Gait Compensation among Children with Non-Operative Legg-Calvé-Perthes Disease: A Systematic Review.

Perthes disease is a condition that affects walking patterns in young children due to poor blood circulation in the hip joint. Understanding the gait strategies of affected children is of great importance for an objective assessment and better management of this condition. The aim of this systematic review was to evaluate the current literature to identify gait compensation patterns in non-operative children with Perthes disease. METHODS: A systematic electronic search was performed using MEDLINE, CINAHL, Embase, BIOSIS, and the Cochrane Library to identify studies published from inception up until December 2023. An adapted Downs and Black checklist was utilised to assess methodological quality and project risk of bias. Percentage agreement and nominal kappa statistics with bootstrapped bias-corrected 95% confidence intervals (CIs) were used. RESULT: A comprehensive literature search revealed 277 citations for review, of which 210 studies entered full-text screening. In total, eight studies met the inclusion criteria for quality assessment by two independent reviewers. The results revealed variations in data quality, with scores ranging from 12 to 17 due to missing information related to subject characteristics, biomechanical model, and power calculation. CONCLUSIONS: This review reveals common compensation strategies associated with walking among non-operative children with Perthes disease such as Trendelenburg gait due to weakness of the hip abductor muscle.

Retraction: Urachal Abscess: A Rare Etiology of Acute Abdominal Pain in Adults.

[This retracts the article DOI: 10.7759/cureus.18193.].

Demographic and clinical characteristics of children with limb loss in Saudi Arabia: A retrospective study.

PURPOSE: The aim of this study was to describe the demographic and clinical characteristics of children with limb loss in Saudi Arabia. METHODS: This is a retrospective study on children attending a limb loss clinic in a tertiary hospital in Riyadh, Saudi Arabia, between July 2012 and June 2020. Descriptive statistics were computed to describe the sample characteristics. A Chi-Squared test was conducted to explore the relationship between a child's sex with the type of limb loss (congenital or acquired) and extent of limb loss (major and minor) and the association between child's age and the mechanism of injury in traumatic limb loss. RESULTS: A total of 122 children aged 2-16 years were included of whom 52% were boys. Congenital limb loss represented 57% of the sample with upper extremity loss accounting for 63.7% of all limb loss in this type. Trauma-related limb loss represented the most frequent etiology (88.2%) in the acquired limb loss group. Road traffic accidents accounted for 51.7% of the mechanism of injuries in trauma-related limb loss. Child's sex was not associated with the type of limb loss nor the extent of limb loss ( p > 0.05). In addition, child's age was not associated with the mechanism of injury in traumatic limb loss ( p > 0.05). CONCLUSION: Child's sex was not a determinant of type nor the extent of limb loss. Most of the acquired limb loss was trauma-related with road traffic accidents as the most common mechanism of injury. The findings of this study illuminate the importance of ongoing prosthetic care for children with a limb loss because young children may require multiple prostheses as they grow in age and size.

Prevalence and risk factors for falls among community-dwelling adults in Riyadh area.

Objectives: This study aimed to assess fall prevalence, identify related risk factors, and establish cut-off scores for fall risk measures among community-dwelling adults in Riyadh region of Saudi Arabia. Methods: A cross-sectional study was conducted in community, Riyadh city, Saudi Arabia. A sample of 276 Saudi citizens aged ≥40 years who were able to read and write in Arabic. Fall history and number of falls in the past 12 months were determined via self-reports. Variables assessed included demographic information, self-reported chronic diseases, depressive symptoms, and back pain severity. Results: Participants were classified as either fallers (n = 28, 10.14%) or non-fallers. Fallers were more likely to have arthritis (odds ratio [OR]: 7.60, p = 0.001), back pain (OR: 5.22, p = 0.002), and higher depressive symptom scores (OR: 1.09, p = 0.013) than non-fallers. The number of reported falls was significantly associated with an elevated body mass index (incidence rate ratio [IRR]: 1.09, p = 0.045), arthritis (IRR: 8.74, p < 0.001), back pain (IRR: 4.08, p = 0.005), neurological diseases (IRR: 13.75, p < 0.007), and depressive symptoms (IRR: 1.08, p = 0.005). Cut-off scores predictive of falls associated with back pain and depressive symptoms were 1.5 (sensitivity: 0.61; specificity: 0.79; area under the curve [AUC]: 0.70) and 11.5 score (sensitivity: 0.57; specificity: 0.76; AUC: 0.66), respectively. Conclusions: The prevalence of falls was relatively low among the individuals considered in this study. Chronic conditions, back pain severity, and depressive symptoms were determined to be associated with falls among community-dwelling individuals in Saudi Arabia.

Arabic Patient-Reported Measures of Activity and Participation for Children: A Systematic Review of Psychometric Properties.

AIM: To systematically review measurement properties of Arabic patient-reported outcome measures (PROMs) that assess activity and participation in children with and without health conditions. METHOD: Four databases were searched. Arabic PROMs with focus on activity and/or participation constructs were selected. Data on measurement properties were extracted and the methodological quality of the studies was assessed by COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) risk of bias checklist. RESULT: Of the total 149 articles screened, only 10 studies involving 10 measures that assessed activity and/or participation in children with or without health conditions were included. The focus of all PROMs is primarily on the activity of daily living at home and/or school, but dimensions of measurement differed across PROMs. None of the PROMs demonstrated sufficient properties for all psychometrics. The most studied psychometric property was internal consistency, whereas the least studied psychometric property was structural validity. Responsiveness was not investigated in any of the studies included. CONCLUSIONS: Despite the presence of Arabic PROMs on activity and participation for children, none of the reviewed measures satisfied all psychometric properties. Clinicians and researchers are encouraged to carefully select PROMs that are psychometrically sound and appropriate for the construct being measured.

Body Mass Index Within Multifactor Predictors of Ventral Hernia Recurrence: A Retrospective Cohort Study.

Background A ventral hernia is a protrusion of the peritoneum through the defective abdominal wall. Several risk factors increase the likelihood of hernial recurrence. One of the most common risk factors is obesity, defined by the World Health Organization (WHO) as increased body mass index (BMI). Few studies have explored the effects of BMI and other factors on hernia recurrence. Hence, we aimed to investigate the role of increased BMI in hernia recurrence in conjunction with various risk factors such as age, sex, type of hernia, the time elapsed between the occurrence and recurrence, complications of hernia, and procedure. Methods This retrospective cohort study was conducted at King Abdulaziz University Hospital (KAUH). All the patients were admitted between 2015-2022. A total of 1676 medical records were obtained from all patients who underwent hernia repair more than once or were diagnosed with a recurrent hernia during the study period. Results Our study revealed an insignificant correlation between a BMI of more than 25 kg/m2 and the recurrence of inguinal hernias, predominantly indirect hernias. Furthermore, overweight and obese patients experience a longer interval between the first and second hernia repairs. Interestingly, all the patients with inguinal and umbilical hernias had the same diagnosis at the second presentation. However, the findings also included a significant increase in umbilical hernias in individuals with a high BMI and higher recurrence rates among male patients with inguinal hernias. Conclusion BMI higher than 25 kg/m2 increases recurrence rates for umbilical hernias but decreases the recurrence of inguinal hernias.

The Association Between Neck Pain and Psychological Distress Experienced by King Abdulaziz University Students: A Cross-Sectional Study.

Background Musculoskeletal discomfort resulting from soft tissue injuries to muscles, bones, nerves, tendons, joints, or cartilage is referred to as musculoskeletal disorders. Neck pain is a common musculoskeletal condition with a significant socioeconomic impact on patients. Previous literature has linked the onset of neck pain to various factors, including psychological factors that may affect musculoskeletal disorders (MSDs), similarly to physical factors. Psychological conditions, including anxiety and depression, may result in MSDs. Limited studies on the relationship between neck pain and psychological distress have been conducted among undergraduate students in Jeddah. The study aimed to investigate the relationship between neck pain and psychological distress. Additionally, the study examined the risk factors for developing neck pain, depression, and anxiety in King Abdulaziz University (KAU) undergraduate students. Method This cross-sectional study was conducted in November 2022 at KAU in Jeddah, Saudi Arabia, by distributing a google forms survey among undergraduate university students in KAU, excluding graduate students and students who did not agree to participate. We received 509 responses; each respondent gave written consent and participated in the study. Result Neck pain prevalence was 50.7% of all students (95% CI, 46.3-55.1). Significantly higher neck pain scores were observed in women (p<0.001), in students who did little or no exercise, and in those who drank coffee more frequently >3 cups daily. Anxiety (p<0.001) and depression (p<0.001) scores were also positively and significantly correlated with neck pain scores. The results of the association analysis revealed that women had significant scores for anxiety (p<0.001) and depression (p<0.001). Female sex (p<0.001) and increased neck pain score (p<0.001) were independent risk factors for anxiety. Higher neck pain scores were also associated with depression (p<0.001). Conclusion Our study showed that anxiety and depression significantly impact neck pain. Furthermore, the increased score of depression and anxiety indicates worsening neck pain.

Child engagement in daily life measure V2: validation of psychometric properties for children with cerebral palsy.

PURPOSE: Measurement development is a reiterative process requiring refinements and revalidation. The purpose of this study was to examine structural validity and reliability of the Child Engagement in Daily Life Measure (Version 2) for parents of children with cerebral palsy (CP) across a broader age span. METHODS: Participants were 1054 parents of children with CP 1.5-11 years of age. Parents completed the Child Engagement in Daily Life measure that consists of the Participation in Family and Recreational Activities domain (11 items) and the Performance of Self-care Activities domain (18 items) as part of two longitudinal studies related to outcomes for children with CP. RESULTS: Rasch analysis indicated acceptable fit of items, stable item calibration, and logical ordering of items by difficulty for both frequency of participation in family and recreational activities and performance of self-care activities. Test-retest reliability was good to excellent: ICC = 0.78 for frequency of participation, ICC = 0.68 for enjoyment of participation, and ICC = 0.97 for self-care. CONCLUSIONS: Evidence supports reliability and validity of the Child Engagement in Daily Life Measure (Version 2) for parent-report of their children's participation in family and recreational activities and performance of self-care activities for children with CP 1.5-12 years of age.IMPLICATIONS FOR REHABILITATIONParticipation in family and recreational activities and performance of self-care activities of children with cerebral palsy can be assessed using the concise parent-report Child Engagement in Daily Life Measure V2.Knowledge of the continuum of difficulty of the frequency of participation in family and recreational activities and performance of self-care activities can assist practitioners in progressing service plans.Practitioners are encouraged to use the measure to guide discussions with parents and children on areas to focus services to support participation in family and recreational activities and performance of self-care activities.

Evaluation of participation and performance indicators in a breast cancer screening program in Saudi Arabia.

OBJECTIVES: To evaluate early performance indicators for breast cancer screening at the King Abdulaziz University Hospital in Saudi Arabia. METHODS: This study retrospectively evaluated data from women who underwent their first breast cancer screening program in Jeddah, Saudi Arabia between 2012 and 2019. Data on screening results were used to estimate performance indicators and generate descriptive statistics. RESULTS: Of the 16000 women invited from 2012 to 2019, a total of 1911 (11.9%) participated. The majority of women (68.8%) were between 40 and 55 years old. Based on the screening process results, 26.6%, 40.1%, 9.7%, 1.3%, 0.7%, and 5.2% of women had BI-RADS scores of R1, R2, R3, R4, R5, and R0 respectively. The remaining 16.3% did not have mammogram records. The recall rate, or the percentage of women who underwent further evaluation, was 19.9%; 18.9% underwent a biopsy procedure. In addition, 1.6% of women had cancer screen-detected, although only 0.7% were diagnosed with breast cancer. CONCLUSION: In light of the low participation and high recall rates, it is essential that the screening program utilizes performance indicators to optimize resource utilization and ensure the quality of the service provided. Additionally, a national framework and standardized performance indicators could mitigate this problem for other cancer screening programs.

Mechanical and Morphological Changes of the Plantar Flexor Musculotendinous Unit in Children with Unilateral Cerebral Palsy Following 12 Weeks of Plyometric Exercise: A Randomized Controlled Trial.

To investigate how plyometric exercise (PLYO-Ex) affects mechanics and morphometrics of the plantar flexor musculotendinous unit in children with unilateral cerebral palsy, 38 participants (aged 10-16 years) were allocated at random to either the PLYO-Ex group (n = 19; received 24 sessions of plyometric muscle loading, conducted 2 times a week for 3 months in succession) or the control group (n = 19; underwent traditional physical therapy for the same frequency and duration). Measurements were taken pre- and post-intervention. Standard ultrasound imaging was applied to evaluate morphometrics of the gastrocnemius muscle and Achilles tendon unit and an isokinetic dynamometer was used to evaluate maximum voluntary isometric plantar flexors contraction (IVCmax). With controlling for pre-treatment values, significant post-treatment changes favoring the PLYO-Ex group were observed for morphological (tendon (p = 0.003, η2p = 0.23) length; belly length (p = 0.001, η2p = 0.27); tendon thickness (p = 0.035, η2p = 0.35); muscle thickness (p = 0.013, η2p = 0.17); fascicle length (p = 0.009, η2p = 0.18); pennation angle (p = 0.015, η2p = 0.16)) and mechanical and material properties (IVCmax (p = 0.009, η2p = 0.18); tendon's elongation (p = 0.012, η2p = 0.17), stiffness (p = 0.027, η2p = 0.13); stress (p = 0.006, η2p = 0.20); strain (p = 0.004, η2p = 0.21)). In conclusion, plyometric exercise induces significant adaptations within the musculotendinous unit of the plantar flexors in children with unilateral cerebral palsy. These adaptations could improve muscular efficiency and consequently optimize physical/functional performance.

A Case of Acute Compartment Syndrome Resolved Without Surgical Intervention.

Acute compartment syndrome (ACS) is often a result of a traumatic event or fractures. Nevertheless, other non-traumatic etiologies may rarely cause ACS. We present a case of a male patient who presented with unilateral below-the-knee pain without trauma or any external factor and was treated conservatively. A diagnosis of idiopathic compartment syndrome was made by MRI.

Arthroplasty of a Charcot Knee in a Patient With Congenital Insensitivity to Pain.

Hereditary sensory and autonomic neuropathies (HSANs) include hereditary disorders that cause congenital insensitivity to pain. Moreover, patients diagnosed with such disorders are known to have genetic mutations that alter their deep pain sensation, making them more prone to developing bone and joint complications such as repetitive fractures, joint swelling, and Charcot arthropathy. Neuropathic arthropathy (Charcot joint) is a rare and relatively poorly understood condition; it is suggested to be caused by autonomic dysfunction and repetitive microtrauma and characterized by instability and joint destruction. Diagnosing the idiopathic Charcot joint is challenging and is considered to be a diagnosis of exclusion. In addition, there are limited cases of Charcot knees managed by arthroplasty. Patients with Charcot knees are commonly characterized by profound bone loss, diffuse synovitis, and instability in the knee joint. In this article, we report the case of a 13-year-old patient with known NTRK1 gene mutation who presented with recurrent knee joint swelling episodes and instability without pain. She was diagnosed with Charcot knee joint and underwent right hinged total knee replacement. At one-year follow-up, she continued to have good knee stability and an overall functional gait. Our findings suggest that managing Charcot knee joint with total knee replacement in patients with HSAN may show improvement in terms of stability, swelling, and overall gait.

Post-COVID-19 Syndrome: Incidence, Risk Factor, and the Most Common Persisting Symptoms.

INTRODUCTION: The pandemic of the coronavirus disease 2019 (COVID-19) has caused a significant burden worldwide. The most common presentation of coronavirus disease is acute, and most patients recover completely. However, now a substantial proportion of patients experience long-term health effects. Post-COVID-19 syndrome (PCS) is defined as "signs and symptoms that develop after an infection consistent with COVID-19 that persist for more than 12 weeks and have not been explained yet by an alternative diagnosis." We faced a lack of studies regarding PCS in the Gulf area. Therefore, this study aimed to assess the incidence, risk factors, and most common persisting symptoms of PCS in confirmed COVID-19 patients who presented to King Abdulaziz University Hospital (KAUH) in Jeddah between June 1, 2020 and December 31, 2020. METHODS: This retrospective cohort study was conducted via telephone survey, which took place in June 2022 at KAUH. PCS was defined as the presence of one or more symptoms beyond 12 weeks from the onset of the illness. The inclusion criteria were patients aged 18 or above with laboratory-confirmed SARS-CoV-2 infection through positive RT-PCR in KAUH from June 1, 2020 to December 31, 2020, and both genders were included. The exclusion criteria were inability to provide informed consent, death, currently active COVID-19 infection (PCR +ve), and if they did not complete the interview. Medical records were obtained from patients diagnosed with COVID-19 through positive RT-PCR tests from June 1, 2020 to December 31, 2020. RESULTS: Data of 504 patients were analyzed. The incidence of PCS was 45.0% (95%CI, 40.7% to 49.5%). PCS was associated with female gender (OR = 1.71, 95%CI, 1.13 to 2.59, p = 0.011), having three or more co-morbid conditions (OR = 2.37, 95%CI, 1.19 to 4.75, p = 0.014), receiving steroids (OR = 2.13, 95%CI, 1.16 to 3.98, p = 0.016), also patients who experienced congestion (OR = 1.68, 95%CI, 1.05 to 2.71, p = 0.032) and depression (OR = 1.80, 95%CI, 1.03 to 3.18, p = 0.039) during acute COVID-19 infection. The most commonly reported symptoms beyond 12 weeks included fatigue (19.6%), joint pain (14.1%), and decreased exercise tolerance (12.7%). CONCLUSION: In conclusion, the main risk factors to develop PCS are being female, having three or more co-morbidities, receiving steroids, or patients presenting with nasal congestion and/or depression.

A Case of Mild Trichohepatoenteric Syndrome With New Variant Mutation in SKIV2L Gene: Case Report.

Trichohepatoenteric syndrome (THES) is a rare autosomal recessive genetic disease characterized by severe early onset diarrhea, woolly and brittle hair, immunodeficiency, and liver disease. A mutation in either SKIV2L or TTC37 genes can cause the disease. We report a case of a 41-month-old girl who suffered from intractable watery diarrhea, hair abnormality, dysmorphic features, and poor weight gain. The diagnosis was made through whole-exome sequencing analysis. The analysis detected a new variant mutation (c.1201G > A) p. (Glu401Lys) in the SKIV2L gene. She was admitted once for poor weight gain and nasogastric tube (NGT) feeding, with which the patient showed improvement. She was discharged to go home on hypoallergenic baby formulas and a regular diet with improved weight gain.

A Six-Year-Old Child With Mosaic Trisomy 13.

Trisomy 13 was first described by Patau in 1960. It is a rare genetic disease caused by having an extra copy of chromosome 13. Mosaic trisomy 13 happens when a percentage of the cells are trisomic for chromosome 13, while the remaining cells are euploid. Patau syndrome has a limited survival rate, and most of the carriers die before completing the first year of life. Unlike Patau syndrome, mosaic trisomy 13 is known for longer survival. It is associated with central nervous system malformations, cardiac defects, and psychomotor delay. We report a six-year-old male patient, the third child of a first-degree consanguinity. Born at term via emergency cesarean section due to meconium-stained amniotic fluid and fetal distress. Apgar score nine at one minute and nine at five minutes. Initial examination showed typical dysmorphic features like deep-seated eyes, small palpebral fissure, low set of ears, high arched palate, short neck, and right-hand polydactyly. The diagnosis was made through chromosomal analysis, and it revealed mosaic trisomy 13.

Urachal Abscess: A Rare Etiology of Acute Abdominal Pain in Adults.

Abdominal pain is a common cause of emergency department visits. It often poses a diagnostic challenge for physicians given the broad spectrum of its possible medical and surgical etiologies. We report the case of a 32-year-old man who presented to the emergency department with a complaint of lower abdominal pain for one week. Abdominal examination revealed suprapubic mass and tenderness. Laboratory investigation revealed elevated leukocyte count and inflammatory markers. An abdominal ultrasound examination showed a collection with poorly defined borders. Additionally, CT demonstrated a soft tissue mass adjacent to the anterior abdominal wall with an upward track to the umbilicus, conferring the diagnosis of a urachal abscess. The patient underwent successful management of the abscess with surgical excision. This case highlights the importance for clinicians to be aware of congenital urachal anomalies since early recognition of the urachal cyst is essential to determine the proper surgical management.

Alarm Therapy in the Treatment of Enuresis in Children: Types and Efficacy Review.

Enuresis is defined as bedwetting in children aged five years and older when organic reasons have been ruled out. It can result in substantial psychological repercussions and uncomfortable circumstances for both the child and the family. Medical (desmopressin, tricyclic antidepressants [TCAs]) and behavioral treatment are the basis for the treatment of enuresis. Alarm therapy is considered the first treatment modality of choice for enuresis with almost 50% cure rates are in the long term. Cooperation and compliance from parents and children are the cornerstones of the effectiveness of alarm therapy. Multiple factors, such as technical issues, might slow down the therapeutic response time. The objective of this study is to review the role of alarm therapy in the treatment of enuresis, its types, and its efficacy and to explore the factors that may increase or decrease its efficacy.

Tobacco smoking and depressive symptoms among male medical students in Al-Baha University.

BACKGROUND: Smoking is a psychosocial problem regarding its causes mainly. In primary health care units, depression is the most common problem that affects the whole body and arises with physical, emotional, and cognitive symptoms. This study aimed to determine the prevalence rate of tobacco smoking and depressive symptoms among male medical students of Albaha university. Also, to investigate the association between tobacco smoking and depressive symptoms among male medical students of Albaha university. METHOD: A cross-sectional study was conducted on All the male medical students in the all-academic year levels of Al-Baha medical college using a self-administrated questionnaire. RESULTS: Two hundred and eight medical students completed the study. About half of the participants (49.5%) weren't smokers. More than two-thirds (69.5%) started smoking in the first academic year. Our statistical analysis results reported; a significant correlation regarding the marital status (P-value = 0.000). The abnormality was significantly higher among current smokers (P-value = 0.013) and markedly lower among nonsmokers (P-value = 0.004). Regarding types of smoking, cigarette smokers were seriously depressed (P-value = 0.000). CONCLUSION: There is a relationship between smoking and depressive state among medical students. Researches must be conducted to explain this relation of depression symptoms with tobacco and not to increase the prevalence of smoking by helping students quit smoking.

Cross-cultural adaptation of the Arabic version of Self-Care Domain of Child Engagement in Daily Life and Ease of Caregiving for Children measures.

PURPOSE: To cross-culturally adapt the Self-Care Domain of Child Engagement in Daily Life and the Ease of Caregiving for Children to Arabic language and Saudi culture and to examine the reliability of the Arabic version of both measures. METHODS: A modified cross-cultural adaptation procedure was employed. A total 36 children with cerebral palsy (aged 1.5-11 years) and their parents participated in the pilot and final testing steps. A committee of 7 stakeholders evaluated cross-cultural equivalence of both measures. Cronbach's alpha, intra-class correlation coefficient, and minimal detectable change were used to establish internal consistency, test-retest reliability, and distribution-based index, respectively. RESULTS: Minor linguistic, not cultural, adaptations were made in the Arabic version of both measures. Conceptual, item, semantic, and operational types of equivalences were supported. The Arabic version of Self-Care Domain of Child Engagement in Daily Life and Ease of Caregiving for Children demonstrated high internal consistency (0.97 and 0.91, respectively), excellent test-retest reliability (0.99 and 0.96, respectively), and appropriate minimal detectable change values (0.29, 0.43, respectively). CONCLUSIONS: The Arabic version of Self-Care Domain of Child Engagement in Daily Life and Ease of Caregiving for Children are reliable and culturally appropriate for use with parents of children with cerebral palsy in Saudi Arabia.