Evaluation of Surgical Correction of Adolescent Idiopathic Scoliosis by Transpedicular Screws and Rods.

Transpedicular screw fixation is a challenging procedure for the correction of deformity of Adolescent Idiopathic Scoliosis (AIS) in the dorso-lumbar spine. The inadvertently misplaced screws have a high risk of complications. The exactness of the pedicle screws is normally distinct as the screws axis being fully enclosed within the cortices of the pedicle. Evaluation of the surgical correction of adolescent idiopathic scoliosis by transpedicular screws and rods was done in single posterior dynamic approach. This prospective observational study was conducted in the National Institute of Traumatology and Orthopedic Rehabilitation, Dhaka and different Hospitals in Dhaka, Bangladesh from July 2015 to March 2017. Ten patients at the age >9 years and <19 years who were admitted with a diagnosis of AIS during the period of study. The pedicle is a power nucleus of the vertebra and offers a secure grip of all 3 columns. Pedicle screw instrumentation has advantages of rigid fixation with improved 3D correction and it has been accepted as a reliable method with a high margin of safety. Accurate placement of the pedicle screws is important to reduce possible irreversible complication. So, all cases were corrected by transpedicular screws and rods in single posterior approach. In every case fusion was done in selected segments. In this study out of 10 patients 7(70.0%) were 10 to 14 years of age and 3(30.0%) were 15 to 18 years. Mean age 9.51±2.13 years. Minimum 10 years and maximum 18 years. Majority 7(70.0%) of the patients were female and the rest 3(30.0%) male. Five (50.0%) presented with level of involvement, 3(30.0%) patients thoracic and 2(20.0%) patients had lumbar. Maximum 7(70.0%) presented right sided involvement and rest 3(30.0%) left sided involvement. Before surgical intervention 100% patients had rib hump and positive Adams forward bending test, 70.0% patients had asymmetry of shoulder and uneven hip and also 50% patients had pain. After surgical treatment with transpedicular screws and rods through posterior approach, 70% of patients improved in terms of deformity. The average major curve deformity as defined by Cobb angle measurements was measured to be 54.9°±9.9° (40°-68°) in pre-surgery. After surgery this deformity corrected to 16.0°±4.9° (10°-24°) on average as measured in erect posture posterior anterior and lateral view. This represents significant improvement average of 71.4±4.3% (64.6-75.09) (p<0.001). This correction was maintained at 24 months after surgery. Functional results assessed by Modified Macnab criteria, significant number of 7(70.0%) patients had excellent outcome, 2(20.0%) patients had good outcome, 1(10.0%) patients had fair outcome and no poor outcome. Ninety percent (90%) patients had satisfactory results. No patient deteriorates neurologically after surgery. It is concluded that satisfactory curve correction and maintenance thereof is possible in adolescent idiopathic scoliosis, with posterior instrumentation by transpedicular screw and rods with effective reduction of cost and associated risks.

Pericardial Tumor Presenting As Recurrent Pericardial Effusion--A Case Report.

Pericardial tumors are unusual and may be difficult to characterise with imaging. They manifest as large, non-contractile, solid masses within the pericardium. Presenting symptoms include heart failure, arrhythmias, sudden death, cyanosis and chest pain. But it can also present as recurrent pericardial effusion misdiagnosed as tuberculosis and other infectious causes. Accordingly a patient with pericardial mass (tumor) presented with recurrent pericardial effusion as a rare case.

Smoking behaviour, knowledge and perceived susceptibility to lung cancer among secondary-school students in Amman, Jordan.

Smoking in Jordan is a serious problem as it affects almost all segments of society including children. This study aimed to evaluate the smoking behaviour of Jordanian secondary-school students (aged 16-18 years), their awareness of the dangers of smoking and their perceived susceptibility to lung cancer. Of the stratified random sample of students from Amman schools (n = 648), 43% were ever smokers (had smoked for 1 year) and 27.6% were current smokers, while 81% reported having a smoker in the family. Students in western Amman (higher socioeconomic status) and those who started smoking at a younger age demonstrated better knowledge about smoking-related consequences. Perceived susceptibility to lung cancer was significantly associated with sex, perceived seriousness of lung cancer and school location. Students' sex, socioeconomic status and the family environment were important factors that influenced students' smoking behaviour and risk perceptions and these findings have significant policy implications.

A case of acute intermittent porphyria.

Acute intermittent porphyria (AIP) is a rare autosomal dominant hereditary metabolic disorder having protean manifestations. The clinical presentations of abdominal pain, peripheral neuropathy and changes in mental status are the classic triad of an acute attack. A 15-year old girl was admitted in the medicine department of Sylhet MAG Osmani Medical College with the complaints of recurrent abdominal pain, convulsions and weakness of lower limbs. She presented with a combination of medical and neuropsychiatric symptoms suggestive of a case of AIP. The clinical presentation and the presence of porphyrins in urine confirmed the diagnosis of AIP. AIP can be life-threatening, so an accurate diagnosis and proper management are highly important.

Effect of female education on the proximate determinants of fertility in Bangladesh.

"This paper investigates the effect of female education on fertility in Bangladesh...through three proximate determinants of fertility: marriage, postpartum non-susceptibility to conception, and contraception.... The analysis found that a small amount of education tends to increase fertility.... The effect of education on proximate determinants shows that it is positive for postpartum non-susceptibility to conception, [while] in contrast it is negative for marriage and contraception. Therefore, [the] contribution of the duration of postpartum non-susceptibility is stronger for less educated women, while marriage and contraception have important effects when education is high at the individual level."