ChestCovidNet: An Effective DL-based Approach for COVID-19, Lung Opacity, and Pneumonia Detection Using Chest Radiographs Images.

Currently used lung disease screening tools are expensive in terms of money and time. Therefore, chest radiograph images (CRIs) are employed for prompt and accurate COVID-19 identification. Recently, many researchers have applied Deep learning (DL) based models to detect COVID-19 automatically. However, their model could have been more computationally expensive and less robust, i.e., its performance degrades when evaluated on other datasets. This study proposes a trustworthy, robust, and lightweight network (ChestCovidNet) that can detect COVID-19 by examining various CRIs datasets. The ChestCovidNet model has only 11 learned layers, eight convolutional (Conv) layers, and three fully connected (FC) layers. The framework employs both the Conv and group Conv layers, Leaky Relu activation function, shufflenet unit, Conv kernels of 3×3 and 1×1 to extract features at different scales, and two normalization procedures that are cross-channel normalization and batch normalization. We used 9013 CRIs for training whereas 3863 CRIs for testing the proposed ChestCovidNet approach. Furthermore, we compared the classification results of the proposed framework with hybrid methods in which we employed DL frameworks for feature extraction and support vector machines (SVM) for classification. The study's findings demonstrated that the embedded low-power ChestCovidNet model worked well and achieved a classification accuracy of 98.12% and recall, F1-score, and precision of 95.75%.

Key dependent information confidentiality scheme based on deoxyribonucleic acid (DNA) and circular shifting.

In this era of advanced information technology, the exploration and development of novel mechanisms to ensure information confidentiality have consistently captivated the attention of upcoming researchers. In this article, we present a pioneering approach that combines DNA sequencing with a four-dimensional (4D) hyperchaotic map to bolster the security of digital information. Our primary focus is on the design of a robust and secure scheme for encrypting color images, leveraging DNA cryptography and hyperchaos. By extracting three distinct DNA sequences, we generate encryption keys through the integration of DNA computing and 4D hyperchaotic maps. Notably, these keys are intricately linked to the plaintext and vary with any alterations in the input. Consequently, the proposed encryption method stands resilient against an array of potential cryptographic attacks. To gauge the algorithm's security, we subject it to rigorous standard statistical analysis. Our findings underscore the efficiency and robustness of the proposed framework, establishing its potential for facilitating secure communication.

Minimally invasive sacroiliac joint fusion using triangular titanium implants versus nonsurgical management for sacroiliac joint dysfunction: a systematic review and meta-analysis.

BACKGROUND: Minimally invasive sacroiliac joint (MISIJ) fusion is a surgical option to relieve SIJ pain. The aim of this systematic review and meta-analysis was to compare MISIJ fusion with triangular titanium implants (TTI) to nonoperative management of SIJ dysfunction. METHODS: We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. We included prospective clinical trials that compared MISIJ fusion to nonoperative management in individuals with chronic low back pain attributed to SIJ dysfunction. We evaluated pain on visual analogue scale, Oswestry Disability Index (ODI) score, health-related quality of life (HRQoL) using the 36-Item Short Form Health Survey (SF-36) physical component (PCS) and mental component summary (MCS) scores, patient satisfaction, and adverse events. RESULTS: A total of 8 articles representing 3 trials that enrolled 423 participants were deemed eligible. There was a significant reduction in pain score with MISIJ fusion compared with nonoperative management (standardized mean difference [SMD] -1.71, 95% confidence interval [CI] -2.03 to -1.39). Similarly, ODI scores (SMD -1.03, 95% CI -1.24 to -0.81), SF-36 PCS scores (SMD 1.01, 95% CI 0.83 to 1.19), SF-36 MCS scores (SMD 0.72, 95% CI 0.54 to 0.9), and patient satisfaction (odds ratio 6.87, 95% CI 3.73 to 12.64) were significantly improved with MISIJ fusion. No significant difference was found between the 2 groups with respect to adverse events (SMD -0.03, 95% CI -0.28 to 0.23). CONCLUSION: Our analysis showed that MISIJ fusion with TTI shows a clinically important and statistically significant improvement in pain, disability score, HRQoL, and patient satisfaction with a similar adverse event profile to nonoperative management in patients with chronic low back pain attributed to SIJ dysfunction.

Automatic neonatal sleep stage classification: A comparative study.

Sleep is an essential feature of living beings. For neonates, it is vital for their mental and physical development. Sleep stage cycling is an important parameter to assess neonatal brain and physical development. Therefore, it is crucial to administer newborn's sleep in the neonatal intensive care unit (NICU). Currently, Polysomnography (PSG) is used as a gold standard method for classifying neonatal sleep patterns, but it is expensive and requires a lot of human involvement. Over the last two decades, multiple researchers are working on automatic sleep stage classification algorithms using electroencephalography (EEG), electrocardiography (ECG), and video. In this study, we present a comprehensive review of existing algorithms for neonatal sleep, their limitations and future recommendations. Additionally, a brief comparison of the extracted features, classification algorithms and evaluation parameters is reported in the proposed study.

An effective approach for plant leaf diseases classification based on a novel DeepPlantNet deep learning model.

Introduction: Recently, plant disease detection and diagnosis procedures have become a primary agricultural concern. Early detection of plant diseases enables farmers to take preventative action, stopping the disease's transmission to other plant sections. Plant diseases are a severe hazard to food safety, but because the essential infrastructure is missing in various places around the globe, quick disease diagnosis is still difficult. The plant may experience a variety of attacks, from minor damage to total devastation, depending on how severe the infections are. Thus, early detection of plant diseases is necessary to optimize output to prevent such destruction. The physical examination of plant diseases produced low accuracy, required a lot of time, and could not accurately anticipate the plant disease. Creating an automated method capable of accurately classifying to deal with these issues is vital. Method: This research proposes an efficient, novel, and lightweight DeepPlantNet deep learning (DL)-based architecture for predicting and categorizing plant leaf diseases. The proposed DeepPlantNet model comprises 28 learned layers, i.e., 25 convolutional layers (ConV) and three fully connected (FC) layers. The framework employed Leaky RelU (LReLU), batch normalization (BN), fire modules, and a mix of 3×3 and 1×1 filters, making it a novel plant disease classification framework. The Proposed DeepPlantNet model can categorize plant disease images into many classifications. Results: The proposed approach categorizes the plant diseases into the following ten groups: Apple_Black_rot (ABR), Cherry_(including_sour)_Powdery_mildew (CPM), Grape_Leaf_blight_(Isariopsis_Leaf_Spot) (GLB), Peach_Bacterial_spot (PBS), Pepper_bell_Bacterial_spot (PBBS), Potato_Early_blight (PEB), Squash_Powdery_mildew (SPM), Strawberry_Leaf_scorch (SLS), bacterial tomato spot (TBS), and maize common rust (MCR). The proposed framework achieved an average accuracy of 98.49 and 99.85in the case of eight-class and three-class classification schemes, respectively. Discussion: The experimental findings demonstrated the DeepPlantNet model's superiority to the alternatives. The proposed technique can reduce financial and agricultural output losses by quickly and effectively assisting professionals and farmers in identifying plant leaf diseases.

A hybrid deep learning-based intrusion detection system for IoT networks.

The Internet of Things (IoT) is a rapidly evolving technology with a wide range of potential applications, but the security of IoT networks remains a major concern. The existing system needs improvement in detecting intrusions in IoT networks. Several researchers have focused on intrusion detection systems (IDS) that address only one layer of the three-layered IoT architecture, which limits their effectiveness in detecting attacks across the entire network. To address these limitations, this paper proposes an intelligent IDS for IoT networks based on deep learning algorithms. The proposed model consists of a recurrent neural network and gated recurrent units (RNN-GRU), which can classify attacks across the physical, network, and application layers. The proposed model is trained and tested using the ToN-IoT dataset, specifically collected for a three-layered IoT system, and includes new types of attacks compared to other publicly available datasets. The performance analysis of the proposed model was carried out by a number of evaluation metrics such as accuracy, precision, recall, and F1-measure. Two optimization techniques, Adam and Adamax, were applied in the evaluation process of the model, and the Adam performance was found to be optimal. Moreover, the proposed model was compared with various advanced deep learning (DL) and traditional machine learning (ML) techniques. The results show that the proposed system achieves an accuracy of 99% for network flow datasets and 98% for application layer datasets, demonstrating its superiority over previous IDS models.

Multi-step attack detection in industrial networks using a hybrid deep learning architecture.

In recent years, the industrial network has seen a number of high-impact attacks. To counter these threats, several security systems have been implemented to detect attacks on industrial networks. However, these systems solely address issues once they have already transpired and do not proactively prevent them from occurring in the first place. The identification of malicious attacks is crucial for industrial networks, as these attacks can lead to system malfunctions, network disruptions, data corruption, and the theft of sensitive information. To ensure the effectiveness of detection in industrial networks, which necessitate continuous operation and undergo changes over time, intrusion detection algorithms should possess the capability to automatically adapt to these changes. Several researchers have focused on the automatic detection of these attacks, in which deep learning (DL) and machine learning algorithms play a prominent role. This study proposes a hybrid model that combines two DL algorithms, namely convolutional neural networks (CNN) and deep belief networks (DBN), for intrusion detection in industrial networks. To evaluate the effectiveness of the proposed model, we utilized the Multi-Step Cyber Attack (MSCAD) dataset and employed various evaluation metrics.

The Efficacy and Safety of Intra-articular Low Molecular Weight Fraction of Human Serum Albumin for the Management of Moderate to Moderately Severe Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

Osteoarthritis is a chronic degenerative joint disease that affects weight-bearing joints. Low molecular weight fraction of 5% (LMWF-5A) human serum albumin is an intra-articular injection that emerged for the treatment of knee osteoarthritis. The aim of this review is to assess the efficacy and safety of LMWF-5A versus placebo through a systematic review and meta-analysis. The Cochrane Central Register of Controlled Trials (CENTRAL), Medical Literature Analysis and Retrieval System Online (MEDLINE), EBSCO, and ClinicalTrials.gov registry databases were utilized to search for studies. Only randomized controlled trials (RCTs) that evaluated the efficacy of LMWF-5A versus placebo were included. Efficacy endpoints were represented by Western Ontario and McMaster Universities Arthritis Index (WOMAC) A and C scores for pain and function, respectively. Serious adverse events (SAEs), non-serious adverse events (NSAEs), and mortality rates were used to evaluate the safety of the drug. The revised Cochrane risk of bias tool was used for the risk of bias assessment. Seven RCTs (n=2939) that met the inclusion criteria were included. The meta-analysis did not find significant improvement in pain (WOMAC A) (standardized mean difference (SMD)= -0.01, 95% confidence interval (CI) -0.10 - 0.09, P=0.87, I²=30%). Additionally, no significant change in function was noted (WOMAC C) (SMD=0.01, 95% CI -0.08 - 0.10, P=0.87, I²=22%). The pooled analysis did not find a significant difference between LMWF-5A and placebo regarding the incidence of joint swelling (P=0.84), joint stiffness (P=0.53), arthralgia (P=0.53), extremity pain (P=0.45), NSAEs (P=0.21), SAEs (P=0.92), or mortality (P=1.00). However, the subgroup analysis showed a significant reduction of 42% in NSAEs upon administration of 10 mL of LMWF-5A (risk ratio (RR)=0.58, 95% CI 0.35-0.97, P=0.04). In summary, our meta-analysis did not find significant differences between LMWF-5A and placebo regarding the incidence of NSAEs, SAEs, or mortality. On the other hand, LMWF-5A did not demonstrate superiority over saline in terms of efficacy. Therefore, it is not an effective drug for managing knee osteoarthritis.

Public awareness about arthritic diseases in Saudi Arabia: a systematic review and meta-analysis.

PURPOSE: Raising public knowledge and perception would have a discernible impact on providing optimal care and reducing the burden of arthritis in the community. This systematic review aimed to identify the public knowledge about the common arthritic conditions in Saudi Arabia. METHODS: We searched MEDLINE, Embase, and CENTRAL for relevant literature. We included questionnaire-based cross-sectional studies performed in Saudi Arabia assessing the public perception of general knowledge, causes/risk factors, signs/symptoms, and relieving/management measures of the common arthritic conditions including osteoarthritis (OA), rheumatoid arthritis (RA), and gout. The meta-analysis was performed on outcomes reported in ≥ two studies utilizing a random-effects model RESULTS: Ten studies representing 6703 participants were deemed eligible for inclusion in this review. A total of 35 questions were feasible to be included in the meta-analysis. The meta-analysis estimated that 83.51%, 54.51%, and 80.42% have ever hearsd or read about OA, RA, and gout. Joint pain and swelling were perceived to be the main signs/symptoms of OA, RA, and gout. 7.5% think OA is predisposed by genetics while only 33.6% think the same of RA. RA knowledge in general is suboptimum. Only 27.04% think medications can help in the management of gout. CONCLUSION: The Saudi public perception of the general knowledge and causes/risk factors of the most common arthritic conditions was acceptable. The level of knowledge about other aspects of the common arthritic conditions is still limited and needs to be addressed by future educational interventions. TRIAL REGISTRATION: PROSPERO registration number: CRD42022345274.

Comparison of immobilization periods following open reduction and internal fixation of distal radius fracture: A systematic review and meta-analysis.

STUDY DESIGN: Systematic review and meta-analysis. INTRODUCTION: The use of volar locking plate (VLP) in the fixation of fracture fragments promised a new era in the management of distal radius fracture (DRF). PURPOSE OF THE STUDY: To compare the patient-reported outcomes, functional outcomes, pain, and adverse events between the different periods of immobilization following open reduction and internal fixation of DRFs with VLP. METHODS: We searched Medline/Pubmed, Web of Science, Ovid, and CINAHL. The inclusion criteria was randomized controlled trials that compared different immobilization periods after open reduction and internal fixation of DRFs with VLP. The last search was performed on 2 June 2020. The different immobilization periods were divided into the following 3 groups: ≤1-week group, 2-3-week group, and 5-6-week group. RESULTS: Seven eligible randomized controlled trials provided data on 509 patients. We found that compared to 5-6-week group, ≤1-week and 2-3-week groups showed a reduction in overall Patient-Reported Wrist Evaluation score (SMD = -0.48, 95% CI -0.73 to -0.22, P < .001; SMD = -0.69, 95% CI -0.97 to -0.41, P < .001, respectively). We also found that there were improvements in the other patient-reported outcomes including overall Disabilities of the Arm, Shoulder, and Hand score and pain; and functional outcomes including overall grip strength and range of motion measures in favor of ≤1-week and 2-3-week groups. CONCLUSION: This systematic review and meta-analysis showed that compared to immobilization for 5 to 6 weeks after DRF repair, immobilization for ≤1 week or 2-3 weeks showed improvements in the patients-reported outcomes and functional outcomes. The differences between the 3 immobilization groups may not be clinically important considering the small changes as follow up progresses.

Effect of ultrasound-guided versus landmark-guided local corticosteroid injection for carpal tunnel syndrome: a systematic review and meta-analysis.

BACKGROUND: Carpal tunnel syndrome (CTS), the commonest neuropathy of the upper limb, can be managed with different therapeutic approaches. Local corticosteroid injection has been adopted widely in clinical practice, as it showed great efficacy in treating CTS. However, the best injection technique continues to be a subject of controversy. The aim of this systematic review and meta-analysis was to evaluate the efficacy of ultrasound-guided (US-guided) versus landmark-guided (LM-guided) corticosteroid injection on the clinical and electrophysiological outcomes in patients with CTS. METHODS: We performed a systematic literature search in Medline, Embase, and CENTRAL, from which we included randomized controlled trials (RCTs) that compared US-guided and LM-based corticosteroid injection in treating individuals with CTS. We evaluated the following outcomes: Boston carpal tunnel questionnaire functional status scale (BCTQ-FSS) and symptom severity scale (BCTQ-SSS), and adverse event rate. The standardized mean difference (SMD) was used to represent continuous outcomes, while the risk ratio (RR) was used to represent dichotomous outcome. RESULTS: A total of 8 RCTs that enrolled 500 wrists were deemed eligible. US-guided injection showed a significantly better BCTQ-FSS (SMD = -0.22, 95% CI -0.39 to -0.04), BCTQ-SSS (SMD = -0.77, 95% CI -1.22 to -0.31), and adverse event rate (RR = 0.32, 95% CI 0.21 to 0.49) compared to LM-based injection. CONCLUSION: This meta-analysis showed the superiority of US-guided corticosteroid injection over LM-guided corticosteroid injection in enhancing functional status, improving symptom severity, and reducing the adverse event rate in individuals with CTS.

Botulinum toxin type A for lower limb lengthening and deformity correction: A systematic review and meta-analysis.

BACKGROUND: Botulinum toxin type A (BTX-A) is the most popular therapeutic agent for muscle relaxation and pain control. Lately, BTX-A injection received great interest as a part of multimodal pain management for lower limb lengthening and deformity correction. This systematic review aimed to determine the role of BTX-A injection in pain management for during lower limb lengthening and/or deformity correction. METHODS: We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared the BTX-A injection to placebo for individuals undergoing lower limb lengthening and/or deformity correction. We sought to evaluate the following outcomes: pain on visual analogue scale (VAS), range of motion parameters, average opioid consumption, and adverse events. The standardized mean difference (SMD) was used to represent continuous outcomes while risk ratio (RR) was used to represent dichotomous outcomes. RESULTS: A total of 4 RCTs that enrolled 257 participants (337 limbs) deemed eligible. Adjuvant BTX-A injection showed a significant reduction in post-operative pain compared to placebo (SMD = -0.28, 95% CI -0.53 to -0.04). No difference was found between BTX-A injection and placebo in terms of range of motion parameters, average opioid consumption, or adverse events after surgical limb lengthening and/or deformity correction (RR = 0.77, 95% CI -0.58 to 1.03). CONCLUSIONS: Adjuvant BTX-A injection conferred a discernible reduction in post-operative pain during surgical limb lengthening and/or deformity without increasing the risk of adverse events. PROSPERO REGISTRATION NUMBER: CRD42021271580.

Single Bundle Versus Double Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

Background: Anterior cruciate ligament (ACL) tear is considered as one of the most common sport-related musculoskeletal injuries. Double bundle (DB) and single bundle (SB) surgical techniques has been widely adopted for ACL reconstruction. This systematic review aimed to provide updated evidence by comparing the short-term, mid-term, and long-term knee stability and functional outcomes of DB and SB reconstruction techniques. Methods: We searched Medline, Web of Science, and CENTRAL. We have selected randomized controlled trials (RCTs) that compared DB and SB ACL reconstruction techniques for primary isolated ACL tear. We have assessed the following outcomes: pivot shift test, Lachman test, KT-1000/2000 knee ligament arthrometer, Lysholm knee function score, Tegner activity score, and graft failure. We have used the standardized mean difference (SMD) was to summarize the continuous outcomes while risk ratio (RR) was used to summarize the dichotomous outcomes. Results: A total of 34 RCTs that enrolled 2,992 participants deemed eligible. Overall, DB showed significantly better outcomes in terms of pivot shift test (RR = 0.61, 95% confidence interval (CI) 0.49-0.75), Lachman test (RR = 0.77, 95% CI 0.62 to 0.95), and KT 1000/2000 arthrometer (SMD = - 0.21, 95% CI - 0.34 to - 0.08). No discernible difference was found between DB and SB techniques in the overall Lysholm score (SMD = 0.12, 95% CI - 0.03 to 0.27), Tegner score (SMD = 0.03, 95% CI - 0.17 to 0.24), or graft failure rate (RR = 0.78, 95% CI 0.33 to 1.85). Conclusions: Our review suggests that DB ACL reconstruction technique shows significantly better knee stability and functional outcomes than SB at short-term follow-up. However, both techniques exhibit similar outcomes at mid-term and long-term follow-up. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-022-00718-0.

Influence of perioperative opioid-related patient education: A systematic review and meta-analysis.

OBJECTIVE: To determine the role of perioperative protocolized opioid-specific patient education on opioid consumption for individuals undergoing surgical procedures. METHODS: We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) that compared protocolized perioperative opioid-specific patient education to the usual care for adult individuals undergoing surgical interventions. The standardized mean difference (SMD) was used to represent continuous outcomes while the risk ratio (RR) was used to represent dichotomous outcomes. RESULTS: In total, 15 RCTs that enrolled 2546 participants were deemed eligible. Protocolized opioid-specific patient education showed a significant reduction in postoperative opioid consumption and postoperative pain score compared to usual care (SMD= -0.15, 95% confidence interval [CI]: -0.28 to -0.03 and SMD= -0.17, 95% CI: -0.28 to -0.06, respectively). No significant difference was found between the protocolized opioid-specific patient education and the usual care in terms of the number of refill requests (RR=0.82, 95% CI: 0.50-1.34), patients with opioid leftovers (RR=0.92, 95% CI: 0.78-1.08), and patients taking opioids after hospital discharge. CONCLUSIONS: This meta-analysis demonstrated that protocolized opioid-specific patient education significantly reduces postoperative opioid consumption and pain score but has no influence on the number of opioid refill requests, opioid leftovers, and opioid use after hospital discharge. PRACTICE IMPLICATIONS: Healthcare professionals may offer opioid-related educational sessions for the surgical patients during the perioperative period through a video-based material that emphasizes the role of alternative analgesics to opioids, patients' expectations about the post-operative pain, and the potential side effects of opioid consumptions.

Association Between Osteoporosis and Refracture Rate Among Patients With Hip Fractures at King Abdulaziz Medical City, Saudi Arabia.

Background Hip fracture is a major medical and surgical topic and is a significant cause of morbidity and mortality. Older women, especially those with osteoporosis, are at an increased risk for hip fractures. Multiple studies have shown the effect of osteoporosis on the refracture rate among the elderly population. Therefore, selecting a targeted population for screening and treating osteoporosis has an essential role in decreasing the hip fracture rate. This study aimed to determine the association between osteoporosis treatment and refracture rate among patients with hip fractures at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Methods Collected data included patient demographics (men: ≥55 years old; women: ≥50 years old), the used osteoporosis investigation method, osteoporosis treatment history, presence of comorbidities, and refracture as a primary outcome. The refracture rate among patients with hip fracture was calculated and used to determine the association between hip refracture and osteoporosis. Results Our study included a total of 292 patients who presented to our hospital due to hip fractures. The patients were divided into two groups, the osteoporotic and non-osteoporotic groups. These groups were then compared. There was no statistical significance between osteoporosis and hip refracture (p = 0.721), and there was no association between the treatment of osteoporosis and hip refracture (p = 0.493). Statistical difference was found between patients who had undergone dual-energy X-ray absorptiometry scan and were not treated for osteoporosis (p = 0.00). Lastly, the mortality of the refracture group was 10%, while it was 11% in the no-refracture group (p = 1.00). Conclusion Morbidity and mortality rates are higher among patients with hip fractures. Our study showed that there was no association between hip refracture rate and osteoporosis whether the patient is treated for osteoporosis or not. We recommend a systematic review that can include more studies in this field to acquire more definitive results regarding this topic.

Early versus late weightbearing in conservative management of acute achilles tendon rupture: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Achilles tendon rupture (ATR) is one of the most frequently encountered injuries in Sports Medicine. ATR can be managed surgically or conservatively followed by early functional rehabilitation or cast immobilization. The aim of the present systematic review and meta-analysis was to provide an update about the role of early weightbearing (WB) versus late WB on the clinical outcomes of adults with acute ATR. METHODS: We performed a systematic literature search in Web of Science, Ovid, Medline/PubMed, and CENTRAL. We included randomized controlled trials (RCTs) that compared early WB, defined as weight-bearing within 4 weeks of treatment, to late WB for individuals with acute (<14 days) ATR. We sought to evaluate the following outcomes: re-rupture rate, Achilles Tendon Rupture Score (ATRS), return to pre-injury sport activity, time to return to work, and adverse event rate. The standardized mean difference (SMD) was used to represent continuous outcomes while the risk ratio (RR) was used to represent dichotomous outcomes. RESULTS: A total of 9 RCTs that enrolled 1046 participants were deemed eligible. There was no significant difference between early WB and late WB in terms of re-rupture rate (RR=0.75, 95% CI 0.49 to 1.16), ATRS (SMD=0.06, 95% CI -0.03 to 0.16), return to pre-injury sport activity (RR=1.05, 95% CI 0.86 to 1.28), time to return to work (SMD=0.03, 95% CI -0.20 to 0.26), or adverse event rate (RR=1.87, 95% CI 0.53 to 6.63). CONCLUSION: This meta-analysis shows no difference in the functional outcomes and patient-reported outcomes between early functional rehabilitation and cast immobilization for conservatively treat individuals with acute ATR.

Short leg cast versus orthotic removable support for the management of pseudo-Jones avulsion fracture: A systematic review and meta-analysis.

BACKGROUND: The fifth metatarsal base avulsion fracture (i.e., Pseudo-Jones fracture) is one of the most common foot fractures. The management of pseudo-Jones fractures could be carried out surgically or conservatively. This systematic review and meta-analysis aimed to provide an update about the efficacy of orthotic removable support compared to short-leg casting for individuals with pseudo-Jones fracture. METHODS: We searched Embase, Medline, and Cochrane Central register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) that compared the clinical outcomes of orthotic removable support and short-leg cast for adult individuals with a fifth metatarsal base avulsion fracture. We used 95% as a confidence level and P <0.05 as a threshold. The standardized mean difference (SMD) was used for the continuous outcomes, and the risk ratio (RR) was used for the dichotomous outcomes. RESULTS: A total of 6 RCTs incorporating 403 individuals out were deemed eligible. There was no significant difference between orthotic removable support and short-leg casting regarding AOFAS score (standardized mean difference (SMD)= 0.31, 95% CI -0.17 to 0.8), pain on VAS score (SMD= -0.08, 95% CI -0.39 to 0.22), VAS-FA score (SMD= 0.22, 95% CI -0.19 to 0.62) EQ-5D VAS score, and non-union rate (RR=0.37, 95% CI 0.05 to 2.74). CONCLUSION: The current meta-analysis reveals that there is no difference between orthotic removable support and short-leg casting for the conservative management of individuals sustaining pseudo-Jones fracture.

Neglected Neck of Femur Fracture Managed by Surgical Hip Dislocation: A Case Report and Literature Review.

INTRODUCTION: Femoral neck fractures (FNFs) in young adults are relatively uncommon emergency that requires early diagnosis and management possible to prevents joint complications. CASE REPORT: A 24-year-old male presented with a right hip pain for 3 months after a heavy physical exercise during military training. The imaging exhibited a transcervical FNF with displacement and a potential of avascular necrosis (AVN). The patient was managed by Open reduction and internal fixation through surgical hip dislocation (SHD) and bone grafting from the right iliac bone. The patient returned to his full military services 14 weeks following the surgery and was followed for 3 years without any symptomatic or functional problems. CONCLUSION: SHD could be one of the surgical options hired in the management of late presentations of FNFs in young adults with high suspicion of AVN.

Returning to Sport After Anterior Cruciate Ligament Reconstruction in Physically Active Individuals.

Background Physically active individuals are susceptible to sports injuries, one of which is anterior cruciate ligament (ACL) injury. ACL injury can be managed conservatively or by surgical reconstruction. Returning to sport (RTS) after ACL injury is one of the main goals of ACL reconstruction (ACLR). However, rates of return vary and can be affected by several factors. The objectives of this study were to estimate the rate of return and to identify the factors that might affect RTS after ACLR.  Methods This was a cross-sectional study, including individuals who had an ACLR. Participants were sent an online survey included questions about their injury, sport participation, International Knee Documentation Committee form (IKDC), and the Tampa Scale for Kinesiophobia (TSK-11). Participants who had their surgery in the period between January 2011 to December 2018 and participated in sports regularly were included. Descriptive statistics were performed. Chi-square and student t-tests were performed to explore the differences between participants who returned and the ones that did not.  Results A total of 93 participants were included. The majority (69.9%) were playing soccer before the injury. Though more than half (61.3%) returned to sports, only 29% participated at the same level before the injury. Fear of reinjury was the most frequent reason for delaying or not returning (30%), followed by pain (29). Significantly better IKDC (p=0.002) and TSK-11 (p<0.001) scores were noted in participants who had returned to sports. On the other hand, participants' age, body mass index (BMI), time from injury to surgery, time since surgery, and times of sports participation per week were not found to be significantly different between those who returned versus those who did not. Conclusion The participants in this study had a low rate of return with fear of reinjury being the most common reason not to return. However, a participant's IKDC and TSK-11 scores were associated factors for RTS, thus optimizing those factors after surgery is crucial.

Knowledge, Awareness, and Attitudes Toward Obstructive Sleep Apnea among the Population of the Asir Region of Saudi Arabia in 2019.

Background Obstructive sleep apnea (OSA) is a sleep disorder that involves the cessation or significant decrease in airflow along with a distinct effort to breathe. While there are several types of sleep apnea, OSA is the most common. Methodology This descriptive online cross-sectional study assessed knowledge, awareness, and attitudes towards OSA over 30 days in a nonrandomized sample of the general population of the Asir region of Saudi Arabia. Subjects were included if they lived in the Asir region and were aged >18 years. Results Of the respondents who participated in the study, 64% were aware of OSA, whereas 36% were not. Most respondents reported that OSA was dangerous, whereas 24% did not know whether OSA was dangerous. Moreover, 81% of respondents reported that they did not know about methods of diagnosing OSA, and 84% did not know about the methods to treat OSA. Conclusions Subjects living in the Asir region of Saudi Arabia showed a low level of awareness of all aspects of OSA. Their lack of sources of knowledge indicates the need for medical staff to improve awareness and knowledge of OSA.