Favourable outcome of severe, unstable grade III slipped capital femoral epiphysis managed by closed reduction percutaneous pinning with mid-term follow up: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Slipped capital femoral epiphysis (SCFE) is one of the most common hip pathology in adolescents. Outcome of SCFE management largely depends on the grading of the pathology. Severe, unstable SCFE poses high risk for avascular necrosis (AVN). The objective of this study is to report a good outcome without AVN in an acute, unstable, high grade SCFE managed by closed reduction and percutaneous pinning along with factors that need to be given consideration. CASE PRESENTATION: A 13 years old boy was unable to bear weight due to severe pain on right hip after trauma since 2 weeks. Patient was diagnosed with acute, unstable high grade SCFE, patient underwent closed reduction and percutaneous pinning (CRPP) using cannulated screw and K wire augmented with spica cast. At 12 weeks patient was already fully active. At 18 month follow up there was no sign of AVN with full hip range of movement. CLINICAL DISCUSSION: Treatment for unstable, severe SCFE is still challenging. Unreduced severe slippage will deliver serious impingement and end up with early degenerative arthritis. The magnitude of reduction in a severe, unstable SCFE poses high risk for AVN. While some studies claimed reduction is justified only when it is serendipitous, we successfully and purposely performed CRPP. CONCLUSION: Even after 2 weeks from onset, an acute and severe slippage can still be reduced closely and fixed percutaneously. The hip regain full range of motion with no sign of AVN on x ray at 18 months follow up.

COVID-19 Vaccination Intention in Patients with Autoimmune Diseases in Indonesia: An Application of the Integrated Behavioural Model.

Vaccine hesitancy can be a challenge for those with autoimmune diseases. This study investigated the acceptance of COVID-19 vaccination by patients with autoimmune diseases in Indonesia using the integrated behavioral model (IBM). This cross-sectional study was conducted from December 2021 to February 2022. A total of 404 patients with autoimmune diseases completed the survey. The majority of respondents (57.9%) said they intended to get vaccinated against COVID-19. The IBM model with added demographic variables explained 54.1% of the variance of vaccination intention (R2 = 0.541). Self-efficacy, perceived norms, experiential attitude, and instrumental attitude are significantly correlated with vaccination intention in components of health behavior theories. Self-efficacy is the most critical factor influencing vaccination intention in patients with autoimmune diseases (F(2, 401) = 96.9, p < 0.001, R2 = 0.326). In the multivariate analysis, vaccine intention was found to be positively associated with patients' occupation as health-care workers (ß = 0.105). Meanwhile, having a personal history of contracting COVID-19 and having co-morbidities other than autoimmune diseases were negatively correlated to the willingness to be vaccinated against COVID-19. This study confirms the viability of the IBM model for predicting the COVID-19 vaccination intention of patients with autoimmune diseases. It is essential to provide patients with autoimmune diseases with information that is clear and supported by evidence-based medicine.