Country-based modelling of COVID-19 case fatality rate: A multiple regression analysis.

BACKGROUND: The spread of the severe acute respiratory syndrome coronavirus 2 outbreak worldwide has caused concern regarding the mortality rate caused by the infection. The determinants of mortality on a global scale cannot be fully understood due to lack of information. AIM: To identify key factors that may explain the variability in case lethality across countries. METHODS: We identified 21 Potential risk factors for coronavirus disease 2019 (COVID-19) case fatality rate for all the countries with available data. We examined univariate relationships of each variable with case fatality rate (CFR), and all independent variables to identify candidate variables for our final multiple model. Multiple regression analysis technique was used to assess the strength of relationship. RESULTS: The mean of COVID-19 mortality was 1.52 ± 1.72%. There was a statistically significant inverse correlation between health expenditure, and number of computed tomography scanners per 1 million with CFR, and significant direct correlation was found between literacy, and air pollution with CFR. This final model can predict approximately 97% of the changes in CFR. CONCLUSION: The current study recommends some new predictors explaining affect mortality rate. Thus, it could help decision-makers develop health policies to fight COVID-19.

A novel sliding double flexible intramedullary nail technique for the management of lower extremity long bone fractures and deformities in osteogenesis imperfecta.

This study aimed to investigate the effectiveness of the sliding double flexible intramedullary nail technique (SDFIN) in managing lower extremity long bone fractures and deformities in patients with osteogenesis imperfecta (OI) based on radiographic measurements. This study was conducted involving type III or IV Silence OI patients who underwent treatment with SDFIN for fractures, deformity correction, or previous device failure. The surgical technique involved the insertion of two straight flexible intramedullary nails in each bone segment, with one inserted from the caudal epiphysis and the other from the proximal region. Clinical and radiological outcomes were evaluated with a mean follow-up of 62.8 ±â€…20.3 months. Among the 33 lower extremity long bone segments treated with SDFIN, revision was required in 12 segments, resulting in an overall complication rate of 51.5%. Complications included nail migrations observed in 10 cases, decreased joint range of motion in seven, refractures and malrotations in five, nail fracture, and nail extrusion in one case were observed. The femur group had a complication rate of 50%, while the tibia group had a rate of 53.3%. The SDFIN technique demonstrated satisfactory outcomes in managing leg fractures and deformities in OI patients. The technique showed comparable results to newly designed Faisser-Duval rods at a lower cost. Further research and refinement of the technique are necessary to reduce complications and improve patient outcomes.

Investigating the mortality trend of gastrointestinal cancers in Babol, North Iran (2013-2021).

BACKGROUND AND AIM: This study aims to examine the mortality rate and trend of gastrointestinal cancers, particularly gastric cancer, as the leading cause of death among cancers in northern Iran over a 9-year period. In light of the changing incidence and mortality rates of cancer in Iran and around the world, the importance of these diseases in people's lives, and the necessity of updating and monitoring the trend of cancer mortality, we have decided to report on the mortality trend of gastrointestinal cancers, based on crude and age-standardized rates. METHOD: This study is a cross-sectional examination of deaths caused by gastrointestinal cancers in Babol city, Iran, between 2013 and 2021. Data was collected from the cause of death registration and classification system of Babol University of Medical Sciences. Population estimation was obtained from the latest census reports. The crude and age-standardized mortality rates and trends of the cancers were calculated. RESULTS: Overall, there were 1345 deaths from gastrointestinal cancers with an average age of 69.11 ± 14.25 years. The crude and age-standardized rates of these cancers rose from 24.1 to 20.1 per hundred thousand people in 2012 to 29.5 and 25.5 per hundred thousand people, respectively. This trend became more prevalent significantly with the increase of each decade of age for both men (P-value Trend = 0.002) and women (P-value Trend = 0.012). An analysis of gastrointestinal cancers revealed a decreasing trend for cancers of the small intestine, an increasing trend for cancers of the colon, pancreas, and gallbladder, and a stable trend for the remaining cancers over the study period. CONCLUSION: The age-standardized rate and the number of gastrointestinal cancers is rising, highlighting the importance of preventative measures such as screening, increasing public awareness, and appropriate diagnostic methods.

Prevalence of Ocular Toxoplasmosis in the General Population and Uveitis Patients: A Systematic Review and Meta-Analysis.

PURPOSE: The present study aimed to estimate the global prevalence of ocular toxoplasmosis in the general population and patients with uveitis. METHODS: Four electronic databases were searched and 130 studies for evaluating the prevalence of OT among the general population and uveitis patients were included. RESULTS: The pooled prevalence of OT among the general population was estimated at 2% (95% CI, 2-3%; 762/486 051). The highest prevalence rate was observed in America 6% (95% CI, 1-11%). In uveitis patients, a prevalence rate of 9% (95% CI, 8-10%; 5668/88 006) was reported. The countries with a lower middle income had higher prevalence rates. The prevalence of OT in posterior uveitis 33% (95%CI, 24-42%) was substantially higher than in panuveitis 7% (95% CI, 5-8%). CONCLUSION: Our results provide a new perspective on the prevalence of OT. Knowledge of international and regional patterns of disease is essential for the establishment of precise diagnostic protocols and control programs.

The structure and diversity of microbial communities in Paederus fuscipes (Coleoptera: Staphylinidae): from ecological paradigm to pathobiome.

BACKGROUND: Paederus fuscipes is medically the most famous rove beetle, which causes dermatitis or conjunctivitis in humans, as well as gastrointestinal toxicosis in livestock, via releasing toxic hemolymph containing pederin. Pedrin biosynthesis genes have been identified in uncultured Pseudomonas-like endosymbionts that are speculated to be acquired through a horizontal transfer. However, the composition of the P. fuscipes microbial community, especially of the gut and genital microbiome, remains unclear. This study was aimed to characterize the structure and diversity of P. fuscipes-associated bacterial communities in terms of gender, organ, and location using the Illumina HiSeq platform in the southern littorals of Caspian Sea. RESULTS: The OTUs identified from P. fuscipes specimens were collapsed into 40 phyla, 112 classes, 249 orders, 365 families, 576 genera, and 106 species. The most abundant families were Pseudomonadaceae, Spiroplasmataceae, Weeksellaceae, Enterococcaceae, and Rhizobiaceae, respectively. Thirty top genera made up > 94% of the P. fuscipes microbiome, with predominating Pseudomonas, followed by the Spiroplasma, Apibacter, Enterococcus, Dysgonomonas, Sebaldella, Ruminococcus, and Wolbachia. Interesting dissimilarities were also discovered within and between the beetle microbiomes in terms of genders and organs. Analyses showed that Spiroplasma / Apibacter as well as Pseudomonas / Pseudomonas were the most abundant in the genitals / intestines of male and female beetles, respectively. Bacterial richness did not display any significant difference in the three provinces but was higher in male beetles than in females and more in the genitals than intestines. CONCLUSIONS: The present study identified Pseudomonas-like endobacterium as a common symbiont of P. fuscipes beetles; this bacterium begins its journey from gut and genitalia of females to reach the male rove beetles. Additionally, male and female rove beetles were characterized by distinctive microbiota in different organs, likely reflecting different functions and/or adaptation processes. Evidence of the extension of P. fuscipes microbiome from the environmental paradigm to the pathobiome was also presented herein. A comprehensive survey of P. fuscipes microbiome components may eventually lead to ecological insights into the production and utilization of defensive compound of pederin and also the management of linear dermatitis with the use of available antibiotics against bacterial pathogens released by the beetles. Video Abstract.

The effect of the caudal insertion angle of pedicle screws on postoperative thoracic kyphosis in adolescent idiopathic scoliosis: a pilot study.

The study was a prospective analysis of collected data to compare the effect of the insertion angle (parallel or oblique relative to the upper-end plates) of thoracic pedicle screws on postoperative thoracic kyphosis in patients with idiopathic thoracic scoliosis. This study was conducted on idiopathic adolescent scoliosis (AIS) patients. Two groups of patients were defined according to the insertion angle of thoracic pedicle screws in relation to the upper-end plate of the corresponding vertebra, the insertion angles being either oblique or parallel. Seven consecutive AIS patients were compared in each group. Pre- and postoperative standing X-rays were obtained. Cobb's angles, sagittal parameters such as thoracic kyphosis (TK) (T1-T12) and lumbar lordosis (LL) (L1-S1) were all measured. The average of the main curve or compensatory curve corrections showed no significant differences between the two groups. From a sagittal profile perspective, the mean TK in the oblique screw group was 39.3 ± 11.5 preoperatively, which was reduced to 30.9 ± 6.41 after surgery. The mean TK in the parallel group was 36.4 ± 14 preoperatively and 42.1 ± 13.9 postoperatively. There was a significant reduction in TK in the oblique screws group compared with the second group ( P = 0.038). The insertion angle of pedicle screws had no significant effect on Cobb's angle and lumbar lordosis changes. However, oblique insertion of thoracic screws decreased thoracic kyphosis postoperatively, which could be considered a negative point. As such, the insertion of thoracic screws in a caudal direction should not be routinely used because of its lordogenic effect.

Prevalence of cutaneous Leishmaniasis in the Middle East: a systematic review and meta-analysis.

Cutaneous leishmaniasis (CL), caused by an obligate intracellular protozoan parasite from the genus Leishmania, imposing a significant burden on underdeveloped countries especially those located in the Middle East. Four electronic databases were searched to evaluate the prevalence of CL in the Middle East. The random effects model (95% confidence intervals (CI)) were applied to determine the overall and subgroup pooled prevalence. Heterogeneity was assessed by Cochran's Q test and I2 statistics. Among 2424 peer-reviewed papers, 37 datasets from 34 studies were included in the current meta-analysis. 285560 individuals were assessed across 9 Middle Eastern countries. The pooled prevalence of CL was estimated at 12% (95% CI 9-15 %; 10718/285560). The highest prevalence rate was observed in Syria (39%, 37-42%), and the lowest one was found in Iraq and Lebanon (0%, 0-1%). The prevalence of CL in studies that applied LST assays had the highest rate (48%, 17-80%). The infection rate in males was similar to females (7%, 4-10%). The prevalence of infection in individuals living in urban areas was higher than in rural areas (14%, 10-19%). The prevalence of CL in the age group 0-15 years was higher than in individuals 16-40 and >40 years (9%, 6-13%). Most of the lesions were found on the face, and single lesions were more prevalent than two and three ones. In conclusion, the occurrence of CL was considerable in Middle Eastern countries. Therefore, more efforts should be made to precisely report the CL in this region for developing appropriate preventive and controlling strategies. .

The study of trends in mortality of respiratory system cancers in Babol, North of Iran (2013-2021).

Background: In Iran, cancers are known as the second leading cause of death, among which respiratory system cancers are particularly important because lung cancer is the second most common cause of death in this country. This study aimed to estimate the crude and age-standardized mortality and its trends during 9 years in the Northern city of Iran, Babol. Methods: In this cross-sectional study, all the recorded deaths due to respiratory system cancers in Babol during the years 2013-2021 on the Classification of Causes of Deaths and Death Registration System of Babol University of Medical Sciences were taken into consideration, and the population estimate was based on the latest census. Finally, the crude and age-standardized rates of mortality and trends of cancer incidents were calculated. Results: In general, 393 deaths with an overall mean age of 67.8±3.9 years have happened due to respiratory system cancers. The crude and standardized rates of respiratory system cancers increased from 6.5 and 5.5 per hundred thousand people in 2013 to 9.1 and 7.8 per hundred thousand people in 2021, respectively. With each decade in age, their trends increased significantly in men (p=0.024) and remained constant in women (p=0.262). In examining the trend of respiratory system cancers, we found an increasing trend for lung cancer and a constant trend for larynx and oropharynx cancers. There was also a decreasing trend for hypopharyngeal cancer. Conclusions: The age-standardized rate and trend of respiratory system cancers are increasing. Therefore, it is important to prevent their prevalence by reducing the risk factors and increasing the general awareness of risks and timely diagnosis.

Thoracolumbar and Lumbar Posterior Vertebral Resection for the Treatment of Rigid Congenital Spinal Deformities in Pediatric Patients: A Long-Term Follow-up Study.

Objective: We sought to determine whether a posterior vertebral resection on congenital deformities of thoracolumbar and lumbar vertebrae leads to more complications and provides less correction. Methods: Twenty-three patients underwent a posterior vertebral resection for a rigid congenital spinal deformity, which included scoliosis (13 patients), kyphoscoliosis (6 patients), and pure kyphosis (4 patients). The surgeries involved removing 1 to 2 vertebrae using multiaxial pedicle screws in all but 2 of the patients. All surgeries were performed under intraoperative spinal cord monitoring. Thoracic curve, lumbar lordosis, focal kyphosis, shift, and sagittal vertical axis were collected at baseline and during the last follow-up (taking place after at least 3 years) and were then statistically analyzed. Results: The major curve correction was about 55% in cases of scoliosis, with focal kyphosis improving from 54.3 ± 19.1 degrees to 21.3 ± 15 degrees. Two patients experienced intraoperative neuromonitoring changes, with data returning to baseline without any surgical intervention. Sensory or motor palsy after the surgery was not reported in patients.Despite improving sagittal or coronal deformities, 8 patients experienced excessive sagittal decompensation during follow-up, 1 of whom underwent revision surgery. Sagittal decompensation was by far the most common complication. Larger kyphoscoliosis or focal kyphosis angles were preoperative risk factors for postoperative sagittal imbalance (P value < 0.05). Conclusions: Using a lumbar or thoracolumbar posterior vertebral resection enables surgeons to correct rigid curves in the pediatric population without major risk to nerve roots. The primary complications would be sagittal decompensation and the likelihood of undercorrection, which requires mindful addressing during the preoperative planning stages.

Ilizarov kyphectomy technique in the management of the gibbus deformity with an open wound in meningomyelocele patients: a case report with five years of follow-up.

PURPOSE: To propose an alternative method of surgical technique to address gibbus deformity in meningomyelocele with open wound simultaneously. METHODS: We report a rare case of an 8-year-old girl with a refractory skin breakdown on her gibbus deformity, which underwent an Ilizarov kyphectomy technique to address her skin breakdown, and spinal deformity at the same time, while planning a definitive fusion in the future. RESULTS: The patient was followed up for about 5 years. Her spine and overlying skin seem stable and no definite fusion has been offered to the patient so far. CONCLUSION: Ilizarov kyphectomy technique is an alternative procedure that can provide a safe and effactive method to address severe kyphosis deformity with skin breakdown. However, a comparison should be drawn to other procedures, while including more patients with longer follow-up.

Outcomes of Temporary Hemi-Epiphysiodesis Using a New Device for The Treatment of Pediatric Valgus Knee Deformity: a Preliminary Report.

BACKGROUND: This study aimed to evaluate the efficacy of hemi-epiphysiodesis using a new device (X-plate) for the correction of genu valgum. METHODS: In total, 22 children with a total of 34 pathologic knee valgus deformities underwent the procedure and were followed up 25.3 months on average. RESULTS: The mean time to clinical correction of genu valgum was 10.9±2.2 months. Furthermore, the mean preoperative anatomic Lateral Distal Femoral Angle (aLDFA) and mechanical Tibia Femoral angle (mTFA) were obtained at 75.1±3.8 and 6±2.8 degrees, respectively. When clinical correction of the deformity was achieved, the mean of aLDFA and mTFA corrections were determined at 8.9±5.3 and 6.5±3.2 degrees, respectively. The mean speed of aLDFA and mTFA corrections were estimated at 0.8±0.45 and 0.6±0.3 degrees per month, respectively. The postoperative aLDFA and mTFA were measured at 84±4.2 and -0.8±2.9 on average. With a mean of 25.3±14.5 months at final follow-up, there were 6 (17.6%) mild valgus knees, 26 (75.5%) normal alignment knees, and only 2 (5.9%) mild varus knee within an acceptable clinical limit. CONCLUSION: Hemi-epiphysiodesis using X-plate at the distal physis of the femur is an effective and safe method for the treatment of valgus knee deformity in children.

Bioactivities of rose-scented geranium nanoemulsions against the larvae of Anopheles stephensi and their gut bacteria.

Anopheles stephensi with three different biotypes is a major vector of malaria in Asia. It breeds in a wide range of habitats. Therefore, safer and more sustainable methods are needed to control its immature stages rather than chemical pesticides. The larvicidal and antibacterial properties of the Pelargonium roseum essential oil (PREO) formulations were investigated against mysorensis and intermediate forms of An. stephensi in laboratory conditions. A series of nanoemulsions containing different amounts of PREO, equivalent to the calculated LC50 values for each An. stephensi form, and various quantities of surfactants and co-surfactants were developed. The physical and morphological properties of the most lethal formulations were also determined. PREO and its major components, i.e. citronellol (21.34%), L-menthone (6.41%), linalool (4.214%), and geraniol (2.19%), showed potent larvicidal activity against the studied mosquitoes. The LC50/90 values for mysorensis and intermediate forms were computed as 11.44/42.42 ppm and 12.55/47.69 ppm, respectively. The F48/F44 nanoformulations with 94% and 88% lethality for the mysorensis and intermediate forms were designated as optimized formulations. The droplet size, polydispersity index, and zeta-potential for F48/F44 were determined as 172.8/90.95 nm, 0.123/0.183, and -1.08/-2.08 mV, respectively. These results were also confirmed by TEM analysis. Prepared formulations displayed antibacterial activity against larval gut bacteria in the following order of decreasing inhibitory: LC90, optimized nanoemulsions, and LC50. PREO-based formulations were more effective against mysorensis than intermediate. Compared to the crude PREO, the overall larvicidal activity of all nanoformulations boosted by 20% and the optimized formulations by 50%. The sensitivity of insect gut bacteria may be a crucial factor in determining the outcome of the effect of toxins on target insects. The formulations designed in the present study may be a good option as a potent and selective larvicide for An. stephensi.

Effect of Meteorological Factors on Hyalomma Species Composition and Their Host Preference, Seasonal Prevalence and Infection Status to Crimean-Congo Haemorrhagic Fever in Iran.

BACKGROUND: The impact of environmental factors and host on Hyalomma spp. community structure and abundance in the main Crimean-Congo haemorrhagic fever (CCHF) foci of Iran is largely unknown. METHODS: Biotic and abiotic factors, including host, temperature, humidity, altitude, Köppen-Geiger climate types, season, and precipitation on Hyalomma spp. community structure and abundances in 11 provinces of Iran were investigated. Additionally, the possible infection of ticks with CCHF virus was evaluated using reverse transcription PCR technique. RESULTS: Species analyses demonstrated the presence of Hyalomma anatolicum, H. marginatum, H. dromedarii, H. asiaticum, H. detritum and H. schulzei in the study area. Hyalomma anatolicum was the dominant species in the southern and northern parts, whereas H. dromedarii was distributed mostly in central parts of the country. The highest tick infestation was recognized in hot season. Spatial variation in tick relative density was observed between habitat types where more ticks were collected in deserts, semi-deserts, and Mediterranean habitats. Except for H. dromedarii, which was more prevalent on camel (P= 0.044), there were no significant variations in the frequencies of other Hyalomma species on different hosts. Hyalomma anatolicum, H. dromedarii frequencies had significant positive and negative association with temperature and precipitation respectively. Also humidity has positive impact on H. asiaticum frequency. CONCLUSION: Data presented here will help improve ecological models to forecast the distribution of Hyalomma spp. ticks, to evaluate the risk of CCHF and other tick-borne diseases, and to design proper vector control measures to suppress Hyalomma populations in Iran.

Iliac Pedicle Wedge Graft as a New Modification for Iliac Osteotomies in Young Adolescents: A Single-blind Randomized Clinical Trial.

BACKGROUND: Iliac osteotomies in adolescent patients may accompany graft related difficulties such as graft absorption and delayed union. A new modification of iliac osteotomies has been proposed to address these difficulties. METHODS: A total of 24 consecutive hip joints in 21 juvenile or adolescent patients who were candidate for salter or triple pelvic osteotomy were included. A modification was performed to harvest a wedged bone graft based on a muscle pedicle of Tensor Fascia Lata and inserted at pelvic osteotomy site instead of a traditional graft technique. The hips were randomized into two groups. The traditional wedge graft was used in group 1, while the new modification was performed in group 2. The primary outcome of this study was duration of union. The secondary outcomes were Center Edge Angle (CE) Angle on pre-operation, immediately post-operation and at the end of follow-up. RESULTS: Both groups were similar statistically regarding their age, gender , estimated blood loss and the duration of follow-up. However, significant differences were found in the time to complete union between the two groups (P=0.03). CE angle decreased in both groups when comparing its last follow-up to its right postoperative values, but the decrease was significant only in group 1(P=0.03). The type of surgery (Salter or TPO) had no significant effect on the average time to union. That shows faster union in pedicle graft group and less coverage loss during follow-up period than conventional graft patients. CONCLUSION: With the modification proposed , the healing at the osteotomy site was faster and the loss of correction, owing to the graft resorption, decreased. Using this pedicle wedge graft technique may improve the results of pelvic osteotomies in adolescent.

Outer Ear Infections in Iran: A Review.

BACKGROUND: Otitis externa is the fungal and bacterial infection of the outer ear. AIM: We aimed to investigate the published papers about the outer ear infections in Iran and suggest standardised investigations and treatments. METHODS: We used different electronic databases like PubMed, Scopus, Web of Science, Iranmedex, Google Scholar, and Magiran with specific keywords. RESULTS: We obtained forty published full-text articles for review of data. Our results indicated the women were more infected than men. The ages of patients were < 1-81 years. As clinically symptoms, itching and Feel the ear fairy were the most common presenting complaints in most cases. Most infections were the pure bacterial and fungal origin, respectively. However, some of the studies were mixed fungal-bacterial infections - Pseudomonas spp. And Aspergillus niger were the most common bacteria and fungi isolates respectively in Iranian patents. CONCLUSION: Fungal and bacterial specific cultures may be recommended, and anti-fungal drugs may be added, to treatment regimens in patients with otitis externa to reduce the clinical symptoms.

Role of Clotrimazole in Prevention of Recurrent Otomycosis.

Otomycosis is one of the relatively common diseases in the world which is caused by different fungi especially saprophytes. Concerning the relapse of this disease in a number of individuals, the present study was performed to evaluate the inhibitory effect of clotrimazole drop in the relapse of otomycosis. Clinical samples were taken by an ENT specialist from patients suspicious of having otomycosis. A part of these samples were stained, and others were cultured. The diagnosis of otomycosis was made on the basis of the recognizable and characteristic appearance of fungal hyphae or mycelium and fruiting bodies and/or conidiophores under microscopic examination. Patients with suspected otomycosis are not at risk of recurrence after treatment with clotrimazole drops. Out of the 161 individuals in whom definite diagnosis of otomycosis was made, the most affected individuals were, in the age range of 40-49 years, women, urban citizens, and housewives. Pruritus and diminished hearing were the main complaints of the patients. Aspergillus niger and A. flavus as well as Candida albicans were the main causes of the disease. The relapse of disease was observed in only five patients (3.1%), where A. niger was the main fungus. Most relapses were observed in women and in those with diminished hearing, manipulating the ears, ulcers in the canal, and tympanum. Our results suggested that usage of clotrimazole can be effective in reducing the relapse of otomycosis, and concerning the high cost of treating otomycosis while the low cost of using clotrimazole, usage of this drop is recommended to reduce the relapse of otomycosis.

Foot scan assessment of metatarsus adductus: A useful adjunct to Bleck's classification.

To determine the severity of metatarsus adductus (MA) comparing with Bleck's classification as a commonly acceptable method for assessing MA, static foot scan has been used. In this cross-sectional descriptive research study, 100 subjects were equally divided into four groups according to Bleck's classification. The feet were scanned and MA severity (MAS) index was measured on the obtained foot scan images. The MAS index was the ratio of the transverse deviation of the forefoot from the lateral border heel line to the width of the ball of the foot. The mean of the MAS index in normal, mild, moderate, and severe MA was 0.02±0.02, 0.1±0.01, 0.159±0.03, and 0.216±0.025, respectively. The difference of MAS index between each group was significant (p<0.001). The mean of MAS index in 4 groups was consistent with Bleck's classification, with a significant increase from normal to severe MA (p<0.05). Since the results of this method are consistent with Bleck's classification and this novel foot scan assessment appears to be more objective than Bleck's classification, the authors recommend this method to be used in examination of patients with MA. However, further studies should be conducted to define interobserver and intraobserver reliability. LEVEL OF EVIDENCE: III.

Pigmented villonodular synovitis in pediatric population: review of literature and a case report.

BACKGROUND: Pigmented villonodular synovitis (PVNS) is a rare proliferative process in children that mostly affects the knee joint. CASE PRESENTATION: The study follows the case of a 3-year-old boy presenting recurrent patellar dislocation and PVNS. Due to symptoms such as chronic arthritis, he had been taking prednisolone and methotrexate for 6 months before receiving a definitive diagnosis. After a period of showing no improvements from his treatment, he was referred to our center and was diagnosed with local PVNS using magnetic resonance imaging (MRI). The patient was treated for his patellar dislocation by way of open synovectomy, lateral retinacular release, and a proximal realignment procedure, with no recurrence after a 24-month follow-up. CONCLUSION: PVNS may appear with symptoms resembling juvenile idiopathic arthritis, thus the disease should be considered in differential diagnosis of any inflammatory arthritis in children. PVNS may also cause mechanical symptoms such as patellar dislocation. In addition to synovectomy, a realignment procedure can be a useful method of treatment.

Transfer of Pectoralis Major to Subscapularis in the Management of Brachial Plexus Birth Palsy Sequels.

BACKGROUND: Limitations in abduction and external rotation are the sequel of brachial palsy. The purpose of this study was to evaluate functional outcomes of modified L'Episcopo procedure in children with brachial palsy who do not have gross shoulder joint subluxation. METHODS: From 2002 to 2012, a continuous series of 22 patients with brachial plexus birth palsy underwent a modified L'Episcopo procedure. Through an axillary approach, subscapularis release with latissimus dorsi rerouting and transfer of pectoralis major to subscapularis footprint was performed. RESULTS: The mean age of patients at surgery was 49 months. The mean follow-up time was 51 months (range, 24 to 90 mo). Preoperatively, the mean active abduction and external rotation were 77.5 and 2.5 degrees, respectively. The mean active abduction and external rotation were 135.6 and 32 degrees, respectively, at the final follow-up (P<0.001). CONCLUSIONS: This modified L'Episcopo technique is an effective and reproducible procedure that improves shoulder function significantly. LEVEL OF EVIDENCE: Level III.

Assessment of Coronal Radiographic Parameters of the Spine in the Treatment of Adolescent Idiopathic Scoliosis.

BACKGROUND: To determine the most important preoperative factors that affect postoperative coronal parameters of scoliotic curves. METHODS: All Adolescent Idiopathic Scoliosis (AIS) patients included in the study were classified according to Lenke and King Classification. The fusion levels were selected according to the rigidity of the existing curves (correction less than 50%), tilt of T1 and shoulders, sagittal angle of the curves and with considering stable and neutral end vertebra. The radiographic coronal parameters: shoulders tilt angle, iliolumbar angle and coronal balance were measured in all patients before, after, and in the last follow-up visit. RESULTS: One hundred twenty patients after mean of 25 months follow-up (18-40 months) were included in the study. Before operation, abnormal coronal balance (more than 2 cm shift) was noticed in 46 patents (38%) and in the last visit, was noted in 22 patients (18%). Multivariate regression analysis revealed a significant predictive value of the preoperative coronal balance on the last visit coronal balance (P value=0.01). CONCLUSION: Preoperative coronal balance is very important to make a balanced spine after surgery. Other parameters like Lenke classification or main thoracic overcorrection did not affect postoperative coronal decompensation.