Craniocaudal spread and clinical translation for combined erector spinae plane block and retrolaminar block in soft embalmed cadavers: a randomised controlled equivalence study.

BACKGROUND: Erector spinae plane (ESP) block spread can be unpredictable. We previously improved the spread of ESP injection by addition of retrolaminar (RL) injection. However, it is not clear whether spread at high thoracic levels is similar to spread at midthoracic levels. Our primary objective was to demonstrate that craniocaudal dye spread was equivalent after combined ESP and RL injection using a 19 G Tuohy needle at the third (T3) and sixth (T6) vertebrae in soft embalmed Thiel cadavers. METHODS: We randomised 20 combined ESP and RL injections to the T3 and T6 vertebral levels on both sides of 10 prone Thiel cadavers. A 3-8 MHz transducer was placed in the paramedian sagittal plane and a single anaesthetist injected 10 ml dye onto the transverse process, then 10 ml dye onto the laminae of T3 or T6. Cadavers were dissected 24 h later. RESULTS: Mean (sd) craniocaudal spread of dye after combined ESP + RL injection at T3 and T6 vertebral levels was equivalent: 8.6 (1.8) vs 8.7 (2.3) levels, respectively; difference (90% confidence interval): -0.1 (-1.4 to 1.6), P=0.904. Dye extended uniformly, cranially and caudally, from the point of injection. A 3D prosection created from a Thiel cadaver confirmed that the dorsal ramus emerges from the costotransverse foramen deep to the intertransverse ligament within the retro-superior costotransverse ligament space. Combined ESP and RL block in six patients before mastectomy achieved extensive anterior, lateral, and posterior chest wall paraesthesia over four to six dermatomes. CONCLUSIONS: Combined ESP and RL injections showed equivalent and consistent spread at T3 and T6 injection sites. A pilot study confirmed translation to patients.

A review of scaphoid fracture, treatment outcomes, and consequences.

PURPOSE: Scaphoid fractures are the most common carpal fracture and can lead to severe complications like carpal collapse and osteoarthritis. This study reviewed scaphoid fracture patterns, outcomes, and consequences in conservative and surgical management. METHODS: Sixty-four patients with scaphoid fracture who attended the hand clinic at King Hussein Medical City from January 2022 to December 2022 were included and reviewed regarding the anatomical fracture site, the associated injury, the treatment modality (conservative versus surgical), the healing time, and fracture sequelae such as nonunion and scaphoid nonunion advanced collapse. RESULTS: Most patients were males (62 patients, 96.9%), and most (47, 73.4%) fell within 25 to 40 years. Scaphoid waist fracture was the most common location (40, 52.5%). Most patients (47, 73.4%) received conservative treatment and 17 (26.6%) were fixed acutely. However, nonunion complicated 53 fractures (82.8%). Notably, there were no differences in the union rate or time between cases of scaphoid nonunion treated with vascularized or nonvascularized grafts. Furthermore, there were no variations in union rates among genders, extremities, age, fracture locations, or among smokers. However, a higher union rate was noted in office workers and those who received conservative treatment. CONCLUSION: Nonunions were higher in our study than in the literature, as our department is a referral center for established nonunion cases. For conservative treatment, we recommend aggressive management and follow-up with a clinical and CT scan at three months and early referral of non-united fractures to the hand clinic to avoid the advanced collapse of the scaphoid.

Outcome in TFCC repair using micro anchor and trans­osseous technique.

The triangular fibrocartilage complex (TFCC) is an intrinsic stabiliser of the distal radioulnar joint (DRUJ), which serves an important role in wrist movement, forearm rotation and grip strength. A stable DRUJ is a key requirement for pain-free movement of the wrist. TFCC tears are a common ulnar-sided wrist pain associated with decreased grip strength and impaired function. TFCC tears are classified according to the location and cause. The Palmer classification delineates tears into traumatic type 1 and degenerative type 2. The present study investigated the clinical outcomes of using micro suture anchors in open repair in comparison with trans-osseous TFCC repair. From July 2017 to July 2020, 51 patients underwent open repair of TFCC tear by hand and upper limb surgeons in Royal Rehabilitation Center at King Hussein Medical Center (Amman, Jordan). Stability of DRUJ and tenderness at the ulnar aspect of the wrist were evaluated by Disability of the Arm, Shoulder and Hand (DASH) and Modified Mayo Wrist Score (MMWS) pre- and post-operatively. A total of 38 patients (27 male and 11 females) underwent open repair using micro suture anchors and 13 (7 male and 6 female) by trans-osseous repair. A total of 51 patients in the follow-up 6-48 months had significant improvement in pain and range of motion. A total of 45 patients showed improved grip strength and were pain-free; six patients showed improvement of grip strength and decreased pain. For the patients who underwent TFCC repair by micro suture anchors, there was an improvement of MMWS from 70 to 90%, and for those who underwent TFCC repair by trans-osseous technique, MMWS improved from 65 to 85%. There was also significant improvement in DASH score post-operatively with both techniques, from 60 to 15% in the trans-osseous technique and from 70 to 15% in the suture anchors. Open repair of TFCC tears using either micro anchor or trans-osseous repair led to pain-free range of motion, improved grip strength, stable DRUJ and improvement in DASH and MMWS scores, with no significant differences in clinical outcome between techniques.

A Cross-Sectional Analysis of Health Behavior in School-Aged Children: The Qassim Study.

Background Childhood obesity is a worldwide public health epidemic. Sedentary lifestyles and unhealthy dietary patterns increased the rates of overweight and obesity among children. This study aimed to (1) estimate healthy behaviors (including dietary patterns and physical activity) and (2) determine the prevalence of overweight and obesity among Saudi school-aged children in the Qassim region, Saudi Arabia. Methods A population-based cross-sectional study was conducted among Saudi schoolchildren aged between five and 16 years old. The study group consisted of 339 children including 237 males and 102 females. Data were collected using a questionnaire based on the Health Behavior in School-Aged Children (HBSC) survey. Body mass index (BMI) for age and gender was computed for each child using the AnthroPlus 2007 software (World Health Organization {WHO}, Geneva, Switzerland). Statistical Package for Social Sciences (SPSS) version 23.0 (IBM SPSS Statistics, Armonk, NY) was used for data analyses. Results The prevalence of overweight and obesity among Saudi children was 46 (13.6%) and 81 (23.9%), respectively. Males consumed more soft drinks and energy drinks, whereas females consumed more fruit juice. As children grew older, the consumption of unhealthy food and beverages increased. Males engaged in more daily physical activity compared to females. Conclusion Saudi schoolchildren (aged 5-16 years) demonstrated significant gender-specific variations in dietary patterns and levels of physical activity. A significant proportion of Saudi children were overweight or obese. The study highlighted the complex relationship between age, school class, gender, and health behaviors among Saudi school-aged children. Policymakers and parents could benefit from the understanding of such complex relationships to promote healthy behaviors among school-aged children.

Inhibitory potential of natural plant extracts against Escherichia coli strain isolated from diarrheic camel calves.

Background: Camel calf's diarrhea is considered the chief economic loss in the camelid population. There is currently no vaccine licensed to prevent colibacillosis in camel calves. The new era of bacterial antibiotic resistance explains the treatment failure and the high mortality and morbidity associated with the disease. Current protective treatments have thus far limited efficacy and need to be replaced. Due to their antimicrobial properties and safety, natural products are recently finding a capital role in infection management. Aims: The current study explores Escherichia coli F17 susceptibility as a clinical strain isolated from diarrheic camel calves to a wide panel of natural products. Methods: Agar diffusion method, integrity of cell membrane, hydrophobicity of bacterial surface, biofilm assays, and motility were used to evaluate the antibacterial activity of Coffea, Retama raetam, Moringa oleifera, Juniperus phoenicea, Uritica dioica, Camellia sinensis, Lavandula angustifolia, and Cuminum cyminum extracts against isolated bacteria. Results: Interestingly, all eight tested extracts have the damaging ability of E. coli F17's cell membrane and cause the nucleic acid release after 12 hours. Escherichia coli F17 strain has the surface of hydrophobicity which changed after contact with extracts of the plant. Moreover, the motility of the studied bacteria changed after exposure to all plant extracts. Conclusion: This study demonstrated that all extracts, exempt U. dioica, can remove up to 50% biofilm of E. coli biomass as compared with the control. Natural extracts can be used as potential antimicrobial agents to mitigate diarrhea in camel calves.

Age-Related Variations in Serum Zinc Levels Among Female Patients in Sulaymaniyah, Iraq: Implications for Addressing Zinc Deficiency.

Background Zinc plays a crucial role in human nutrition and various biochemical processes, making it indispensable for all life forms. Therefore, it is important to address low zinc levels, particularly among women, to prevent potential health issues. Objective This study aimed to evaluate the serum zinc levels of female patients in Sulaymaniyah, Iraq. Methods This retrospective cross-sectional study included a total of 299 patients, ranging in age from 16 to 48 years, who sought medical care at Baxshin Hospital in Sulaymaniyah Governorate, Iraq, between October 2022 and April 2023. The biochemical test was conducted to screen the patient's blood samples for serum zinc levels. Results Among 299 patients, 99 individuals had low zinc levels, 11 had high zinc levels, and 189 exhibited normal zinc levels. The analysis revealed a significant difference between low, normal, and high serum zinc levels, as evidenced by a p-value of <0.05. In terms of age-related variations, individuals under 20 years old had an average serum zinc level of 121.4 µg/dL. However, those between 21 and 30 years old demonstrated the highest average serum zinc level of 153.6 µg/dL, followed by 135 µg/dL for individuals aged 31-40, and 119 µg/dL for those above 40 years old. Conclusion These findings indicate that serum zinc levels may vary based on the age group of individuals. Consequently, further research is needed to explore the implications of these variations and establish appropriate strategies to address zinc deficiency among women in Sulaymaniyah.

Perceptions and Attitudes of Jordanian Medical Students on Using 3D Interactive Anatomy Dissection in Teaching and Learning Anatomy.

Background and Aims: This study evaluates the use of virtual anatomy dissection (Anatomage Table) in teaching anatomy for Jordanian medical students. The study also highlights any gender differences in students' perception on this method of teaching anatomy. Methods: This is a cross-sectional questionnaire-based study that was carried out on medical students enrolled in Al-Balqa Applied University, a Jordanian public university. A group of expert anatomists designed a questionnaire that investigates the students' perceptions and attitudes toward using virtual anatomy dissection. The questionnaire also investigated student's opinions and expectations on the impact of using this method on the academic achievement of students. Results: The findings of the study showed that most students agreed that Anatomage Table helped them better understand (64.3%) and memorize (64%) anatomy lectures. In addition, most students were interested in using this learning method in lab groups (72.3%). However, the didactic approach that combined anatomical models and the Anatomage Table was preferred over the unilateral approach that included only the Anatomage Table (80.5% vs 30.2%, p<0.001, r=0.9). Of note, there was a statistically significant difference between males and females in their preference for Anatomage Table (p<0.001), and in their perceptions on the impact of Anatomage Table on understanding of lectures (p<0.001) and memorization of anatomical structures (p=0.004). Conclusion: The Anatomage Table is a powerful teaching and learning method in undergraduate medical education. Its application to Al-Balqa Applied University has proven to be effective so far. It can be used to overcome the problems facing anatomical education in the college of medicine in Al-Balqa Applied University and perhaps other universities in Jordan, but this needs better cooperation between universities and stakeholders to provide adequate funding for this method.

Assessing serum C-reactive protein as a predictor of COVID-19 outcomes: a retrospective cross-sectional study.

Despite being very infectious and fatal, the coronavirus disease 2019 (COVID-19) lacks a reliable and practical biomarker to assess how serious it will be. Aim: The current study aims to conclude the possibility of C-reactive protein (CRP) level serving as a biomarker for early prediction of COVID-19 infections. Methods: In this retrospective cross-sectional study, 88 people participated who were infected with COVID-19, aged from 25 to 79 years old. Compare the CRP test range of all samples from patients who visited the hospital between January and April 2022. Results: All participants were confirmed to have COVID-19 through nasopharyngeal swab analysis and real-time polymerase chain reaction real-time polymerase chain reaction testing. Results showed that the majority of infected individuals had elevated CRP levels. A P-value of less than 0.05 indicated a significant difference in CRP levels between alive and dead patients. No significant difference in CRP levels was found between male and female patients. The average CRP level of deceased patients was 137.79 mg/l, while the average CRP level of survivors was 14.37 mg/l. The median interquartile range of deceased patients was also found to be significantly higher compared to survivors. Conclusion: In conclusion, serum CRP levels potentially predict the severity and development of sickness in patients with COVID-19 infections.

The attitude and knowledge of pediatricians and family physicians toward COVID-19 vaccination in children: A cross-sectional study.

COVID-19 vaccines to children are expected to reduce the transmission of the disease to high-risk groups and achieve herd immunity in younger populations. A positive attitude toward COVID-19 vaccination in children among healthcare workers (HCWs) is predicted to reduce parents' hesitancy to vaccinate their children. This study aimed to assess the knowledge and attitude of pediatricians and family physicians toward COVID-19 vaccination in children. A total of 112 pediatricians and 96 family physicians (specialists and residents) were interviewed to assess the level of knowledge, attitude, and perceived safety of COVID-19 vaccines for children. Physicians willing to receive regular COVID-19 vaccination (analogous to the influenza vaccine) had significantly higher knowledge and attitude scores (P < .05). Multivariate analysis indicated that a higher knowledge score and having at least five years of experience as a specialist were significantly associated with a positive attitude among pediatricians or family physicians (P < .05). Pfizer/BioNTech was the preferred COVID-19 vaccine in children among physicians of both groups (>67%). Around 71% of physicians believed COVID-19 vaccines for children do not cause or worsen any health condition. Educational and training programs that increase the knowledge of physicians about COVID-19 vaccines and their safety in children are recommended to inform a more positive attitude.

Higher serum uric acid is associated with poorer cognitive performance in healthy middle-aged people: a cross-sectional study.

Age-related cognitive impairment can occur many years before the onset of the clinical symptoms of dementia. Uric acid (UA), a metabolite of purine-rich foods, has been shown to be positively associated with improved cognitive function, but such association remains controversial. Moreover, most of the previous studies investigating the association included elderly participants with memory-related diseases. Therefore, the present study aimed at investigating whether serum UA (sUA) is associated with cognitive performance in healthy middle-aged individuals. We conducted a cross-sectional study on a cohort of middle-aged individuals (40-60 years old) who participated in the Qatar Biobank. The participants had no memory-related diseases, schizophrenia, stroke, or brain damage. They were divided according to sUA level into a normal group (< 360 µmol/L) and a high group (≥ 360 µmol/L), and underwent an assessment of cognitive function using the Cambridge Neuropsychological Test Automated Battery. Two cognitive function domains were assessed: (a) speed of reaction/reaction time and (b) short-term visual memory. The median age of the 931 participants included in the study was 48.0 years (IQR: 44.0, 53.0), of which 47.6% were male. Adjusted multivariable linear regression analyses showed that higher sUA is associated with poorer performance on the visual memory domain of cognitive function (ß = - 6.87, 95% CI - 11.65 to - 2.10, P = 0.005), but not on the speed of reaction domain (ß = - 55.16, 95% CI - 190.63 to 80.30, P = 0.424). Our findings support previous studies suggesting an inverse association between high sUA levels and cognitive function in elderly and extend the evidence for such a role to middle-aged participants. Further prospective studies are warranted to investigate the relationship between UA and cognition.

Neuronal Cell Types in the Spinal Trigeminal Nucleus of the Camel Brain.

Neurons in the spinal trigeminal nucleus of a camel were morphologically studied by the Golgi impregnation method. The neurons were classified based on the size and shape of their cell bodies, the density of their dendritic trees, and the morphology and distribution of their appendages. At least 12 morphological types of neurons were found in the camel spinal trigeminal nucleus, including the following: stalked, islets, octopus-like, lobulated, boat-like, pyramidal, multipolar, round, oval, and elongated neurons. These neurons exhibited large numbers of various forms of appendages that arise not only from their dendrites but also from their cell bodies. Moreover, neurons with unique large dilatations especially at their dendritic branching points were also reported. The neurons reported in this study displayed an array of different sizes and shapes and featured various forms of appendages arising from cell bodies and dendrites. Such morphologically distinctive neuronal cell types might indicate an evolutionary adaptation to pain and temperature processing pathways at the level of the spinal trigeminal nucleus in camels, which traditionally live in a very harsh climatic environment and are frequently exposed to painful stimuli.

Medical education across three colleges of medicine: perspectives of medical students.

Aim: This study aimed to explore and evaluate various components of the medical education process (lectures, labs, small-group discussions, clinical rotations, and undergraduate research) in three colleges of medicine in Jordan. Methods: This cross-sectional questionnaire-based study included 849 undergraduate students from three main medical colleges in Jordan. Statically valid responses were considered for 684 students. The participants were from Jordan University of Science and Technology, Yarmouk University, and the University of Jordan. Results: The distribution of students according to their admission status was 276 (40%) regular, 266 (38.9%) parallel, and 142 (20.8%) international programs. Personal interest and self-initiation were the major motives for studying medicine in 66.1%. Regarding the frequency of attending classes, University of Jordan students reported the highest rate of regular classes' attendance (93%). The study also reported that lecture notes and textbooks were the main sources of learning for medical students. The study also reported superior academic performance of students in the regular program compared to students in the parallel and international programs. Participants of the study criticized the medical curricula in the three colleges mentioned above because of the lack of active research programs. Most of the students (40%-56%) also complained that the lectures within the modules were not well-integrated, and they felt that the academic environment was moderate (48-59%). In addition, most students in the clinical phase complained of overcrowding in hospital wards during clinical rotation. Conclusions: Based on students' feedback, multiple aspects of the medical education process require substantial reform to meet the expectations of medical students in Jordan.

Evidence on the Heroin-Mediated Impairment of the Oxidative Status of Erythrocytes.

Away from hemorheological properties, the effect of heroin addiction on erythrocytes is poorly investigated. This study aimed to investigate the oxidative impacts of heroin administration on erythrocytes. Study subjects included chronic intravenous heroin addicts and control subjects. Hematological analysis and redox parameters were measured, including serum concentration of methemoglobin ([MethHb]), serum glutathione peroxidase-1 ([GPX-1]), serum glutathione peroxidase (GPX) activity, erythrocytic protein carbonyl content, and oxidized to reduced glutathione (GSSG/GSH) ratio. Hematological analysis revealed that addicts had a significantly higher red cell distribution width, consistent with the mild anisocytosis and poikilocytosis of erythrocytes. As compared to control subjects, significantly higher levels of serum [Met-Hb], [GPX-1], and GPX activity (p < 0.001) were reported among addicted subjects. A significant association between [MetHb] and GPX activity was observed with r = 0.764 (p < 0.001). Furthermore, significantly higher erythrocytic protein carbonyl contents and GSSG/GSH ratio were evident among heroin addicts (p < 0.005) that were significantly associated with r = 0.429 (p=0.01). Results demonstrate preliminary evidence that heroin addiction is implicated in impaired redox status of erythrocytes. Considering the pharmacokinetics of heroin, erythrocytic antioxidant mechanisms, and turnover rate, further investigation is required to evaluate the extent and clinical outcomes, especially upon over-dose administration.

Bone Fracture Patterns and Distributions according to Trauma Energy.

Background: This study investigates the effect of injury mechanism and energy on fracture patterns and distributions. Also, it compares differences in bone fracture patterns based on injury mechanism, gender, and age. Methods: Three thousand and sixty-six admitted patients with bone fractures were reviewed retrospectively, and the fractures were analyzed regarding age, gender, and mechanism of injury. Fractures were located in eleven bones. However, the forearm, hand, leg, and foot were considered one bone, and the fracture was then subclassified according to the anatomic position within each bone. Trauma energy was classified according to the mechanism of injury where simple falls were considered low-energy injury while falling from a height, road traffic accidents, bullet, and industrial injuries were considered high energy. Results: Males represented most of the patients, and most injuries occurred in adults. However, the male patients were more prone to injuries than females across all age groups below fifty years, women above fifty years were more frequent, and a third of females' injuries occurred in the elderly. Simple falls represent two-thirds of the trauma mechanism, and falling from a height and road traffic accidents are the most common high-energy injuries and more prevalent in males. Scapular, clavicular, distal humerus, and shaft of long bones fractures were more prevalent in males. In contrast, females had a higher frequency of proximal humerus, proximal and distal femur, distal leg, and thoracic spine fractures. Industrial injuries are more frequent in males; thus, hand injuries are more frequent. Pathological fractures were higher in females, and spine and pelvic fractures were more associated with high-energy injuries. Conclusions: The trauma's energy determines the bone injury's extent and nature. Knowing the trauma mechanism is essential to expect the extent of injuries and construct preventive measures accordingly.

COVID-19 Routes of Transmission, Protection Aids, and Immunity Enhancement: Community-Based Online Knowledge Survey Among Palestinians.

AIM: Coronavirus disease in 2019 has been defined as a pandemic by the World Health Organization. This study aimed to assess the level of knowledge toward the coronavirus disease 2019 among the Palestinian population. METHOD: A cross-sectional online survey among 554 Palestinians was designed. A structured self-administered online questionnaire was distributed among 190 participants from West Bank and 364 from Gaza Strip during the outbreak through social media. The survey was conducted between 10th and 24th of October, 2020. RESULTS: Of the total enrolled participants, 401 were males and 153 were females; the mean age was 28.4 years with a standard deviation of 10.97. Results showed that the means of knowledge about coronavirus disease 2019 were: 76.7% (standard deviation = 12.8), 72.2 (standard deviation = 10.3), 77.7% (standard deviation = 11.0) for general knowledge, the transmission of coronavirus disease 2019, and immunity and protection aids, respectively. Univariate regression revealed significant associations among the level of knowledge and gender, governorates, education levels, and employment status. However, only gender remained a significant explanatory variable in multivariable analysis, as females were nearly four times more knowledgeable than males (OR = 3.94; 95% CI =1.71, 9.07; p = .001). CONCLUSION: In general, Palestinians had good knowledge about coronavirus disease 2019, modes of transmission, and immunity knowledge. Knowledge was less among males than females. This may need more effort by using different tools of communication to reach more to the male gender.

Patterns of Skills Acquisition in Anesthesiologists During Simulated Interscalene Block Training on a Soft Embalmed Thiel Cadaver: Cohort Study.

BACKGROUND: The demand for regional anesthesia for major surgery has increased considerably, but only a small number of anesthesiologists can provide such care. Simulations may improve clinical performance. However, opportunities to rehearse procedures are limited, and the clinical educational outcomes prescribed by the Royal College of Anesthesiologists training curriculum 2021 are difficult to attain. Educational paradigms, such as mastery learning and dedicated practice, are increasingly being used to teach technical skills to enhance skills acquisition. Moreover, high-fidelity, resilient cadaver simulators are now available: the soft embalmed Thiel cadaver shows physical characteristics and functional alignment similar to those of patients. Tissue elasticity allows tissues to expand and relax, fluid to drain away, and hundreds of repeated injections to be tolerated without causing damage. Learning curves and their intra- and interindividual dynamics have not hitherto been measured on the Thiel cadaver simulator using the mastery learning and dedicated practice educational paradigm coupled with validated, quantitative metrics, such as checklists, eye tracking metrics, and self-rating scores. OBJECTIVE: Our primary objective was to measure the learning slopes of the scanning and needling phases of an interscalene block conducted repeatedly on a soft embalmed Thiel cadaver over a 3-hour period of training. METHODS: A total of 30 anesthesiologists, with a wide range of experience, conducted up to 60 ultrasound-guided interscalene blocks over 3 hours on the left side of 2 soft embalmed Thiel cadavers. The duration of the scanning and needling phases was defined as the time taken to perform all the steps correctly. The primary outcome was the best-fit linear slope of the log-log transformed time to complete each phase. Our secondary objectives were to measure preprocedural psychometrics, describe deviations from the learning slope, correlate scanning and needling phase data, characterize skills according to clinical grade, measure learning curves using objective eye gaze tracking and subjective self-rating measures, and use cluster analysis to categorize performance irrespective of grade. RESULTS: The median (IQR; range) log-log learning slopes were -0.47 (-0.62 to -0.32; -0.96 to 0.30) and -0.23 (-0.34 to -0.19; -0.71 to 0.27) during the scanning and needling phases, respectively. Locally Weighted Scatterplot Smoother curves showed wide variability in within-participant performance. The learning slopes of the scanning and needling phases correlated: ρ=0.55 (0.23-0.76), P<.001, and ρ=-0.72 (-0.46 to -0.87), P<.001, respectively. Eye gaze fixation count and glance count during the scanning and needling phases best reflected block duration. Using clustering techniques, fixation count and glance were used to identify 4 distinct patterns of learning behavior. CONCLUSIONS: We quantified learning slopes by log-log transformation of the time taken to complete the scanning and needling phases of interscalene blocks and identified intraindividual and interindividual patterns of variability.

A Golgi study of neurons in the camel cerebellum (Camelus dromedarius).

Neurons in the cerebellar cortex of camels were studied using modified Golgi impregnation methods. Neurons were classified according to their position, morphology of their soma, density and distribution of dendrites, and the course of their axons. Accordingly, eight types of neurons were identified. Three types were found in the molecular layer: upper and lower stellate cells and basket cells, and four types were found in the granular layer: granule cells, Golgi Type II cells, Lugaro cells, and unipolar brush cells. Only the somata of Purkinje cells were found in the Purkinje cell layer. The molecular layer is characterized by the presence of more dendrites, dendritic spines, and transverse fibers. Golgi cells also show extensive dendritic branching and spines. The results illustrate the neuronal features of the camel cerebellum as a large mammal living in harsh environmental conditions. These findings should contribute to advancing our understanding of species-comparative anatomy in achieving better coordination of motor activity.

Teaching Musculoskeletal Module using dissection videos: feedback from medical students.

BACKGROUND AND AIMS: Over the last two decades many medical schools have been exploring alternatives to hands-on cadaver dissection in teaching anatomy. This study aimed at reporting medical students' feedback on using dissection videos in teaching anatomy of the musculoskeletal system. METHODS: Dissection videos were used to teach the anatomy of the musculoskeletal system for third year medical students. At the end of the module, feedbacks from medical students were reported using a questionnaire designed for this purpose. Statistically valid responses were considered for 284 students. RESULTS: Around 60% of the students enjoyed learning anatomy by watching dissection videos but the majority - mostly non-Jordanian - thought that the duration of the videos should be shorter. 83% (236/284)of the students enjoyed the presence of an instructor to guide them through the video and 85% (241/284) wanted to discuss the content with the instructor after watching. Most of the students liked to have access to the videos at any time in an open lab policy. Only 23% (66/284) of the students - mostly Jordanian - were willing to completely replace cadaveric prosections with dissection videos. Most of the students found that dissection videos helped them to understand anatomy lectures in a better way and in memorizing anatomical details. A significantly higher percentage of Jordanian students preferred watching dissection videos at home and preferred dissection videos to replace traditional anatomy lab sessions. CONCLUSIONS: In the light of our present findings, using dissection videos as a teaching method of anatomy was well received by students. However, it seemed that the students wanted dissection videos to be integrated with using cadaveric prosections rather than replacing them.

Accessory Ossicles in the Region of the Foot and Ankle: An Epidemiologic Survey in a Jordanian Population.

Background and Objectives: The incidence of accessory bones in the region of foot and ankle is quite variable between studies and are often confused with avulsion fractures in trauma patients with musculoskeletal injuries. The aim of this study was to assess the incidence of accessory ossicles of the foot and ankle according to gender, side and coexistence, and to determine how frequently accessory ossicles were misdiagnosed as avulsion fractures. Materials and Methods: Oblique and/or lateral foot radiographs of 1000 adult patients referred from emergency departments to foot and ankle clinic were retrospectively reviewed for the presence of accessory ossicles. The Kappa statistic was used in order to assess the validity of radiographic interpretation for the presence of these bones. Results: Accessory ossicles were detected in 40.2% of the radiographs. The incidence rates for the accessory ossicles in order of frequency were: Os trigonum (15.4%), accessory navicular (13.7%), os peroneum (11.5%), os vesalianum (1.1%), os supranaviculare (0.7%), os subfibulare (0.6%), os talotibiale (0.4%), os calcaneus secundarius (0.3%), os supratalare (0.3%), os infranaviculare (0.3%), os intermetatarseum (0.2%), and os subtibiale (0.1%). Coexistence of two or three ossicles in the same foot was observed in 4.4% of the cases, mostly coexistence with os peroneum (2.9%), followed by accessory navicular (1.6%). 2.7% of accessory ossicles were initially misdiagnosed as avulsion fractures at emergency departments. Interrater agreement over identification of different accessory ossicles was found to be reasonably reliable, with a Kappa greater than 0.80 for all assessed bones. Conclusions: In clinical practice, a thorough knowledge of normal anatomical variants is essential to facilitate appropriate diagnosis and treatment and can help to prevent diagnostic errors.

Pediatric thyroglossal duct cyst excision: A NSQIP-P analysis of 30-day complications.

OBJECTIVE: Identify and compare clinical risk factors, perioperative sequelae, and surgical complications of infants age 2 or younger to children above age 2 undergoing thyroglossal duct cyst (TGDC) excision. METHODS: Retrospective analysis of the American College of Surgeons National Surgical Quality Improvement-Pediatric Database (2014-2018). Study population includes pediatric patients (≤18 years) who underwent excision of TGDC. Infants aged 2 years or younger were compared to children older than 2 years. RESULTS: A total of 3052 cases were identified. There were 375 infants with an age of 2 years or younger and 2977 children who were older than 2 years. Mean age at time of surgery was 6.3 years, with a female-to-male ratio of 1:1.1. Following hospital discharge, there were 70 related readmissions and 3 related reoperations. There was no statistically significant gender (p = .270) or ethnic (p = .122) differences between groups. Additionally, a history of prematurity (p = .759) and postoperative admission status (ie, inpatient versus outpatient, p = .697) were not statistically significantly different between groups. Lastly, general complication rates between age groups including Clostridium difficile colitis, occurrences of bleeding and blood transfusion, surgical site infections, related readmission, and reoperation were not statistically significantly different. CONCLUSION: TGDC excision was not shown to be associated with increased risk when performed in infants age 2 or younger compared to children older than age 2.