) ont été invitées à participer. Nous avons réalisé une culture microbiologique et un test de sensibilité pour les échantillons positifs à la bandelette urinaire et au test de détection des nitrites. RÉSULTATS: Deux cents patients ont participé, dont 109 (54,5%) avaient un diagnostic de pyélonéphrite et 91 (45,5%) un diagnostic de cystite. Quarante-trois échantillons (21,5%) étaient positifs à la culture ; E. coli a été isolé de 27 échantillons, Enterococcus spp. de sept échantillons et Klebsiella pneumoniae de six échantillons. Une résistance à la ciprofloxacine a été observée chez 51,8% des isolats de E. coli, et une résistance à la ceftriaxone chez 66,7% des isolats de E. coli et chez 33,3% des isolats de K. pneumoniae. La résistance à la fosfomycine était faible (un isolat de E. coli). CONCLUSIONS: Cette étude a rapporté une résistance aux antibiotiques de première et deuxième intention utilisés dans le traitement des UTI, conformément au protocole de MSF. Une sensibilisation accrue et un éventuel changement des pratiques locales de prescription sont nécessaires pour freiner la propagation des pathogènes responsables d'UTI résistants aux antimicrobiens.

Efficacy and Safety of Thromboprophylaxis Post-Orthopedic Surgery.

Given the high risk of venous thromboembolism (VTE) post-orthopedic surgery and the vital role of thromboprophylaxis in preventing VTEs, this meta-analysis aimed to assess the efficacy of thromboprophylaxis post major orthopedic surgery and the relevant safety measures. In this review, we conducted a computer-aided search of Google Scholar, PubMed, CINAHL, Cochrane, Medline, and EMBASE databases. We included all published randomized clinical trials (RCTs) that utilized enoxaparin, fondaparinux, dabigatran, rivaroxaban, apixaban, and aspirin for VTE prophylaxis in patients undergoing total hip arthroplasty (THA), hip fracture surgery, and total knee arthroplasty (TKA) based on primary and secondary outcomes. The Cochrane Collaboration tool was used to evaluate the risk of bias. All statistical analyses were performed using Review Manager Software. A total of 23 RCTs were included with a total sample of 48,424 patients and an overall low risk of bias. The efficacy of enoxaparin in preventing VTEs in the TKA group was significantly better than fondaparinux. In the THA group, the efficacy of enoxaparin was significantly better than apixaban. The efficacies of fondaparinux, dabigatran, rivaroxaban, apixaban, and aspirin were comparable to that of enoxaparin in reducing VTE-associated mortality, major bleeding, and adverse events. In conclusion, we found that all included drugs were non-inferior to enoxaparin in VTE-associated mortality, major bleeding, and adverse events.

Perception of Parents Towards COVID-19 Vaccine for Children in Saudi Population.

Background Coronavirus disease 2019 (COVID-19) is a contagious disease that is caused by severe acute respiratory coronavirus 2 (SARS-CoV-2). With the rapid spread of this pandemic, vaccination has been a breakthrough solution. At the time of conducting the study, COVID-19 vaccines were only approved for adults 18 years and older. Therefore, the aim of the study was to assess the parents' likelihood of vaccinating their children once the recommendation for pediatric vaccination is established. Methods This was a cross-sectional study in which a self-administered survey was distributed to all parents visiting National Guard primary healthcare centers in Riyadh, Saudi Arabia. The questionnaires were distributed to parents attending primary care clinics. Data collected in the questionnaire include demographics (gender, marital status, educational level, and age), questions assessing parental perception towards the COVID-19 vaccine, and willingness to offer the vaccine to their children. Results A total of 333 respondents completed the survey with a response rate of 83.3%. Half of the participants were males and the other half were females with the majority (45.6%) aged between 31 and 40 years old. In terms of parental acceptability of vaccinating their children against COVID-19, 53.7% of the parents were willing to vaccinate their children as opposed to 27% who were reluctant to do so. Of those who refused, 97.5% and 96.6% cited lack of information and evidence, respectively, as the most common reasons for not accepting COVID-19 vaccine. We have found that age of the parents, especially those 31-40 years old, age of their children, especially 4-12 years old, and previous acceptance of the seasonal influenza vaccine were significantly associated with higher parental acceptability of COVID-19 vaccine. In contrast, gender, marital status and educational level were not statistically significant factors. Conclusion As COVID-19 spread globally and made people's lives in danger, vaccination became a highly important measure to halt the spread of the disease. Parents are now given the choice of protecting their beloved children from COVID-19 infection and its possible complications. Based on our findings, we noticed that majority of parents are going to vaccinate their children. In addition, some certain age groups of parents and children were significantly associated with decreased vaccine hesitancy to take the COVID-19 vaccine.

Factors and Determinants for Uptake of COVID-19 Vaccine in a Medical University in Riyadh, Saudi Arabia.

Background The coronavirus disease 2019 (COVID-19), which is also known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is an infection that is caused by the novel coronavirus. COVID-19 has severely affected the public health by causing more than 200 million cases and four million deaths worldwide. There are, presently, no specific antiviral treatments for COVID-19. As immunization is one of the most successful and cost-effective health interventions to prevent this infectious disease, a number of vaccines, around 112, have been developed. In Saudi Arabia, many vaccination campaigns have already started. There are currently four approved COVID-19 vaccines but only three are available for use in Saudi Arabia. Methods This was a cross-sectional study in which a web-based survey was distributed to medical students in their clinical years at the College of Medicine in King Saud bin Abdulaziz University, Riyadh, Saudi Arabia. A total of 209 questionnaires were distributed. The survey assessed the demographic data, perception towards COVID-19 vaccine, barriers and predictors for accepting COVID-19 vaccine. Results Two-hundred and four respondents completed the survey with a response rate of 96.7%. Overall, 118 of the participants were males and 86 were females. Sixty-six percent of our participants had taken the vaccine. Of those, males and females were distributed equally in half. Fifty-three percent of the participants who had taken the vaccine aged 21-23. This age group had a significant effect on acceptance of the vaccine. Most common deterrent to taking COVID-19 vaccine was safety issues despite not having a statistical significance. In terms of motivators, the majority thought that fear of getting COVID-19 infection was the most important motivator to taking COVID-19 vaccine, which was statistically significant as well. Conclusion In the setting of spreading COVID-19 infection, the vaccine is still the solution to halting infection spread. Based on our findings, we see that there was a high acceptance rate (66.2%) of COVID-19 vaccine.

Physician's Perception Toward Using Telemedicine During COVID-19 Pandemic in King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Introduction The novel coronavirus, officially known as COVID-19, was first reported in Wuhan, China, in December of 2019. Since that time, medical services in Saudi Arabia have adapted to the situation by delivering medical care via virtual clinics. Therefore, the aim of the study is to assess physicians' perception and the level of satisfaction with telemedicine during the COVID-19 pandemic in Riyadh, Saudi Arabia. Methods This was a cross-sectional study that included family medicine consultants and fellows who had used telemedicine in primary health care centers in Riyadh, Saudi Arabia. It was conducted using an online validated questionnaire. The questionnaire was completed by 219 family medicine consultants and fellows, after obtaining their informed consent. The data that were extracted from the questionnaire included demographics, level of satisfaction, and questions related to their experience with telemedicine. Results Two hundred and nineteen participants enrolled in this study with 50.6% males and 49.4% females. The overall level of physicians' satisfaction with telemedicine was 64.3%. However, only one-third preferred telemedicine over office visits. Of these, 60% were males and 40% were females. The only factor that had a statistically significant effect on the preference of office visits or telemedicine was time efficiency (p-value < 0.001). Of those who preferred office visits over telemedicine, 52% of them cited ease of discussion and the ability to make a comprehensive physical examination as the most important reasons for choosing office visits. Technologic issues were the least important factor for choosing either clinic (4.1%). Of those who preferred telemedicine, avoiding contact with patients suspected of COVID-19 was the most commonly cited factor (27.4%). Family medicine physicians face multiple barriers while using telemedicine during the COVID-19 pandemic. The most commonly cited barrier was the inability to make a full and comprehensive assessment of the patient. Conclusions In the setting of highly transmissible disease epidemics, telemedicine has a lot of potential for providing quick and safe care that is appropriate for screening and management. Based on our findings, using telemedicine should be encouraged by improving physicians' skills in this field since telemedicine is a crucial step to reduce the risk of COVID-19 transmission and provide community-wide treatment.

Factors and Determinants of Choosing Pathology as a Future Career: Results From a Multi-Institution Study.

Background Globally, less than 10% of graduating medical students select pathology as a future career. Many factors were reported from different settings to influence the choice of pathology. The aim of this study was to investigate the factors that determine medical students' preferences in choosing pathology as a future career. Methods This cross-sectional study surveyed students from three governmental medical schools in Riyadh, Saudi Arabia. A self-administered questionnaire that contained demographic questions and items that addressed perceived factors that affect the choice of pathology was distributed to medical students. Collected data were analyzed using Statistical Product and Service Solutions (SPSS) Statistics for Windows, Version 25.0 (Armonk, NY: IBM Corp). A chi-square test was used to determine the association between independent variables and interest in pathology. Results Out of the 400 questionnaires distributed, 338 students completed the survey with a response rate of 84.5%. Overall, surgery (24%) and internal medicine (20%) were the most favored, specialties with only 5% of the students selecting pathology as their first choice. Patient-doctor interaction (72.2%) was perceived as the most important factor in not choosing pathology as a future career. Taking an elective course, younger age groups, and year in medical school were all significantly associated (p<0.001) with an interest in pathology. Conclusion In this study, most of the students indicated surgery and internal medicine as their first specialty choices. Only 5% of the students chose pathology as their first choice. Two-thirds of medical students perceived pathologists do not interact with patients. A significant association was found between younger age groups, enrolling for a pathology course, and having an interest in pathology.

Patient satisfaction with virtual clinic during Coronavirus disease (COVID-19) pandemic in primary healthcare, Riyadh, Saudi Arabia.

BACKGROUND: The novel coronavirus, officially known as COVID-19, was first reported in Wuhan, China in December of 2019. Since that time, medical services in Saudi Arabia have adapted to the situation by delivering medical care via virtual clinics. Therefore, the present study aimed to assess patients' level of satisfaction with virtual clinics during the COVID-19 pandemic in Saudi Arabia. MATERIALS AND METHODS: This cross-sectional study was conducted among patients who had experienced virtual clinics in primary healthcare centers in Riyadh, Saudi Arabia. An online validated questionnaire was sent to all participants who had at least one virtual visit between March 2020 to July 2020. The data sought included demographics, level of satisfaction and questions related to their experience with virtual clinics. Computed frequencies and percentages for categorical variables, and median, mean, and standard deviation for continuous variables. Satisfaction scores were compared between groups using Mann-Whitney U test and Kruskal Wallis test. RESULTS: A total of 439 patients completed the questionnaire (response rate 97.5%); 54% were male. The participants were divided into three age groups: 18-39, 40-59, and ≥60 years. Overall level of patients' satisfaction with virtual clinic was 68.1%. Factors statistically significantly associated with satisfaction included gender, age group and level of education (post-graduate and middle school) and being well-informed on the use of telemedicine. Specific age groups that were significant were 18-39 and 40-59 years; 50.2% of the males found telemedicine very convenient, compared to only 36.1% females. Family medicine clinics were the most commonly visited virtual clinics, whereas obstetrics and gynecology clinics were the least attended virtual clinics. The inability to meet the health-care professional face-to-face was reported by 53.8% as the most important disadvantage. CONCLUSION: This study shows a high level of satisfaction with virtual clinics in Saudi Arabia during the COVID-19 pandemic despite the service being relatively new in healthcare service in the country. Our study demonstrated that satisfaction was linked to age, gender, education and the type of clinic used.

A mesoscale finite element modeling approach for understanding brain morphology and material heterogeneity effects in chronic traumatic encephalopathy.

Chronic Traumatic Encephalopathy (CTE) affects a significant portion of athletes in contact sports but is difficult to quantify using clinical examinations and modeling approaches. We use an in silico approach to quantify CTE biomechanics using mesoscale Finite Element (FE) analysis that bridges with macroscale whole head FE analysis. The sulci geometry produces complex stress waves that interact with one another to create increased shear stresses at the sulci depth that are significantly larger than in analyses without sulci (from 0.5 to 18.0 kPa). Sulci peak stress concentration regions coincide with experimentally observed CTE sites documented in the literature. HighlightsSulci introduce stress localizations at their depth in the gray matterSulci stress fields interact to produce stress concentration sites in white matterDifferentiating brain tissue properties did not significantly affect peak stresses.

New Classification System for Cleft Alveolus: A Computed Tomography-based Appraisal.

AIM: The present study proposed a new classification system based on computed tomography (CT) scan appraisal; this enables the surgeon to identify the extent of the defect and helps to execute the proper treatment plan. BACKGROUND: Various terminologies and classifications were proposed to understand developmental defects. But none of the existing classifications/nomenclatures used the preoperative radiographic evaluation (i.e., computed tomography scan-CT scan) in the management and prognosis. Various treatments were advocated and practiced successfully for the surgical correction of lip and palate. MATERIALS AND METHODS: The available CT scans from archives of the Department of Radiology and Oral and Dental Surgery were evaluated (retrospectively) for cleft alveolus and its morphology as per the proposal. The English language literature was searched in the MEDLINE database without date restriction to revise existing literature on numerous classification systems/nomenclatures using MeSH keywords related to cleft lip, palate, alveolus, developmental disturbance, facial clefts, and classification. Existing classification systems were revisited with a note on the drawbacks. After careful examination of morphological patterns of all clefts, the new CT scan-based alveolar cleft classification is proposed depending on the extent of cleft. RESULTS: The literature revealed a total of twenty-nine classifications of cleft lip and palate starting from the year 1922 to the year 2015, but none exclusively classified the cleft alveolus based on CT scan observations. The observation of three thousand CT scans showed five types of cleft alveolus, depending on the extent of involvement. CONCLUSION: The CT scan-based classification is essential to the surgeon for successful surgical planning of cleft alveolus. The proposed classification is clinically relevant in this digital era for relating surgical outcomes. The three-dimensional viewing of a defect is essential for the surgeon for virtual planning. This paper provides a CT scan-based classification for universal acceptance in this era of digital technology, and CT scan aids in achieving these goals. CLINICAL SIGNIFICANCE: The new proposal is based on preoperative evaluation of cleft using a CT scan. CT scan imaging provides a clear picture of the cleft in three dimensions for the operating surgeon. Advanced technology-enhanced surgical management modalities like CAD/CAM guided templates to support graft for successful management. The classification system will help the medical and surgical fraternity in various aspects. The three-dimensional modeling of defect and printing of a defect model using additive manufacturing technology helps the surgeon for presurgical visualization and virtual planning in a better way. This strategy of defect classification using a CT scan will help obtain better clinical outcomes and patient satisfaction.

Exploring the efficacy of melodic intonation therapy with Broca's aphasia in Arabic.

BACKGROUND:  Even though the efficacy of melodic intonation therapy (MIT) with persons with aphasia (PWA) has been explored in different languages, the efficacy of MIT with Arabic-speaking PWA has never been explored. Aims: To explore the efficacy of MIT, adapted to Arabic, in promoting the expressive abilities of a 70-year-old Jordanian Arabic-speaking male subject with severe Broca's aphasia 3 months post-onset. Methods: An 8-week MIT therapy programme with tapping (1.5 h daily, 6 days a week) was used in a multiple baseline design across two types of trained phrases (i.e. automatic and self-generated phrases). Outcome measures included accuracy of production of trained (at the end of each session) and untrained phrases (at the end of each week). Pre- and post-treatment measures used, were the bilingual aphasia test, the American Speech-Language Hearing Association Functional Assessment of Communicative Skills, the communicative effectiveness index and the American Speech and Hearing Association Quality of Communication Life Scale. Accuracy of production for the trained and untrained phrases was also measured 2 weeks and 4 weeks after the treatment programme was finished. Results: The patient, (MK), improved his expressive productions post-treatment in automatic and self-generated phrases. Automatic phrases exceeded the established 75% accuracy criterion, whereas the self-generated phrases reached criterion and remained constant at follow-up. Moreover, MK gradually started improving on the generalisation stimuli, once the treatment on the self-generated phrases started and maintained the gains 2 weeks and 4 weeks post-treatment. Conclusion: MIT appears to be a viable treatment option for Jordanian Arabic-speaking persons with Broca's aphasia. However, more research is needed with larger groups of Jordanian Arabic-speaking persons with Broca's aphasia to provide more support to the present findings. Moreover, future studies might focus on the efficacy of MIT with persons with Broca's aphasia from different Arab countries and from countries where Arabic is part of the multicultural structure like South Africa and other countries on the African continent.

Determination of lumbosacral transitional vertebrae in kidney urinary bladder x-ray films in the Saudi population.

OBJECTIVES: To investigated the rate of occurrence of lumbosacral transitional vertebrae (LSTV), spinal variant, in kidney urinary bladder (KUB) plain radiographs in a Saudi population.  Methods: Between January 2012 to January 2015, KUB plain films obtained from patients at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, were reviewed, and the presence or absence of LSTV was documented and classified as incomplete or complete. Patients who had evidence of spinal surgery that would obscure the view were excluded.  Results: A total of 2078 patients underwent KUB examinations during the study period; LSTV anomalies were detected in 158 of these. Sacralization was present in 153 (96.8%) of this cohort, while lumbarization was present in 5 (3.2%). A total of 136 (86.1%) of the sacralized segments were of the incomplete type, whereas 17 (10.7%) were complete. Of the lumbarized vertebrae, 3 (1.8%) were incomplete, and 2 (1.2%) were complete. The most frequent type in men was type Ib (28.5%) for sacralized segments, and type IIb for lumbarized segments (0.6%). In women, type Ia was the most common form of sacralized segments (11.3%) and type IIb was the most common form of lumbarized segments (2.8%). Conclusion: The prevalence of LSTV in Saudi patients is 7.6%, with a higher incidence of sacralization than lumbarization. Further studies with larger sample sizes and longer follow-up time are needed to demonstrate the clinical significance thereof.

Where technology does not go: specialised neonatal care in resource-poor and conflict-affected contexts.

Setting: Although neonatal mortality is gradually decreasing worldwide, 98% of neonatal deaths occur in low- and middle-income countries, where hospital care for sick and premature neonates is often unavailable. Médecins Sans Frontières Operational Centre Brussels (MSF-OCB) managed eight specialised neonatal care units (SNCUs) at district level in low-resource and conflict-affected settings in seven countries. Objective: To assess the performance of the MSF SNCU model across different settings in Africa and Southern Asia, and to describe the set-up of eight SNCUs, neonate characteristics and clinical outcomes among neonates from 2012 to 2015. Design: Multicentric descriptive study. Results: The MSF SNCU model was characterised by an absence of high-tech equipment and an emphasis on dedicated nursing and medical care. Focus was on the management of hypothermia, hypoglycaemia, feeding support and early identification/treatment of infection. Overall, 11 970 neonates were admitted, 41% of whom had low birthweight (<2500 g). The main diagnoses were low birthweight, asphyxia and neonatal infections. Overall mortality was 17%, with consistency across the sites. Chances of survival increased with higher birthweight. Conclusion: The standardised SNCU model was implemented across different contexts and showed in-patient outcomes within acceptable limits. Low-tech medical care for sick and premature neonates can and should be implemented at district hospital level in low-resource settings.

Contexte: La mortalité néonatale diminue progressivement dans le monde, mais 98% des décès néonataux surviennent encore dans les pays à revenu faible et moyen, où les soins hospitaliers pour les nouveaux-nés malades et prématurés sont souvent indisponibles. Médecins Sans Frontières Centre d'Opérations Bruxelles (MSF-OCB) a géré huit unités spécialisées de soins néonataux (SNCU) au niveau du district dans des contextes de faibles ressources et affectés par des conflits dans sept pays.Objectif: Evaluer la performance du modèle de MSF-SNCU dans différents contextes en Afrique et en Asie du Sud Est. Les objectifs ont été de décrire la mise en place des huit SNCU, les caractéristiques des nouveau-nés et les résultats cliniques de 2012 à 2015.Schema: Etude descriptive multicentrique.Résultats: Le modèle de MSF-SNCU a été caractérisé par l'absence de machines de haute technologie et l'accent mis sur des soins infirmiers dévoués et des soins médicaux. La prise en charge s'est concentrée sur la gestion de l'hypothermie, de l'hypoglycémie, du soutien à l'alimentation et de l'identification/du traitement précoces d'une infection. Dans l'ensemble, 11 970 nouveau-nés ont été admis, dont 41% ont eu un faible poids de naissance (<2500 g). Les principaux diagnostics ont été un faible poids de naissance, une hypoxie et des infections néonatales. La mortalité d'ensemble a été de 17%, similaire dans les différents sites. Les chances de survie ont augmenté parallèlement au poids de naissance.Conclusion: Le modèle standardisé de SNCU a été mis en œuvre dans différents contextes et les résultats pour les nouveau-nés hospitalisés se sont avérés être dans des limites acceptables. Des soins médicaux de basse technologie pour les nouveau-nés malades et prématurés peuvent et doivent être mis en œuvre au niveau des hôpitaux de district dans les contextes de faibles ressources.

Marco de referencia: La mortalidad neonatal ha disminuido de manera gradual en todo el mundo, pero el 98% de las muertes neonatales ocurre en los países de bajos y medianos ingresos, que no suelen contar con una atención hospitalaria de los neonatos prematuros. El centro operativo de Bruselas de Médecins Sans Frontières (MSF-OCB) administra ocho unidades de atención neonatal especializada (SNCU) en entornos de bajos recursos y afectados por conflictos, a nivel distrital en siete países.Objetivo: Evaluar el desempeño del modelo SNCU de MSF en diferentes entornos en África y el sureste asiático. Se describe la puesta en marcha de ocho unidades, las características de los neonatos y los desenlaces clínicos del 2012 al 2015.Método: Fue este un estudio descriptivo multicéntrico.Resultados: El modelo SNCU de MSF se caracterizó por la falta de dispositivos de alta tecnología y una prioridad atribuida a la prestación de atención médica y de enfermería por parte de profesionales dedicados. Se concedió un interés especial al manejo de la hipotermia, la hipoglucemia, el apoyo alimentario y la detección precoz y el tratamiento de las infecciones. Se ingresaron 11 970 neonatos, de los cuales el 41% consistió en lactantes con bajo peso al nacer (<2500 g). Los principales diagnósticos fueron bajo peso al nacer, asfixia perinatal e infecciones neonatales. En general, la mortalidad fue 17%, en proporción uniforme en todos los centros. Las probabilidades de supervivencia aumentaban con un mayor peso al nacer.Conclusión: El modelo normalizado SNCU se introdujo en diferentes contextos y ofreció a los pacientes ingresados desenlaces dentro de límites aceptables. La atención médica de los neonatos prematuros y enfermos en plataformas de baja tecnología es viable y se debería introducir en los hospitales de nivel distrital de los entornos con bajos recursos.

Development and validation of a physical model to investigate the biomechanics of infant head impact.

Head injury in childhood is the single most common cause of death or permanent disability from injury. However, despite its frequency and significance, there is little understanding of the response of a child's head to injurious loading. This is a significant limitation when making early diagnoses, informing clinical and/or forensic management or injury prevention strategies. With respect to impact vulnerability, current understanding is predominantly based on a few post-mortem-human-surrogate (PMHS) experiments. Researchers, out of experimental necessity, typically derive acceleration data, currently an established measure for head impact vulnerability, by calculation. Impact force is divided by the head mass, to produce a "global approximation", a single-generalised head response acceleration value. A need exists for a new experimental methodology, which can provide specific regional or localised response data. A surrogate infant head, was created from high resolution computer tomography scans with properties closely matched to tissue response data and validated against PMHS head impact acceleration data. The skull was 3D-printed from co-polymer materials. The brain, represented as a lumped mass, comprised of an injected gelatin/water mix. High-Speed Digital-Image-Correlation optically measured linear and angular velocities and accelerations, strains and strain rates. The "global approximation" was challenged by comparison with regional and local acceleration data. During impacts, perpendicular (at 90°) to a surface, regional and local accelerations were up to three times greater than the concomitant "global" accelerations. Differential acceleration patterns were very sensitive to impact location. Suture and fontanelle regions demonstrated ten times more strain (103%/s) than bone, resulting in skull deformations similar in magnitude to those observed during child birth, but at much higher rates. Surprisingly, perpendicular impacts produced significantly greater rotational velocities and accelerations, which are closer to current published injury thresholds than expected, seemingly as a result of deformational changes to the complex skull geometry. The methodology has proven a significant new step in characterising and understanding infant head injury mechanics.

A preliminary exploration of ulnar variance in healthy wrists at a tertiary hospital in Jeddah.

OBJECTIVES: To gain preliminary insight by exploring ulnar variance changes in a Saudi-based sample.   METHODS: This 6-month (December 2013 to June 2014) cross-sectional study was conducted on a randomly selected healthy adult volunteers with a sample size of 104, at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Posteroanterior (PA), anteroposterior (AP), and PA grip views are taken. The variables of interest were the PA, AP, and PA fist measurements of both right and left wrists. An independent t-test was used to compare means between groups. RESULTS: A total of 104 volunteers were recruited. Among 17 participants who had a negative ulnar variance on right PA views, a significantly high proportion (n=9; 56.2%) maintained a negative value on fist views; 7 participants (43.8%) had a neutral ulnar variance while none (0%) had a positive value (p less than 0.001). Similarly, a significant proportion of participants who had neutral, or positive values on right PA views maintained the same values on right fist views (p less than 0.001). On radiographs of the right wrist, the ulnar variance decreased with a change in wrist position, with an absolute difference in magnitude of 2.13 (p less than 0.001) between PA and AP views. Similarly, the ulnar variance on the left side decreased significantly between PA and AP views (absolute difference in magnitude, 1.68; p less than 0.001).   CONCLUSIONS: Ulnar variance changes in our sample are similar to what is reported in the literature.