Diagnostic accuracy of ultrasonography in diagnosis of Carpal Tunnel Syndrome.

Objective: This study aimed to assess the diagnostic accuracy of Ultrasonography, considering nerve conduction study (NCS) as the gold standard diagnostic modality for carpal tunnel syndrome (CTS). Methods: A cross-sectional study was conducted at the Neurology Department of Allied Hospital, Faisalabad from August, 2020 to January, 2021. NCS and Ultrasonography of wrist were performed for diagnosis of CTS. The sensitivity, specificity, predictive value (NPV), positive predictive value (PPV), and diagnostic accuracy (DA) were calculated for the screening test (Ultrasonography of the wrist), taking NCS as the gold standard. Results: The mean age of the study population was 41.53 ± 8.80 years, with female pre-dominance (71.66%). The right hand was involved in 24(40%) patients, left hand was involved in 4(6.66%) patients, and both hands were involved in 32(53.33%) patients. Among 60 patients, ultrasonography diagnosed 56 (TP+FN) as having CTS, confirmed via nerve conduction study. Sensitivity, specificity, NPV, PPV, and DA of Ultrasonography of the wrist for CTS were 92.8%, 75%, 42.8%, 98.1%, and 91.6%, respectively. Conclusion: Based on the sensitivity and specificity, Ultrasonography may assist in diagnosing CTS.

Genetic overview of postaxial polydactyly: Updated classification.

Polydactyly or polydactylism, also known as a hyperdactyly, is a congenital limb defect with various morphologic phenotypes. Apart from physical and functional impairments, the presence of polydactyly is an indication of an underlying syndrome in the newborn. Usually, it follows as an autosomal dominant/recessive inheritance pattern with defects in the limb development's anteroposterior patterning. Although mutations in several genes have been associated with polydactyly; however, the exact underlying cause, pathways, and disease mechanisms are still unexplored, thus making it of multi-factorial origin. Polydactyly is divided into three subtypes; radial, ulnar, and central polydactyly. So far, 11 loci (PAPA1-PAPA11) and seven human genes have been reported to cause non-syndromic postaxial polydactyly in humans, including the ZNF141, GLI3, IQCE, GLI1, FAM92A1, KIAA0825, and DACH1. In this review, we discuss emerging evidences of clinical and molecular characterization of polydactyly types in term of the involvement of newly associated genes and loci for non-syndromic postaxial polydactyly, and how these might impact our understanding of the genetic mechanisms and molecular etiology involved in the cause of polydactyly.

Delayed discharges at a tertiary rehabilitation centre in Saudi Arabia: contributing factors and cost impact.

There are various challenges in discharging hospitalized patients with disabilities. Discharge process for individuals with disabilities is multifactorial and can vary from one health system to another. The current study is aimed to explore the factors contributing to delayed discharges and to determine the number of exceeded bed days and subsequent cost impact at a government rehabilitation facility in Saudi Arabia. This retrospective cohort study was conducted at the Rehabilitation Hospital of King Fahad Medical City, Riyadh. All the 2285 discharges from inpatient rehabilitation from August 2011 to March 2017 were included in the study. Patients with delayed discharge were identified. Information about the diagnosis and reasons for delayed discharge was obtained from the rehabilitation hospital bed utilization data. The cost impact was calculated based on the number of days patients stayed beyond the estimated length of stay for each diagnosis. Of the 2285 discharges, 531 (23.3%) were delayed. The most common clinical conditions of patients with delayed discharge included spinal cord injury (n = 168, 31.6%) and traumatic brain injury (n = 145, 27.3%). The factors that led to delayed discharges were medical complications (n = 352, 66.7%), organizational factors (n = 83, 15.7%), family factors (n = 46, 8.7%), and external factors (n = 46, 8.7%). A total of 21 817 hospital bed days were exceeded, with an approximate estimated cost of 80 million Saudi Arabian Riyals. Early rehabilitation and enhancement of the discharge process may significantly decrease delayed discharge rates. Strategies need to be adapted to identify patients at risk of delayed discharge based on the factors highlighted in this study. Development of long-term care capacity, community services, and optimizing family and social support can promote timely discharge.

Effectiveness of alteplase infusion for the management of prosthetic mitral valve thrombosis in paediatric age group and proposed algorithm.

INTRODUCTION: The incidence of prosthetic valve implantation is increasing in the paediatric population. Prosthetic valve thrombosis leading to obstruction could potentially be a life-threatening complication. There is a debate regarding optimal management of this complication, and there is limited use of thrombolytic therapy in childhood in the setting of valve thrombosis. OBJECTIVE: We aim to share our experience of successfully using fibrinolytic therapy in terms of alteplase for paediatric prosthetic mitral valve thrombosis and to propose a management algorithm. METHODS: This retrospective analysis of the database was conducted at our hospital including patients who underwent thrombolysis (alteplase) for prosthetic mitral valve thrombosis from June, 2011 to June, 2021. A total of 10 patients with 20 attempts of alteplase infusion were found in our record. RESULTS: Alteplase was successful in 19 attempts to relieve valve thrombosis. The safe and effective dose of alteplase was between 0.1 and 0.3 mg/kg/hour. There were no associated major bleeding complications and alteplase was administered either by central or peripheral line. CONCLUSION: Thrombolysis by alteplase infusion was found to be successful in relief of prosthetic mitral valve thrombosis in paediatric population without major bleeding complications.

Magnetic, Electronic, and Optical Studies of Gd-Doped WO3: A First Principle Study.

Tungsten trioxide (WO3) is mainly studied as an electrochromic material and received attention due to N-type oxide-based semiconductors. The magnetic, structural, and optical behavior of pristine WO3 and gadolinium (Gd)-doped WO3 are being investigated using density functional theory. For exchange-correlation potential energy, generalized gradient approximation (GGA+U) is used in our calculations, where U is the Hubbard potential. The estimated bandgap of pure WO3 is 2.5 eV. After the doping of Gd, some states cross the Fermi level, and WO3 acts as a degenerate semiconductor with a 2 eV bandgap. Spin-polarized calculations show that the system is antiferromagnetic in its ground state. The WO3 material is a semiconductor, as there is a bandgap of 2.5 eV between the valence and conduction bands. The Gd-doped WO3's band structure shows few states across the Fermi level, which means that the material is metal or semimetal. After the doping of Gd, WO3 becomes the degenerate semiconductor with a bandgap of 2 eV. The energy difference between ferromagnetic (FM) and antiferromagnetic (AFM) configurations is negative, so the Gd-doped WO3 system is AFM. The pure WO3 is nonmagnetic, where the magnetic moment in the system after doping Gd is 9.5599575 µB.

Knowledge and Attitudes of Rehabilitation Professional Toward Telerehabilitation in Saudi Arabia: A Cross-Sectional Survey.

Background: Continuity of rehabilitation care after completion of a hospital-based rehabilitation program remains a challenge. This is of considerable significance in Saudi Arabia where there is a lack of community-based rehabilitation, which renders the need of telemedicine services. There is lack of data regarding understanding, awareness, and attitudes of rehabilitation professional toward telerehabilitation. This study was aimed to explore Saudi-based rehabilitation professionals' knowledge of telerehabilitation. Materials and Methods: After pilot testing, a survey questionnaire was distributed to 82 rehabilitation professionals working in different regions of Saudi Arabia. The survey included 14 close-ended questions targeting five domains: demographics, telemedicine knowledge, telerehabilitation service knowledge, social acceptance of these services, and risks associated with these services. Descriptive statistics were obtained by analyzing data using Microsoft Excel. Results: In total 46% of the participants were aware of telerehabilitation service technology but did not use it. 69.51% considered both telerehabilitation and community-based rehabilitation as the best service delivery methods. About 43% of participants reported that lack of knowledge about information technology and cost were the main factors that led to their limited use of telerehabilitation systems. The majority of the participants (52.44%) considered breach of confidentiality to be a risk associated with telerehabilitation services. Conclusions: Even though considerable number of the participants considered telerehabilitation as an important service delivery method, most of them are not involved in telerehabilitation. This renders the need of establishing local telerehabilitation guidelines and addressing the barriers pertaining to training, resources, cost, policy making, confidentiality, and perception of patients.

Telerehabilitation Guidelines in Saudi Arabia.

Rehabilitation needs are increasing globally due to population growth, aging population, high survival rates for people with disability, and severe health conditions. In the past few years, new telecommunication-based practices, including various forms of e-rehabilitation have gained attention all over the world, including the Kingdom of Saudi Arabia (KSA). Telerehabilitation is an alternative way of delivering rehabilitation services in which information and communication technologies are used to expedite communication between the health care professional and the patient at a distant location. It can be beneficial to people in rural areas, especially individuals in isolated communities. At present, the COVID-19 pandemic has forced speedy adoption of telerehabilitation due to restricted traditional in-person visits all over the world, including KSA; however, no telerehabilitation guidelines are available in the country. Since specialized rehabilitation services are limited to main cities of the country, the provision of care by reaching out the underserved areas using telemedicine technology is deemed important. These guidelines were established collaboratively by panel of various rehabilitation experts with input from other practitioners in the field and strategic stakeholders. It will facilitate rehabilitation clinicians practicing in KSA providing consultation, counseling, education, assessment, monitoring, therapy, or follow-up to a patient remotely using telemedicine communication technologies. This document includes administrative, clinical, and technical guidelines, which are aimed to standardize telerehabilitation practice across the country. The core principles are based on standards set forth by American Telemedicine Association and are guided by telemedicine policy in KSA. Additionally, ethical considerations of telerehabilitation practice pertinent to Saudi culture and health care system are elaborated as well. This document serves as a general guide for the provision of telerehabilitation services and do not describe a specialty-specific clinical practice guideline.

Structure-Based Designing, Solvent Less Synthesis of 1,2,3,4-Tetrahydropyrimidine-5-carboxylate Derivatives: A Combined In Vitro and In Silico Screening Approach.

OBJECTIVE: In this study, small molecules possessing tetrahydropyrimidine derivatives have been synthesized having halogenated benzyl derivatives and carboxylate linkage. As previously reported, FDA approved halogenated pyrimidine derivatives prompted us to synthesize novel compounds in order to evaluate their biological potential. METHODOLOGY: Eight pyrimidine derivatives have been synthesized from ethyl acetoacetate, secondary amine, aromatic benzaldehyde by adding catalytic amount of CuCl2·2H2O via solvent less Grindstone multicomponent reagent method. Molecular structure reactivity and virtual screening were performed to check their biological efficacy as an anti-oxidant, anti-cancer and anti-diabetic agent. These studies were supported by in vitro analysis and QSAR studies. RESULTS: After combined experimental and virtual screening 5c, 5g and 5e could serve as lead compounds, having low IC50 and high binding affinity.

Scimitar syndrome: A rare case of recurrent pneumonia.

Scimitar syndrome is a rare, congenital malformation. It is characterized by partial anomalous pulmonary venous connection to inferior vena cava, hypoplastic right lung along with dextroposition of the heart. Depending on the severity of the defect it can present as early as in neonatal period or incidentally later in life. Its incidence is 1-3 per 100,000 patients. We present a case of a two-year-old girl who presented with recurrent fever, cough and was later diagnosed as scimitar syndrome.

The negative effects of anterior cruciate ligament injury during stroke rehabilitation.

Musculoskeletal problems are commonly reported after stroke resulting in abnormal gait biomechanics, pain, and limitation in performing activities of daily living. Anterior circulate ligament is the most frequently injured knee ligament accounting for approximately 50% of all ligament injuries; however, post stroke anterior cruciate ligament injury is rarely reported. We present a case of a 58-year-old female admitted for inpatient stoke rehabilitation after a left middle cerebral artery stroke. After gaining considerable functional recovery, she was planned to be discharged in two weeks' time when she tripped resulting in a torn anterior cruciate ligament on the hemiperetic side. This resulted in increase in the length of stay and loss of functional gains. We discuss the possible mechanisms and the management plan. Patients with stroke should be monitored for musculoskeletal complications and preventive strategies should be devised to protect from possible ligamentous injuries of the knees.

Comparison of topical capsaicin and topical turpentine Oil for treatment of painful diabetic neuropathy.

BACKGROUND: Diabetes Mellitus is a pandemic of the modern era owing to our rapidly deteriorating lifestyle. Painful diabetic neuropathy is one of the costliest and disabling complications of diabetes mellitus. No single treatment exists to prevent or reverse neuropathic changes or to provide total pain relief. Topical Capsaicin and Turpentine Oil are found to be effective in treatment of painful diabetic neuropathy. METHODS: Patients of either gender with ages between 18 and 70 years having painful diabetic neuropathy already taking one oral drug for painful neuropathy and treatment for diabetes mellitus and an HbA1C less than 8.5% were included while Pregnant or lactating mothers, patients with chronic liver disease and patients with renal insufficiency (creatinine >3.0 mg/dl) and peripheral arterial disease were excluded from study. Patients were randomly divided into two groups (A & B) using computer generated random number table. Group A was given topical application of capsaicin while Group B was given topical application of commercially available turpentine oil over painful site on feet. RESULTS: 300 patients were equally divided in two groups. The patients in group A had a Visual Analog Pain Score of 7.91±5.10 at baseline and 5.10±1.343 after 3 months of treatment (p-value 0.0001). The patients in group B had a Visual Analog Pain Score of 7.83±1.012 at baseline and 5.20±1.187 after 3 months of treatment (p-value 0.0001). Chi Square test was applied to compare efficacy of both groups. It was noted that 71 (53%) had efficacy in group A and 63 (47%) had efficacy in the group B but the difference was not statistically significant. (p-value=0.399). CONCLUSIONS: It has been concluded that turpentine oil is effective in managing diabetic neuropathic pain similar to capsaicin cream.

The angulation of the septal structures impacts ventricular imbalance in atrioventricular septal defects with a common atrioventricular junction.

OBJECTIVE: Multiplanar re-formatting of full-volume three-dimensional echocardiography data sets offers new insights into the morphology of atrioventricular septal defects. We hypothesised that distortion of the alignment between the atrial and ventricular septums results in imbalanced venous return to the ventricles, with consequent proportional ventricular hypoplasia. METHODS: A single observer evaluated 31 patients, with a mean age of 52.09 months, standard deviation of 55, and with a range from 2 to 264 months, with atrioventricular septal defects, of whom 17 were boys. Ventricular imbalance, observed in nine patients, was determined by two-dimensional assessment, and confirmed at surgical inspection in selected cases when a univentricular strategy was undertaken. Offline analysis using multiplanar re-formatting was performed. A line was drawn though the length of the ventricular septum and a second line along the plane of the atrial septum, taking the angle between these two lines as the atrioventricular septal angle. We compared the angle between 22 patients with adequately sized ventricles, and those with ventricular imbalance undergoing univentricular repair. RESULTS: In the 22 patients undergoing biventricular repair, the septal angle was 0 in 14 patients; the other eight patients having angles ranging from 1 to 36, with a mean angle of 7.4°, and standard deviation of 11.1°.The mean angle in the nine patients with ventricle imbalance was 28.6°, with a standard deviation of 3.04°, and with a range from 26 to 35°. Of those undergoing univentricular repair, two patients died, with angles of 26 and 30°, respectively. CONCLUSIONS: The atrioventricular septal angle derived via multiplanar formatting gives important information regarding the degree of ventricular hypoplasia and imbalance. When this angle is above 25°, patients are likely to have ventricular imbalance requiring univentricular repair.

FCPS training in the specialty of Physical Medicine and Rehabilitation for physicians in Pakistan: The option less known.

There has been a growing demand for rehabilitation services in Pakistan in recent years, likely due to increasing prevalence of disability. Physical Medicine and Rehabilitation (PM&R) is a branch of medicine which deals with the prevention, diagnosis, and treatment of functional impairments resulting from neuro-musculoskeletal disorders. Physiatrists are physicians who specialize in the specialty of PM&R. College of Physicians and Surgeons of Pakistan started FCPS training in PM&R in the late 1990s. There are various training institutes within and outside Pakistan which are accredited for FCPS training in PM&R. There is a huge vacuum in this specialty in the country likely due to lack of awareness among health care providers. It is considered to be the specialty of the future due to its rapid growth potential, opportunities for sub specializations and unique skills.

From the year 2050; a glimpse of medical education in the future.

This article is supposedly sent from the future; the year 2050.The author describes the evolution of medical education in 21st century and focuses on the challenges ahead of today. The long years of laborious medical education and complex irrelevant curriculum would instigate a loud debate to amend the current educational system. Gradually, the health system would plateau, as rapid turn out of voluminous new information would not be efficiently channelized to actual patient care. Patient dissatisfaction would increase and the clinician-researcher model of physician would be dubious. Consequently, substantial revisions would be inevitable. By year 2050, the author hypothesizes that the system of continuing medical education would be replaced by continuing professional development. The number of years to be a full certified specialist would be significantly shortened and clinicians would be trained to work in a highly specialized multidisciplinary framework. After a common core medical curriculum, health care professionals would adapt different tracks to be physicians, allied health workers and medical scientists. Programme designs would allow early hands on experience in a patient-specialist programme. The main outcomes of patient management would not be limited to diagnosis or treatment of ailment, and would fundamentally incorporate quality of life issues. An early commitment to medical specialty would enable clinicians to focus on their specialized domains, master their skills at the best learning age and retain their energies for tomorrow.

Number of Pakistani physicians working abroad; do we really need to know?

There are around 175,600 registered doctors in Pakistan, but limited data is available about Pakistani physicians pursuing medical careers abroad. Additionally, no data is reported about Pakistani physicians who leave the country to pursue medical career overseas, but end up in non-medical professions. We identified two groups of physicians leaving the country: those going abroad for postgraduate training and residency; and those doing so for better career incentives and monetary benefits and to avoid the deteriorating law and order situation and rising hostilities towards doctors in the last few years. Other factors contributing towards physician's migration include poor service structure and career prospects, lack of research funding, increased workload and stressful work environment. Optimal measures need to be taken so that the locally trained doctors can deliver their services where they are needed the most, instead of seeking overseas opportunities. Similarly, volume of expertise may be enhanced by promoting social accountability among Pakistani physicians working abroad and by creating comparable opportunities within the country.

Complications of major lower limb amputations before prosthetic provision at a tertiary care rehabilitation facility.

BACKGROUND: Although postoperative complications of lower limb amputations and complications related to prosthetics are well known, complications before prosthetic fitting are less often emphasized in literature. There are no Saudi studies documenting the complications before prosthetic fitting where there is high rise in dysvascular amputation, and early prosthetic provision remains a challenge. OBJECTIVES: To investigate the complications following major lower limb amputations (MLLAs). STUDY DESIGN: Retrospective study. METHODS: One hundred thirty-six electronic files for individuals with major lower limb amputations were reviewed. Individuals visiting the primary limb loss clinic for the first time, who have not been fitted with a prosthesis before, were included. RESULTS: Muscle weakness was the most common complication (55.1%), followed by edema (52.9%), while infection was found to be the least frequent (5.1%). Age was significantly associated with etiology ( p value < 0.001), usage of assistive device ( p value = 0.002), and complications ( p value = 0.013). Complications were also significantly associated with time since amputation ( p value = 0.001). In addition, etiology was significantly associated with the usage of assistive device ( p value = 0.012). CONCLUSIONS: Muscle weakness and edema were the most common complications after MLLA in a cohort of patients with median onset of 8.5 ± 6.8 months since amputation. Presence of various complications in MLLAs before prosthetic evaluation reflect gaps of care including delayed prosthetic evaluation. National strategies need to be introduced to promote early rehabilitation interventions, prevent complications, and improve quality of life of individuals with MLLAs.

Caregiver Knowledge, Attitude, and Behavior toward Care of Children with Cerebral Palsy: A Saudi Arabian Perspective.

The care of children with cerebral palsy (CP) requires a complex system of care that is not only dependent on health care resources, but is also strongly influenced by social and cultural attributes. Hence, it is important to explore the understanding and practices of caregivers within a regional perspective. This study was conducted to investigate the knowledge, attitude, and behavior (KAB) of parents with children diagnosed with CP in Saudi Arabia. A cross sectional survey was conducted on the caregivers of children with CP admitted for inpatient rehabilitation between October 2023 to January 2024. A total of 216 caregivers participated in this survey. About 82.9% of caregivers were the mothers of CP children, half (50.5%) were ≤36 years old, 53.7% were highly educated, and 89.2% lived in urban areas. More than half of the participants (57.7%) owned their homes. Regarding children, spastic quadriplegia was the most common type (46.3% of cases). Overall, the participants recorded good values for all variables for KAB. The mean value for attitude was higher (2.67 ± 0.20) when compared to behavior (2.49 ± 0.36) and knowledge (2.46 ± 0.25). Participants who had children with spastic quadriplegia CP reported lower behavior scores than their peers. Strategies with a special emphasis on improving the behaviors of caregivers for children with quadriplegia need to be adapted. Similarly, the living situations of families need to be taken into consideration given its significant association with the attitude of caregivers. A considerable lack of knowledge in handling emergency situations by caregivers signifies a gap in care, which could have potentially life-threatening consequences.

Adductor tenotomy and selective obturator neurectomy for the treatment of spasticity in a man with paraplegia.

CONTEXT: Excessive hip adductor spasticity in patients with spinal cord injury (SCI) can produce scissoring effect of the thighs which can interfere with various activities of daily living. If noninvasive measures do not produce desired results, surgical treatment may be considered. One surgical option for the management of adductor spasticity includes adductor tenotomy and selective obturator neurectomy. This procedure was performed in an individual with T11 paraplegia having severe adductor spasticity in both thighs. METHOD: Case report. FINDINGS: Adductor spasticity at hips was identified as the main barrier in functional activities and rehabilitation of our patient. After a trial of noninvasive treatment, a selective obturator neurectomy and adductor tenotomy were carried out, which completely relieved his adductor spasticity at both thighs without any complications. With comprehensive rehabilitation, the patient showed enhanced functional independence in various activities of daily living. This helped the patient to achieve functional indoor ambulation using orthosis in spite of complete paraplegia. Conclusion/clinical reference: Severe adductor spasticity can have debilitating effects and could be a major barrier in rehabilitation of patients with SCI. Surgical treatment for adductor spasticity can be considered when patients are unresponsive to noninvasive treatment. Relief from adductor spasticity can improve functional outcomes and decrease dependency. Although this procedure is commonly performed in patients with cerebral palsy, it remains a viable surgical alternative in carefully selected patients with SCI when other modes of treatment are contraindicated, failed, or not available.

An approach to [Formula: see text]-single-valued neutrosophic submodules.

Dealing with erroneous, unexpected, susceptible, flawed, vulnerable, and intricate information is simplified with the use of a single-valued neutrosophic set (svns). This is because of the fact that these types of information are more sensitive to error. This is due to the fact that these particular kinds of information are more prone to error. The ideas of fuzzy sets and intuitionistic fuzzy sets have both undergone further development as a direct result of the development of this new theory. In svns, indeterminacy is quantified in a way that is both obvious and unambiguous, and truth membership, indeterminacy membership, and falsity membership are all completely independent of one another. In algebraic analysis, certain binary operations can be thought of as interacting with algebraic modules. These modules are intricate and ubiquitous structures. There are many different applications for modules to be used in. Modules find use in an extremely wide variety of different kinds of businesses and market segments. We investigate the idea of [Formula: see text]-svns and relate it to [Formula: see text]-single-valued neutrosophic module and [Formula: see text]-single-valued neutrosophic submodule, respectively. The goals of this research are to comprehend the algebraic structures of a [Formula: see text]-single-valued neutrosophic submodule of a classical module and enhance the legitimacy of this technique by discussing numerous essential aspects. Both of these goals will be accomplished through the course of this study. The strategies that we have developed in this manuscript are more generalizable than those that have been utilized in the past. These strategies include fuzzy sets, intuitionistic fuzzy sets, and neutrosophic sets.