Divine resilience: Unveiling the impact of religious coping mechanisms on pain endurance in arab older adults battling chronic pain.

BACKGROUND: Chronic pain diminishes the quality of life for many Older Adults individuals. Identifying effective coping methods to enhance pain resilience is imperative as populations age. Older Adults commonly use religious faith and spiritual practices to endure pain, yet little research has explored their impact on pain tolerance. METHODS: This cross-sectional study examined relationships between positive/negative religious coping styles and pain endurance in 200 Arab elders with chronic pain. Participants completed the Brief Arab Religious Coping Scale, Numeric Pain Rating Scale, WHOQOL-BREF, and demographic/medical history questionnaires. RESULTS: Quantitative analysis demonstrated significant positive associations between positive religious reappraisal and active spiritual coping with higher self-reported pain endurance (p<.05). Negative religious coping styles lacked meaningful relationships with pain tolerance. Multiple regression confirmed the unique effects of reappraisal and spiritual practice on improving pain resilience, controlling for covariates. CONCLUSIONS: Outcomes align with perspectives highlighting multidimensional neurocognitive, emotional, and psychosocial pain relief from religious coping. Findings underscore integrating positive faith-based resources in biopsychosocial paradigms for Older Adult's pain management. Additional research should investigate causal pathways and contextual factors influencing religious coping effects on diverse Older Adult subgroups.

Overlap Between Gastroesophageal Reflux Disease and Functional Constipation and Associated Risk Factors Among the General Population in Saudi Arabia.

Introduction: Gastroesophageal reflux disease (GERD) and functional constipation (FC) are two common gastrointestinal disorders that affect many age groups in the community. A few studies were conducted to find the association between GERD and FC, but no study had been conducted in Saudi Arabia. Therefore, this study aims to find the overlap between GERD and FC and associated risk factors among the general population in the Eastern Province, Saudi Arabia. Methods: A cross-sectional study was conducted in the eastern province of Saudi Arabia between August and September 2022. GERDQ and Rome IV criteria were used to collect the data with participants' characteristics through an online questionnaire. Results: Out of 2007 respondents, 1481 filled the required criteria, among them 320 (21.6%) had GERD, and 1292 (87.2%) respondents had FC based on the listed criteria. Eighty percent of respondents with GERD had overlapping FC. Men were more likely than women to experience this significant relationship (53.1% versus 46.9%). Conclusion: There is a significant relationship between GERD and FC among the general population of the eastern province of Saudi Arabia. Consequently, this study could be used to improve the understanding of the overlapping between these gastrointestinal disorders and further new guidelines could be carried out to find the best treatment for these patients.

Religious, Cultural, and Sex Influences on Advance Care Directives in Patients Admitted to a Tertiary Care Center in Kenya.

INTRODUCTION: Advance care directives (AD) are instructions from patients regarding the care they would prefer if they could not make medical decisions in the future. It is widely recognized that racial and ethnic as well as sex differences, particularly in the West, can influence AD. However, to the best of our knowledge, there is limited understanding of how these factors impact AD in sub-Saharan Africa. METHODS: This prospective cross-sectional study was conducted at the Aga Khan University Hospital, Nairobi. We enrolled patients above the age of 18 years who were admitted to the general medical wards. The data were collected using a structured questionnaire that consisted of questions based on demographics and AD. Descriptive statistics were used to summarize the data, including frequencies and percentages, as well as medians and interquartile ranges. RESULTS: The study involved 286 participants, with a median age of 44.0 years (IQR: 37.0 - 52.0). Roughly half of the participants were male (51.7%), and the majority identified themselves as Christians (77.3%) and of African ethnicity (78.3%). Upon further analysis, it was discovered that only 35.3% had an awareness of AD. Notably, individuals from the Hindu religion and Asian ethnicity demonstrated significantly higher knowledge of AD. Furthermore, more males reported having a living will and believed that AD are crucial for patients who could not make independent medical decisions compared to females. CONCLUSION: This study indicated a lower awareness and knowledge of AD among the participants. Hindus and Asians exhibited higher levels of awareness regarding AD. Considering the diverse religious and cultural backgrounds in our setting, there is a pressing need for strategies to increase awareness surrounding AD.

Awareness of Healthy Lifestyle Among Elderly Population During Aging in Al-Ahsa, Saudi Arabia.

INTRODUCTION: The research explores healthy aging among elderly individuals globally and in Saudi Arabia. Factors like health services, lifestyle, and chronic diseases affecting seniors are examined. However, there is a gap in culturally relevant research, particularly in Arabic-speaking countries. This study aims to understand elderly individuals' knowledge, attitudes, and practices regarding healthy lifestyles for effective functional preservation in aging. METHODOLOGY: A cross-sectional study was conducted in the eastern part of Saudi Arabia, specifically Al-Ahsa, from February to May 2023. The Raosoft calculator was employed to determine a sample size of at least 384 participants. The data was analyzed using SPSS. RESULTS: Regarding the associations between knowledge levels and demographics, education significantly impacts knowledge (p=0.003). Retired respondents exhibit higher knowledge (50.4%) compared to those with jobs (10.4%) (p=0.002). Smoking has a significant impact on knowledge (p=0.012). Regarding the opinions on elderly care, respondents agree on the importance of fresh fruits and vegetables (52.2%), increased protein intake (64.3%), less fat (83.5%), and regular exercise (44.3%). Supplements' necessity is disagreed upon (95.7%). Living with family is favored (67.8%), and elderly self-management is recognized (60.9%). Significant differences are seen in fruit and vegetable consumption (p=0.001), less fat usage (p=0.000), exercise habits (p=0.000), smoking (p=0.000), and using just salt in cooking (p=0.000). CONCLUSION: Study findings underscore the importance of education in influencing healthy behaviors and informed choices, with education levels significantly impacting knowledge levels. Respondents' preferences for balanced diets, exercise, and self-management reflect a positive trend toward embracing healthy aging principles. Notably, the study identifies disparities between knowledge groups in various lifestyle factors, highlighting the potential of education to drive positive changes in behaviors.

Implications of Iron Deficiency Anaemia on Glycemic Dynamics in Diabetes Mellitus: A Critical Risk Factor in Cardiovascular Disease.

BACKGROUND: Iron deficiency anemia (IDA) is a highly prevalent comorbidity in patients with diabetes, with rates estimated between 13% and 47% across studies. Iron deficiency anemia may potentially influence hemoglobin A1c (HbA1c) values, which are routinely measured to monitor long-term glycemic control in diabetes. Some evidence suggests that HbA1c may be lower in diabetics with IDA due to increased red blood cell turnover. However, current evidence elucidating the effects of IDA on HbA1c and diabetes outcomes remains inconsistent and inconclusive. OBJECTIVE: This cross-sectional study aimed to evaluate the relationship between IDA, HbA1c levels, and glycemic dynamics in patients with diabetes mellitus. METHODS: The study sample included 143 adult patients diagnosed with diabetes, recruited from outpatient clinics in Saudi Arabia. Iron deficiency anemia was identified through serum ferritin <100 ng/mL, transferrin saturation <20%, and hematologic parameters. The HbA1c levels were measured using standardized laboratory methods. Daily glucose profiles were obtained by continuous glucose monitoring (CGM) in a subset of patients to assess glycemic dynamics. RESULTS: The prevalence of IDA was 39.9% among the diabetic cohort. Patients with IDA had a numerically higher mean HbA1c of 7.2% compared to 6.8% in non-anemic diabetics, suggesting a potential effect of IDA on HbA1c. Those with IDA also spent more time in hyperglycemic ranges, along with greater glucose variability based on CGM data. Iron deficiency measures, including low ferritin and high red cell distribution width (RDW), showed weak positive correlations with HbA1c levels. CONCLUSION: Iron deficiency anemia is highly prevalent among Saudi diabetic patients and is potentially associated with inaccurate HbA1c values and poor short-term glycemic control. However, larger controlled studies are warranted to conclusively investigate mechanisms linking IDA to alterations in HbA1c and glycemic dynamics. Optimized screening and treatment of IDA may lead to more accurate diabetes monitoring and improved outcomes.

Prediction of the 10-Year Risk of Cardiovascular Diseases Among Patients in Primary Health Care Centers in Eastern Province, Saudi Arabia.

Background Cardiovascular diseases (CVDs), primarily coronary artery disease (CAD) and stroke, stand as a leading cause of morbidity and mortality globally. Our objective was to predict the 10-year risk of CVD in the Eastern Province of Saudi Arabia. Methods This cross-sectional study was conducted in eight randomly selected primary healthcare centers using cluster sampling based on geographical location in Saudi Arabia's Eastern Province, specifically the Al-Ahsa region. The study aimed to assess the risk of developing CVD in the next 10 years among patients with at least one cardiovascular risk factor. Patients visiting the healthcare centers for checkups filled out the Framingham Cardiovascular Disease (10-year risk) score questionnaire. Results Of the 665 patients enrolled, 54.4% were female. The average age of the patients was 54.2 (SD 8.48) years. The overall average Framingham Risk Score (FRS) percentage was 19.2% (SD 15.4%). In terms of 10-year CVD risk, 34.6% of the patients were at high risk, 31.6% were at moderate risk, and 33.8% were considered low-risk individuals. Factors associated with a higher risk of CVD included older age, male gender, lower educational attainment, smoking, normal BMI, stage 2 hypertension, and diagnoses of hypertension, diabetes, and obesity. Conclusion Utilizing the FRS, it was determined that older men with lower educational levels had a higher 10-year risk of developing CVD. Furthermore, CVD risk factors such as diabetes, hypertension, obesity, and smoking were associated with individuals' CVD risk. Considering the ease of use and applicability of the FRS in daily clinical practice, as well as its potential to identify high-risk individuals, a more systematic implementation in general practice appears to be warranted.

Impacts of Integrating Family-Centered Care and Developmental Care Principles on Neonatal Neurodevelopmental Outcomes among High-Risk Neonates.

BACKGROUND: Integrating family-centered care (FCC) and developmental care (DC) principles in neonatal care settings may improve neurodevelopmental outcomes for high-risk neonates. However, the combined impact of FCC and DC has been underexplored. This study aimed to investigate the effects of integrated FCC and DC on neurodevelopment and length of hospital stay in high-risk neonates. METHODS: A quasi-experimental pre-post study was conducted among 200 high-risk neonates (<32 weeks gestation or <1500 g) admitted to neonatal intensive care units (NICU) in Saudi Arabia. The intervention group (n = 100) received integrated FCC and DC for 6 months. The control group (n = 100) received standard care. Neurodevelopment was assessed using the Bayley Scales of Infant Development-III. Length of stay and readmissions were extracted from medical records. RESULTS: The intervention group showed significant improvements in cognitive, motor, and language scores compared to controls (p < 0.05). The intervention group had a 4.3-day reduction in the mean length of stay versus a 1.4-day reduction in controls (p = 0.02). Integrated care independently predicted higher cognitive scores (p = 0.001) and shorter stays (p = 0.006) in regression models. CONCLUSION: Integrating FCC and DC in neonatal care enhances neurodevelopmental outcomes and reduces hospitalization for high-risk neonates compared to standard care. Implementing relationship-based, developmentally supportive models is critical for optimizing outcomes in this vulnerable population.

A harmonised dataset for modelling select underutilised crops Across EU.

Whilst simulating crop performance in different environments can help fill the knowledge gap and improve the adoption of crops that are currently neglected and underutilised in conventional agrifood systems, lack of experimental data remains a barrier to widespread modelling of these crops. To date, no attempt has been made to collate sub-species crop data that are specifically suited for modelling underutilised crops. This article describes the first attempt to develop a database for crop modelling data with a focus on European underutilised crops. Following a pilot study to identify crops with the potential across the EU, a structured dataset of detailed experimental data was developed by analysing more than 500 agronomic studies that were published across European agroclimatic zones from 1972 to 2022. The dataset contains minimum information for calibrating basic crop models for any location in the EU provided that enough experimental and environmental data are available. More specifically, the database includes crop phenology, yield, management practices, geographic and pedo-climatic details of select underutilised and neglected species. The information underwent a curation procedure to ensure its quality. The collated database will be used in CropBASE, the global knowledge base for underutilised crops.

Bone Tumor Risk Stratification and Management System: A Consensus Guideline from the ACR Bone Reporting and Data System Committee.

The assessment and subsequent management of a potentially neoplastic bone lesion seen at diagnostic radiography is often complicated by diagnostic uncertainty and inconsistent management recommendations. Appropriate clinical management should be directed by risk of malignancy. Herein, the ACR-sponsored Bone Reporting and Data System (Bone-RADS) Committee, consisting of academic leaders in the fields of musculoskeletal oncology imaging and orthopedic oncology, presents the novel Bone-RADS scoring system to aid in risk assignment and provide risk-aligned management suggestions. When viewed in the proper clinical context, a newly identified bone lesion can be risk stratified as having very low, low, intermediate, or high risk of malignancy. Radiographic features predictive of risk are reviewed include margination, pattern of periosteal reaction, depth of endosteal erosion, pathological fracture, and extra-osseous soft tissue mass. Other radiographic features predictive of histopathology are also briefly discussed. To apply the Bone-RADS scoring system to a potentially neoplastic bone lesion, radiographic features predictive of risk are each given a point value. Point values are summed to yield a point total, which can be translated to a Bone-RADS score (1-4) with corresponding risk assignment (very low, low, intermediate, high). For each score, evidence-based and best practice consensus management suggestions are outlined. Examples of each Bone-RADS scores are presented, and a standardized diagnostic radiography report template is provided.

Factors Influencing Individuals' Decision-Making Regarding Hematopoietic Stem Cell Donation: A Cross-Sectional Study in Saudi Arabia.

INTRODUCTION: Hematopoietic stem cell transplantation (HSCT) is a vital medical intervention for treating various conditions. The preferred methods, i.e., bone marrow transplantation and peripheral blood stem cell transplantation, have saved lives and attracted attention. Saudi Arabia, with a high sickle cell disease and leukemia incidence, faces the challenge of matching donors for HSCT. Factors like knowledge, attitudes, cultural beliefs, and access to information impact donation decisions. METHODS: In May 2023, a cross-sectional online survey was conducted in Saudi Arabia, targeting the general population. Data were collected through an online questionnaire, analyzing demographics, knowledge, attitudes, and factors influencing donation intention. RESULTS: Demographic analysis showed that females, younger individuals (18-25 years), those with higher education, and healthcare workers had better knowledge. Attitudes toward donation varied: 42.4% were willing to donate, while 57.6% were not. Psychological barriers, health concerns, pain, and inadequate knowledge influenced donation reluctance. Of the participants, 3.5% were registered stem cell donors, with 58.8% expressing willingness but not registered. Donors' intent was influenced by family members' need for transplants and knowledge. A majority (56.6%) supported employer support for health programs, while 65.7% believed government funding should assist donors. CONCLUSION: HSCT is vital in treating diseases like sickle cell and leukemia in Saudi Arabia. While many recognize its importance, knowledge gaps about its specifics and donation deter potential donors. Enhanced awareness campaigns and support from employers and the government could increase donor registrations.

Knowledge Regarding Hypoglycemia and Its Management Among Patients With Insulin-Requiring Diabetes Mellitus in Al-Ahsa, Saudi Arabia.

BACKGROUND: Hypoglycemia has a negative influence on patients with diabetes mellitus (DM) using insulin, and a lack of knowledge about hypoglycemia is one of the main causes of hypoglycemia. We aim to assess the level of knowledge about hypoglycemia and its management among insulin-requiring DM patients in Al-Ahsa, Saudi Arabia. METHODS: A cross-sectional study was conducted on patients with insulin-requiring DM in Al-Ahsa, Saudi Arabia, from November 2021 to March 2022. A questionnaire was filled out by the participants to assess their level of knowledge about hypoglycemia, which was categorized as good, fair, or poor if participants scored >7, 6-7, or <6, respectively. RESULTS: A total of 238 participants were recruited. Among participants, 55% were males, mainly in the age group of 40-65 years, and had higher education degrees. Doctors were the main source of information among participants. Most patients had no chronic illnesses other than DM or DM-related complications, although hypertension was reported in 37% of patients. The majority of participants had a good level of knowledge regarding hypoglycemia, and the main factors that increased it were getting information from doctors, social media, or a booklet or pamphlet (p-value <0.05). CONCLUSION: Our participants generally had a good level of knowledge about hypoglycemia, and doctors delivering information about hypoglycemia contributed significantly to this knowledge level.

An electronic health record system implementation in a resource limited country-lessons learned.

Electronic health records have revolutionized the medical world by improving medical care, refining provider documentation, standardizing care, and minimizing sentinel events. Successful implementation of electronic health records remains a daunting task and requires careful strategic planning and buy-in from key stakeholders. Much has been published in resource-rich settings and high-income countries about implementations of electronic health records. However, little is known about the experience in resource-limited settings where challenges remain unique and distinct from other parts of the world. Our intention is to share lessons learned during implementation of a web-based electronic health record at a tertiary care center in Kenya.

Stop-bang questionnaire for screening obstructive sleep apnea syndrome among hypertensive patients in Kenya.

INTRODUCTION: Obstructive sleep apnea (OSA) is a type of breathing problem during sleep caused by the blockage of the upper airway, which can cause cessation of airflow. There is limited research on the prevalence of OSA in hypertensive patients in sub-Saharan Africa (SSA). The study aimed to describe the prevalence and clinical characteristics of OSA among hypertensive patients at a tertiary hospital in Nairobi, Kenya. METHODS: This cross-sectional study was conducted at the Aga Khan University Hospital in Nairobi, Kenya. Two hundred and fifty-one hypertensive patients were screened for OSA risk using the STOP-Bang questionnaire (SBQ). Patients with a SBQ score of ≥ 4 were categorized as high risk for OSA. Descriptive statistics were employed to describe both categorical and continuous variables and binary logistic regression to assess factors associated with the high risk of OSA. RESULTS: The study reported that 78.5% of the participants had high-risk OSA. The median age and body mass index (BMI) were 57.0 years (IQR: 50.0-64.0) and 28.3 kg/m2, respectively. Age, neck circumference, gender, and BMI were significantly higher in the high-risk OSA group as compared to the low-risk group. CONCLUSION: The study highlights the importance of screening hypertensive patients for OSA using the SBQ in clinical settings, particularly in low-and middle-income countries (LMICs). Healthcare providers can use patient characteristics such as age, gender, neck circumference, and BMI to identify those at greater risk of developing OSA. Further research could focus on developing effective OSA prevention and treatment interventions in hypertensive patients.

Factors Affecting Hospitalization Length and in-Hospital Death Due to COVID-19 Infection in Saudi Arabia: A Single-Center Retrospective Analysis.

Background: The emerging COVID-19 coronavirus disease has widely spread, causing a serious worldwide pandemic. Disease severity and mortality risk can be predicted using an analysis of COVID-19 clinical characteristics. Finding out what influences patients' hospitalization length and in-hospital mortality is crucial for decision-making and planning for emergencies. The goal of this study is to identify the factors that influence hospital stay length and in-hospital death due to COVID-19 infection. Methods: This cross-sectional study was conducted from August to October 2020 and included 630 patients with a confirmed diagnosis of COVID-19 infection. Using odds ratios (OR) and 95% confidence intervals (CI), a multivariable logistic regression model was used to assess the variables that are linked to longer hospital stays and in-hospital deaths. Results: Most patients were male (64.3%), and most were older than 40 years (81.4%). The mean length of hospital stay (LoHS) was 10.4±11.6 days. The overall death rate among these COVID-19 cases was 14.3%. Non-survivors were older, had more comorbidities, had prolonged LoHS with increased ICU admission rates and mechanical ventilation usage, and had a more severe condition than survivors. ICU admission, low serum albumin, and elevated LDH levels were associated with longer LoHS, while ICU admission, DM, and respiratory diseases as comorbidities, total leukocytic count, and serum albumin were predictors of mortality. Conclusion: Longer LoHS due to COVID-19 infection was linked to ICU admission, low serum albumin, and elevated LDH levels, while the independent predictors of in-hospital death were ICU admission, DM, and respiratory diseases as comorbidities, total leukocytic count, and serum albumin.

Diagnostic Performance of the Radiological Society of North America Consensus Statement for Reporting COVID-19 Chest CT Findings: A Revisit.

Coronavirus disease 2019 (COVID-19) is a highly contagious respiratory disease that leads to variable degrees of illness, and which may be fatal. We evaluated the diagnostic performance of each chest computed tomography (CT) reporting category recommended by the Expert Consensus of the Radiological Society of North America (RSNA) in comparison with that of reverse transcription polymerase chain reaction (RT-PCR). We aimed to add an analysis of this form of reporting in the Middle East, as few studies have been performed there. Between July 2021 and February 2022, 184 patients with a mean age of 55.56 ± 16.71 years and probable COVID-19 infections were included in this retrospective study. Approximately 64.67% (119 patients) were male, while 35.33% (65 patients) were female. Within 7 days, all patients underwent CT and RT-PCR examinations. According to a statement by the RSNA, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of each CT reporting category were calculated, and the RT-PCR results were used as a standard reference. The RT-PCR results confirmed a final diagnosis of COVID-19 infection in 60.33% of the patients. For COVID-19 diagnoses, the typical category (n = 88) had a sensitivity, specificity, PPV, and accuracy of 74.8%, 93.2%, 94.3%, and 92.5%, respectively. For non-COVID-19 diagnoses, the PPVs for the atypical (n = 22) and negative (n = 46) categories were 81.8% and 89.1%, respectively. The PPV for the indeterminate (n = 28) category was 67.9%, with a low sensitivity of 17.1%. However, the RSNA's four chest CT reporting categories provide a strong diagnostic foundation and are highly correlated with the RT-PCR results for the typical, atypical, and negative categories, but they are weaker for the indeterminate category.

Discrimination and Abuse Among Healthcare Workers from Patients and their Relatives at a Tertiary Hospital in Kenya.

Discrimination and abuse of healthcare workers (HCWs) by patients and their relatives remains a pressing and prevalent problem in various healthcare settings, negatively affecting professional outcomes. Despite this, little has been reported about discrimination and abuse in many low- and middle-income countries such as Kenya. We conducted a cross-sectional survey study between May - August 2021 among healthcare workers at a hospital in Kenya. Email invitations were sent, and the survey was in English, and the data was collected through and online survey. Discrimination based on gender was reported by 24.9% of all HCWs; 39.9% of doctors, 17.2% of nurses, and 10.9% of allied staff whereas racial discrimination was reported by 28.8% of all HCWs; 49.0% of doctors, 18.9% of nurses, and 8.9% of allied staff. Verbal or emotional abuse was the most common form of abuse and was reported by 56.8% of all HCWs while physical abuse was reported by 4.9% of all HCWs. For those that reported discrimination based on gender, 77.4% reported patient and their family members as the main source, whereas 81.2% of those that reported discrimination based on race reported the main source was from patient and their family members. Despite strict laws against discrimination and abuse, a significant portion of healthcare providers suffer from discrimination and abuse primarily from patients and their family members. In addition to education programs and policies to curb such behavior in the work environment, coping mechanisms should be actively sought to help healthcare providers deal with such actions.

Self-Medication Practices During the COVID-19 Pandemic Among the Adult Population in the Eastern Region of the Kingdom of Saudi Arabia.

BACKGROUND: Self-medication is vital to public health because it has an impact on people's health and the current healthcare system, both positively and negatively. During public health catastrophes like the COVID-19 disease, this is particularly true. AIM: This study aimed to examine the behavioral response of the community with regard to self-medication during the COVID-19 pandemic in the eastern region of the Kingdom of Saudi Arabia. METHODS: During the COVID-19 outbreak from March to September 2020, a cross-sectional online survey of 398 participants using structured questionnaires was conducted to observe knowledge, prevalence, patterns, and sources of self-medication among the respondents in the eastern region of the Kingdom of Saudi Arabia. RESULTS: The percentage of respondents who had heard about self-medication was 50.5%, and those who practiced self-medication during COVID-19 were 43.7% of the respondents. Regarding knowledge, 60.3% had a low overall knowledge level versus 39.7% who had a high knowledge level. Most of those who practiced self-medication took medication based on their own decision (34.4%). The most frequently used drugs during the outbreak were analgesics (43.5%) and vitamins (24.9%). Only 1% of participants reported using anti-malaria drugs (hydroxychloroquine). The most common reasons for self-medication practices were having a mild illness (30.4%), followed by fear of infection (26.6%). The symptoms for which the respondents took self-medication were headache (29.6%), cough (26.6%), and fever (24.6%). CONCLUSION: Our investigation showed a low level of knowledge about self-medication and a considerable level of self-medication practices. Therefore, self-medication may be minimized with ongoing awareness-raising and sensitization.

Symptomatic Accessory Ossicles of the Foot and Ankle.

Accessory ossicles are small noncalcified, calcified or ossified structures found throughout the body, often noted as incidental findings. Specifically in the foot and ankle, there are at least 24 different ossicles described the majority of which are incidental. However, there are accessory ossicles that can be symptomatic, leading to significant pain and discomfort. While many of the symptomatic ossicles have been described in the literature, there are several that are under-recognized or under-reported for example, os interphalangeus and os calcaneus secundarius syndromes. This manuscript will review common and uncommon accessory ossicles including painful os peroneum, os naviculare, os calcaneus secundarius, os trigonum and os interphalangeus syndromes as well as medial sesamoiditis, with attention to the clinical and imaging findings and with an outline of the current management.

Agro-climatic sensitivity analysis for sustainable crop diversification; the case of Proso millet (Panicum miliaceum L.).

Current agricultural production depends on very limited species grown as monocultures that are highly vulnerable to climate change, presenting a threat to the sustainability of agri-food systems. However, many hundreds of neglected crop species have the potential to cater to the challenges of climate change by means of resilience to adverse climate conditions. Proso millet (Panicum miliaceum L.), one of the underutilised minor millets grown as a rainfed subsistence crop, was selected in this study as an exemplary climate-resilient crop. Using a previously calibrated version of the Agricultural Production Systems Simulator (APSIM), the sensitivity of the crop to changes in temperature and precipitation was studied using the protocol of the Coordinated Climate Crop Modelling Project (C3MP). The future (2040-2069) production was simulated using bias-corrected climate data from 20 general circulation models of the Coupled Model Intercomparison Project (CMIP5) under RCP4.5 and 8.5 scenarios. According to the C3MP analysis, we found a 1°C increment of temperature decreased the yield by 5-10% at zero rainfall change. However, Proso millet yields increased by 5% within a restricted climate change space of up to 2°C of warming with increased rainfall. Simulated future climate yields were lower than the simulated yields under the baseline climate of the 1980-2009 period (mean 1707 kg ha-1) under both RCP4.5 (-7.3%) and RCP8.5 (-16.6%) though these changes were not significantly (p > 0.05) different from the baseline yields. Proso millet is currently cultivated in limited areas of Sri Lanka, but our yield mapping shows the potential for expansion of the crop to new areas under both current and future climates. The results of the study, indicating minor impacts from projected climate change, reveal that Proso millet is an excellent candidate for low-input farming systems under changing climate. More generally, through this study, a framework that can be used to assess the climate sensitivity of underutilized crops was also developed.