Fractured Lateral Humeral Condyle Accompanied by Acute Radial Nerve Palsy in a Child: First Reported Case in the United Arab Emirates.

Despite being very common, lateral condyle fractures in children are rarely associated with acute nerve injuries. We present the case of a 10-year-old, left-handed male child who presented with a left lateral humeral condyle fracture associated with radial nerve injury. The patient was managed by open reduction and internal fixation plus radial nerve exploration, which was found entrapped in the fracture site. The patient achieved full recovery after 16 weeks. We report this case to present the approach and the operative findings and to emphasize the importance of a preoperative clinical examination in addition to preoperative planning to achieve a favorable outcome.

Ambulatory hypertension diagnosed by 24-h mean ambulatory versus day and night ambulatory blood pressure thresholds in children: a cross-sectional study.

BACKGROUND: The agreement between the commonly used ambulatory blood pressure (ABP) thresholds to diagnose ambulatory hypertension in children (patient's 24-h mean ABP classified by 24-h 95th ABP percentile threshold, American Heart Association [AHA] threshold, or patient's day and night mean ABP classified by day-night 95th ABP percentile thresholds) is not known. We evaluated the agreement among 24-h ABP threshold, AHA threshold, and day-night ABP thresholds to diagnose ambulatory hypertension, white coat hypertension (WCH) and masked hypertension (MH). METHODS: In a cross-sectional study design, we analyzed ABP recordings from 450 participants with suspected hypertension from a tertiary care outpatient hypertension clinic. The American Academy of Pediatrics thresholds were used to diagnose office hypertension. RESULTS: The 24-h ABP threshold and day-night ABP thresholds classified 19% ABP (95% confidence interval [CI], 0.15-0.23) differently into ambulatory normotension/hypertension (kappa [κ], 0.58; 95% CI, 0.51-0.66). Ambulatory hypertension diagnosed by 24-h ABP threshold in 27% participants (95% CI, 0.22-0.32) was significantly lower than that by day-night ABP thresholds in 44% participants (95% CI, 0.37-0.50; P < 0.001). The AHA threshold had a stronger agreement with 24-h ABP threshold than with day-night ABP thresholds for classifying ABP into ambulatory normotension/hypertension (k 0.94, 95% CI 0.91-0.98 vs. k 0.59, 95% CI 0.52-0.66). The diagnosis of ambulatory hypertension by the AHA threshold (26%; 95% CI, 0.21-0.31) was closer to that by 24-h ABP threshold (27%, P = 0.73) than by day-night ABP thresholds (44%, P < 0.001). Similar agreement pattern persisted among these ABP thresholds for diagnosing WCH and MH. CONCLUSIONS: The 24-h ABP threshold classifies a lower proportion of ABP as ambulatory hypertension than day-night ABP thresholds. The AHA threshold exhibits a stronger agreement with 24-h ABP than with day-night ABP thresholds for diagnosing ambulatory hypertension, WCH and MH. Our findings are relevant for a consistent interpretation of hypertension by these ABP thresholds in clinical practice.

Digital evaluation of Bolton's tooth size discrepancies among different malocclusions categories of Egyptian adolescent orthodontic population: A retrospective study.

OBJECTIVE: This retrospective investigation aimed to compare Bolton's ratios among different malocclusion groups of Egyptian adolescent orthodontic patients with original Bolton's standards. MATERIALS AND METHODS: Pre-treatment dental casts of 588 Egyptian subjects, 290 males and 298 females with mean age 16.7±2.2 years, were randomly selected and classified into 220 class I (108 males and 112 females), 230 class II (112 males and 118 females), and 138 class III (68 males and 70 females) groups. Mesiodistal widths from first molar to first molar were measured on 3-dimensionally scanned models via software and ratios were calculated. Two-way analysis of variance compared ratios as a function of skeletal classification and gender. Additionally, percentages of significant discrepancy outside 2 standard deviations (SDs) were calculated. RESULTS: The anterior mean ratio for the total sample were higher (79.4±4.7) and overall mean ratio was lower (90.1±5) than Bolton's standards. The differences between the obtained and standard values were statistically significant (P<0.001). However, there were no significant differences in either anterior ratio (P=0.637) or overall ratio (P=295) regarding gender. Class I cases showed the highest mean anterior ratio of 80±5.7 whereas class II and class III cases had the lowest ratio of 78.5±4.6 and 78.7±3.5, respectively. Concerning overall ratio, class III subjects had the highest ratio of 91.8±2.6 with no substantial distinction from class II cases (90.2±4.7) but was significantly different from class I cases that demonstrated the lowest ratio (89.7±5, P=0.020). High percentages of patients displayed clinically significant tooth size discrepancies (TSD), exceeding either above or below 2SD of Bolton's values, which were more marked in the anterior ratio. These were 25.2% and 7.4% for anterior ratio and 3.4% and 15.4% for overall ratio. CONCLUSIONS: Tooth size ratios of Egyptian orthodontic patients are generally different than the original Bolton's standards. Patients with class I and class III malocclusions had greater anterior and overall ratios than those with class II malocclusions with no considerable gender differences in either ratio.

An evaluation of emergency pain management practices in fragility fractures of the pelvis.

BACKGROUND: Inadequately treated pain is associated with significant morbidity in older adults. We aimed to describe current pain management practices for patients with fragility pelvic fractures, a common emergency department (ED) presentation in older adults. METHODS: We performed a health records' review of adults ≥ 65 years old who presented to two academic EDs with nonoperative fragility pelvic fractures between 01/2014 and 09/2018. The primary outcome measures were type and timing of analgesic medications. Secondary outcome measures included ancillary service consultation, ED length of stay, admission rate and rate of return to ED at 30 days. Data were reported using descriptive statistics. RESULTS: We included 411 patients. The majority were female (339, 82.5%) with mean age 83.9 (SD 8.1) years. Nearly, one-third (130, 31.6%) did not receive any analgesia for their fracture. Analgesia was initiated in 123 (29.9%) patients through paramedic and nursing medical directives; 244 (59.4%) patients received physician-initiated opioids (hydromorphone 228 (55.5%); morphine 28 (6.8%)). Only 23.1% of patients received one or more ancillary services: physiotherapy (10.5%), social work (7.3%), geriatric nurse assessment (14.1%), and homecare (3.9%). Mean ED length of stay was 11.6 (SD 7.1) h; 210 (51.1%) patients were admitted; of those discharged, 45 (22.4%) returned to the ED within 30 days. CONCLUSION: One in three older adults presenting to the ED with nonoperative fragility pelvic fractures receive no analgesia during the course of their prehospital and ED care. Barriers to quality care must be identified and processes implemented to ensure adequate pain management for this population.

RéSUMé: CONTEXTE: La douleur insuffisamment traitée est associée à une morbidité importante chez les personnes âgées. Nous voulions décrire les pratiques actuelles de gestion de la douleur chez les patients souffrant de fractures pelviennes de fragilité, une présentation courante des services d'urgence (SU) chez les personnes âgées. MéTHODES: Nous avons effectué une revue des dossiers médicaux des adultes ≥ 65 ans qui se sont présentés à deux urgences universitaires avec des fractures pelviennes de fragilité non opérées entre 01/2014 et 09/2018. Les principaux critères d'évaluation étaient le type et le moment de la prise de médicaments analgésiques. Les critères d'évaluation secondaires comprennent la consultation des services auxiliaires, la durée moyenne de séjour aux urgences, le taux d'admission et le taux de retour aux urgences à 30 jours. Les données ont été rapportées en utilisant des statistiques descriptives. RéSULTATS: Nous avons inclus 411 patients. La majorité était des femmes (339, 82,5%) avec un âge moyen de 83,9 (écart-type 8,1) ans. Près d'un tiers (130, 31,6 %) n'ont reçu aucune analgésie pour leur fracture. L'analgésie a été initiée chez 123 (29,9%) patients par des directives médicales paramédicales et infirmières ; 244 (59,4%) patients ont reçu des opioïdes à l'initiative du médecin (hydromorphone 228 (55,5%) ; morphine 28 (6,8%)). Seuls 23,1% des patients ont bénéficié d'un ou plusieurs services auxiliaires : physiothérapie (10,5%), travail social (7,3%), évaluation infirmière gériatrique (14,1%) et soins à domicile (3,9%). La durée moyenne de séjour aux urgences était de 11,6 heures (écart-type : 7,1); 210 (51,1 %) patients ont été admis ; parmi ceux qui sont sortis, 45 (22,4 %) sont retournés aux urgences dans les 30 jours. CONCLUSION : Une personne âgée sur trois se présentant aux urgences avec des fractures du bassin non opératoires ne reçoit aucune analgésie au cours de ses soins préhospitaliers et aux urgences. Les obstacles à la qualité des soins doivent être identifiés et des processus doivent être mis en œuvre pour assurer une gestion adéquate de la douleur pour cette population.

Usages of Spark Framework with Different Machine Learning Algorithms.

Sensors, satellites, mobile devices, social media, e-commerce, and the Internet, among others, saturate us with data. The Internet of Things, in particular, enables massive amounts of data to be generated more quickly. The Internet of Things is a term that describes the process of connecting computers, smart devices, and other data-generating equipment to a network and transmitting data. As a result, data is produced and updated on a regular basis to reflect changes in all areas and activities. As a consequence of this exponential growth of data, a new term and idea known as big data have been coined. Big data is required to illuminate the relationships between things, forecast future trends, and provide more information to decision-makers. The major problem at present, however, is how to effectively collect and evaluate massive amounts of diverse and complicated data. In some sectors or applications, machine learning models are the most frequently utilized methods for interpreting and analyzing data and obtaining important information. On their own, traditional machine learning methods are unable to successfully handle large data problems. This article gives an introduction to Spark architecture as a platform that machine learning methods may utilize to address issues regarding the design and execution of large data systems. This article focuses on three machine learning types, including regression, classification, and clustering, and how they can be applied on top of the Spark platform.

Mental health disorders among healthcare workers during the COVID-19 pandemic: a cross-sectional survey from three major hospitals in Kenya.

BACKGROUND: COVID-19 is an international global health emergency and has posed a great challenge to mental well-being and resilience. Little is known about the mental health impact of COVID-19 among healthcare workers (HCWs) in sub-Saharan Africa or other low-resource settings. METHODS: We conducted a cross-sectional study between August and November 2020 among HCWs recruited from three major hospitals in Kenya. The survey questionnaire consisted of six components: demographic and work title characteristics; information regarding care of patients with COVID-19; and symptoms of depression, anxiety, insomnia, distress and burnout, measured using standardised questionnaires. Multivariable logistic regression analysis was performed to identify factors associated with mental health disorders. RESULTS: A total of 433 (65.2% response rate) individuals participated in the survey. Median age was 32.75 years, 58.4% were females and 68.8% were front-line workers. Depression, anxiety, insomnia, distress and burnout were reported in 53.6%, 44.3%, 41.1%, 31.0% and 45.8% of all participants, respectively. Front-line HCWs, females and doctors were at higher risk of mental health symptoms. Nearly half of participants reported inadequate resources or training to care for patients with COVID-19, and those in the government hospital were more likely to report mental health symptoms. CONCLUSIONS: This is among the first studies examining mental health outcomes among HCWs during the COVID-19 pandemic in Kenya. Similar to other studies from around the world, HCWs directly involved with patients with COVID-19 reported higher rates of mental health symptoms. Mitigating strategies specific to Kenyan HCWs are urgently needed to help them cope with mental health symptoms during the pandemic.

Correction to: Long-term effect of high-intensity laser therapy in the treatment of patients with chronic low back pain: a randomized blinded placebo-controlled trial.

After publication of this paper, the authors determined that the name of the author Tamer Mohamed Shosha was incorrectly spelled. The correct presentation should be Tamer Mohamed Shousha.

Long-Term Effect of Pulsed Nd:YAG Laser in the Treatment of Patients with Rotator Cuff Tendinopathy: A Randomized Controlled Trial.

OBJECTIVE: The purpose of the present study was to investigate the long-term effect of pulsed Nd:YAG laser on the treatment of rotator cuff tendinopathy. METHODS: Sixty patients with rotator cuff tendinopathy participated and completed the study. The mean age was 50.2 ± 3.6 years. Participants were randomly assigned to one of two groups: the control group and the treatment group. Both groups were treated with an exercise program, in addition to the pulsed Nd:YAG laser received by the treatment group and the "sham" laser received by the control group, both for three sessions per week for 4 weeks. Outcome measures included pain, assessed by the visual analog scale, and range of motion (ROM), assessed using a traditional goniometer, while the shoulder pain and disability index were used to evaluate the functional recovery of the shoulder joint. Evaluation was carried out before treatment, immediately after treatment, 3 months posttreatment, and 6 months posttreatment. Statistical analyses were used to investigate the effect of interventions and to compare the study groups' pretreatment, posttreatment, and at follow-up points. The significance level was set to p < 0.05. RESULTS: Pain was significantly decreased after treatment and at follow-up points, while ROM and shoulder functions were significantly improved after treatment and at follow-up intervals in both groups. The improvement was more significant in the treatment group than in the control group posttreatment and at follow-up intervals. CONCLUSIONS: Pulsed Nd:YAG laser combined with an exercise program seems to be more effective in the treatment of patients with rotator cuff tendinopathy than a sham laser with exercises.

A new strategy and system for the ex vivo ovary perfusion and cryopreservation: An innovation.

Children and young adults, who suffer from cancer, receive gonadotoxic therapy, which destroys their fertile abilities after survival. Ovarian cryopreservation and transplantation provide the promising solution to this problem, where the ovary can be removed before the gonadotoxic therapy and reimplanted after patient's survival, where the ovary is to be cryopreserved during the period of the therapy. However, cryopreservation of the whole ovary is still facing great obstacles, namely the ischemic reperfusion injury and the defective cryopreservation related to the defective ability to universally deliver the cryopreservation/warming solutions through the ovarian vascular bed. Meanwhile, the currently applied technique of ovarian tissue cryopreservation provides limited follicular recovery because many follicles are lost until the development of revascularization post-transplantation. To solve the problems, an innovative system has been developed to insure immediate and universal delivery of the cryopreservation/warming solutions to the graft, in addition to keeping the graft under continuous perfusion before and after cryopreservation, minimizing any chance for microthrombi formation or ischemia-reperfusion. This innovative system can be applied in the following surgical and clinical interventions: 1) Allogeneic ovarian transplantation; 2) Preservation of fertility after systemic chemotherapy or bone marrow transplantation in young females, where the ovaries could be removed before the therapy and exposed to the adequate cryopreservation provided by the system till re-implantation after the patient's survival; 3) The system is also suitable for the corresponding applications on the testicles.

Slow cryopreservation is not superior to vitrification in human spermatozoa; an experimental controlled study.

BACKGROUND: Spermatozoa cryopreservation is used for the management of infertility and some other medical conditions. The routinely applied cryopreservation technique depends on permeating cryoprotectants, whose toxic effects have raised the attention towards permeating cryoprotectants-free vitrification technique. OBJECTIVE: To compare between the application of slow cryopreservation and vitrification on human spermatozoa. MATERIALS AND METHODS: This was an experimental controlled study involving 33 human semen samples, where each sample was divided into three equal parts; fresh control, conventional slow freezing, and permeating cryoprotectants-free vitrification. Viability and mitochondrial membrane potential (MMP) of control and post-thawing spermatozoa were assessed with the sperm viability kit and the JC-1 kit, respectively, using fluorescence-activated cell sorting analysis. RESULTS: Significant reduction of the progressive motility, viability and MMP was observed by the procedure of freezing and thawing, while there was not any significant difference between both cryopreservation techniques. Cryopreservation resulted in 48% reduction of the percentage of viable spermatozoa and 54.5% rise in the percentage of dead spermatozoa. In addition, high MMP was reduced by 24% and low MMP was increased by 34.75% in response to freezing and thawing. Progressive motility of spermatozoa was correlated significantly positive with high MMP and significantly negative with low MMP in control as well as post-thawing specimens (r=0.8881/ -0.8412, 0.7461/ -0.7510 and 0.7603/ -0.7839 for control, slow and vitrification respectively, p=0.0001). CONCLUSION: Although both cryopreservation techniques have similar results, vitrification is faster, easier and associated with less toxicity and costs. Thus, vitrification is recommended for the clinical application.

High-intensity versus low-level laser therapy in the treatment of patients with knee osteoarthritis: a randomized controlled trial.

The aim of this randomized controlled study was to compare the effects of low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) on pain relief and functional improvement in patients with knee osteoarthritis (KOA). A total of 53 male patients participated in this study, with a mean (SD) age of 54.6 (8.49) years. Patients were randomly assigned into three groups and treated with HILT and exercise (HILT + EX), LLLT and exercise (LLLT + EX), and placebo laser plus exercise (PL + EX) in groups 1, 2, and 3, respectively. The outcomes measured were pain level measured by visual analog scale (VAS) and knee function measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Statistical analyses were performed to compare the differences between baseline and posttreatment measurements. The level of statistical significance was set as P < 0.05. The result showed that HILT and LLLT combined with exercise were effective treatment modalities in decreasing the VAS and WOMAC scores after 6 weeks of treatment. HILT combined with exercises was more effective than LLLT combined with exercises, and both treatment modalities were better than exercises alone in the treatment of patients with KOA.

Long-term effect of high-intensity laser therapy in the treatment of patients with chronic low back pain: a randomized blinded placebo-controlled trial.

The aim of this study was to compare the effect of high-intensity laser therapy (HILT), alone or combined with exercise, in the treatment of chronic low back pain (CLBP). A total of 72 male patients participated in this study, with a mean (SD) age of 32.81 (4.48) years. Patients were randomly assigned into three groups and treated with HILT plus exercise (HILT + EX), placebo laser plus exercise (PL + EX), and HILT alone in groups 1, 2, and 3, respectively. The outcomes measured were lumbar range of motion (ROM), pain level by visual analog scale (VAS), and functional disability by both the Roland Disability Questionnaire (RDQ) and the Modified Oswestry Disability Questionnaire (MODQ). Statistical analyses were performed to compare the differences between baseline and post-treatment measurements. The level of statistical significance was set as P < 0.05. ROM significantly increased after 4 weeks of treatment in all groups, then significantly decreased after 12 weeks of follow-up, but was still significantly more than the baseline value in groups 1 and 2. VAS, RDQ, and MODQ results showed significant decrease post-treatment in all groups, although the RDQ and MODQ results were not significantly different between groups 2 and 3. HILT combined with exercise appears to be more effective in patients with CLBP than either HLLT alone or placebo laser with exercise.

Examination of the effect of structural variation on the N-glycosidic torsion (PhiN) among N-(beta-D-glycopyranosyl)acetamido and propionamido derivatives of monosaccharides based on crystallography and quantum chemical calculations.

GlcNAcbetaAsn linkage is conserved in the N-glycoproteins of all eukaryotes. l-Glutamine (Gln), which is a one carbon higher homolog of Asn, is never glycosylated. X-ray crystallographic study of several beta-1-N-acetamido- and propionamido derivatives of monosaccharides has earlier shown that the N-glycosidic torsion, Phi(N), is influenced to a larger extent by the structural variation of the sugar part than that of the aglycon moiety. In order to examine the influence of the carbohydrate pendent groups on the conformational preference of the N-glycosidic linkage with respect to Phi(N,) several models and analogs with gluco and manno configuration have been studied in the present work by computational chemistry. The crystal structure of XylbetaNHPr is reported here and its molecular packing compared with related analogs. The conjunction of combining Crystallographic and computational studies allows to demonstrate the strong influence that the group at C2, and environmental factors particularly inter- and intramolecular interactions involving regular hydrogen bonds and the weak C-H...O contacts, have on the energy preference of the Phi(N) torsion angle.

Conformational preferences of the aglycon moiety in models and analogs of GlcNAc-Asn linkage: crystal structures and ab initio quantum chemical calculations of N-(beta-D-glycopyranosyl)haloacetamides.

The biological addition of oligosaccharide structures to asparagine residues of N-glycoproteins influences the properties and bioactivities of these macromolecules. The linkage region constituents, 2-acetamino-2-deoxy-beta-D-glucopyranose monosaccharide (GlcNAc) and L-asparagine amino acid (Asn), are conserved in the N-glycoproteins of all eukaryotes. In order to gain information about the structure and dynamics of glycosylated proteins, two chloroacetamido sugars, Glc betaNAcNHCOCH2Cl and Man betaNHCOCH2Cl, have been synthesized, and their crystal structures have been solved. Structural comparison with a series of other models and analogs gives insight about the influence of the N-acetyl group at position C2 on the conformation of the glycan-peptide linkage at C1. Interestingly, this N-acetyl group also influences the packing and network of hydrogen bonds with involvement in weak hydrogen bonds C-H...X that are of biological importance. DFT ab initio calculations performed on a series of models and analogs also confirm that the GlcNAc derivatives present different preferred conformation about the N-CO-CH2-X (chi2) torsion angle of the glycan-peptide linkage, when compared to other monosaccharide derivatives. The energy profiles that have been obtained will be useful for parametrization of molecular mechanics force-field. The conjunction of crystallographic and computational chemistry studies provides arguments for the structural effect of the N-acetyl group at C2 in establishing an extended conformation that presents the oligosaccharide away from the protein surface.