The sensitivity and specificity of COVID-19 rapid anti-gene test in comparison to RT-PCR test as a gold standard test.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a modern infectious disease, first identified in December 2019 in Wuhan, China. The etiology is via severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in a pandemic manner. The study aimed to compare between RT-PCR and rapid anti-gene tests for COVID-19 with regard to sensitivity and specificity. METHODS: This is a cohort hospital-based study done during the period of July to September 2020. Both rapid anti-gene test kit (SARS-CoV-2) and RT-qPCR were used for the detection of COVID-19 in suspected cases. RESULTS: A total of 148 cases were tested using both the RT-qPCR and rapid test. Twenty-nine (19.6%) of these cases had positive results for RT-qPCR and 119 (80.4%) were negative, whereas 52 (35.1%) patients were positive to rapid anti-gene test and 96 (64.9%) of them negative. The sensitivity of the rapid test was 37.9%, the specificity was 65.5% and the accuracy was 64.44%. Rapid IgG test was positive in 47 (31.8) of cases. Although, rapid IgM test was positive in 18 (12.2%). The rapid IgG test was more sensitive than rapid IgM (Sensitivity 34.48% vs. 3.45%), but it was less specific than rapid IgM test (Specificity 68.91% vs. 85.71%). CONCLUSION: We cannot consider rapid anti-gene test alone as a diagnostic method for COVID-19. We should also conduct RT-PCR test and other investigations like imaging CT scan of chest to confirm the diagnosis. The rapid IgG test is more sensitive than rapid IgM, but it was less specific.

Intrapelvic Kirschner wire Migration following Developmental Dysplasia of Hip Surgery and Laparoscopic Removal.

Salter innominate osteotomy remains the most commonly performed pelvic osteotomy for the Developmental Dysplasia of Hip in children after 18 months of age up to six years. Kirschner wire (K- wire) is used to fix the bone graft across the osteotomy site. Of the several complications of the pelvic osteotomy, K- wire migration into the pelvis is rare and only a few case reports are reported. We present a case of a 2-year-old girl with Right sided Developmental Dysplasia of Hip who underwent Femoral shortening and Salter innominate osteotomy, presented three months later with intrapelvic migration of k-wire. Paediatric Surgery consult was obtained and K-wire was removed laparoscopically without any complications successfully.

Scapho-luno-capitate fusion with proximal lunate articular surface preservation for management of grade IIIA Kienböck's disease: a prospective case series.

BACKGROUND: Kienböck's disease is idiopathic lunate avascular necrosis, which may lead to lunate collapse, abnormal carpal motion and wrist arthritis. The current study aimed to assess the outcomes of treating stage IIIA Kienböck's disease by a novel technique of limited carpal fusion via partial lunate excision with preservation of the proximal lunate surface and scapho-luno-capitate (SLC) fusion. MATERIALS AND METHODS: We conducted a prospective study of patients with grade IIIA Kienböck's disease managed with a novel technique of limited carpal fusion comprising SLC fusion with preservation of the proximal lunate articular cartilage. Autologous iliac crest bone grafting and K-wires fixation were used to enhance the osteosynthesis of the SLC fusion. The minimum follow-up period was 1 year. A visual analog scale (VAS) and the Mayo Wrist Score were utilized for the evaluation of patient residual pain and functional assessment, respectively. A digital Smedley dynamometer was used to measure the grip strength. The modified carpal height ratio (MCHR) was used for monitoring carpal collapse. The radioscaphoid angle, scapholunate angle, and the modified carpal-ulnar distance ratio were used for the assessment of carpal bones alignment and ulnar translocation of carpal bones. RESULTS: This study included 20 patients with a mean age of 27.9 ± 5.5 years. At the last follow-up, the mean range of flexion/extension range of motion (% of normal side) improved from 52.8 ± 5.4% to 65.7 ± 11.1%, P = 0.002, the mean grip strength (% of normal side) improved from 54.6 ± 11.8% to 88.3 ± 12.4%, P = 0.001, the mean Mayo Wrist Score improved from 41.5 ± 8.2 to 81 ± 9.2, P = 0.002, and the mean VAS score reduced from 6.1 ± 1.6 to 0.6 ± 0.4, P = 0.004. The mean follow-up MCHR improved from 1.46 ± 0.11 to 1.59 ± 0.34, P = 0.112. The mean radioscaphoid angle improved from 63 ± 10º to 49 ± 6º, P = 0.011. The mean scapholunate angle increased from 32 ± 6º to 47 ± 8º, P = 0.004. The mean modified carpal-ulnar distance ratio was preserved and none of the patients developed ulnar translocation of the carpal bones. Radiological union was achieved in all patients. CONCLUSIONS: Scapho-luno-capitate fusion with partial lunate excision and preservation of the proximal lunate surface is a valuable option for treating stage IIIA Kienböck's disease, with satisfactory outcomes. Level of evidence Level IV. Trial registration Not applicable.

Estradiol deficiency reduces the satellite cell pool by impairing cell cycle progression.

The size of the satellite cell pool is reduced in estradiol (E2)-deficient female mice and humans. Here, we use a combination of in vivo and in vitro approaches to identify mechanisms, whereby E2 deficiency impairs satellite cell maintenance. By measuring satellite cell numbers in mice at several early time points postovariectomy (Ovx), we determine that satellite cell numbers decline by 33% between 10 and 14 days post-Ovx in tibialis anterior and gastrocnemius muscles. At 14 days post-Ovx, we demonstrate that satellite cells have a reduced propensity to transition from G0/G1 to S and G2/M phases, compared with cells from ovary-intact mice, associated with changes in two key satellite cell cycle regulators, ccna2 and p16INK4a. Further, freshly isolated satellite cells treated with E2 in vitro have 62% greater cell proliferation and require less time to complete the first division. Using clonal and differentiation assays, we measured 69% larger satellite cell colonies and enhanced satellite cell-derived myoblast differentiation with E2 treatment compared with vehicle-treated cells. Together, these results identify a novel mechanism for preservation of the satellite cell pool by E2 via promotion of satellite cell cycling.

Persistent Fibroadipogenic Progenitor Expansion Following Transient DUX4 Expression Provokes a Profibrotic State in a Mouse Model for FSHD.

FSHD is caused by loss of silencing of the DUX4 gene, but the DUX4 protein has not yet been directly detected immunohistologically in affected muscle, raising the possibility that DUX4 expression may occur at time points prior to obtaining adult biopsies for analysis, with consequent perturbations of muscle being responsible for disease progression. To test the extent to which muscle can regenerate following DUX4-mediated degeneration, we employed an animal model with reversible DUX4 expression, the iDUX4pA;HSA mouse. We find that muscle histology does recover substantially after DUX4 expression is switched off, with the extent of recovery correlating inversely with the duration of prior DUX4 expression. However, despite fairly normal muscle histology, and recovery of most cytological parameters, the fibroadipogenic progenitor compartment, which is significantly elevated during bouts of fiber-specific DUX4 expression, does not return to basal levels, even many weeks after a single burst of DUX4 expression. We find that muscle that has recovered from a DUX4 burst acquires a propensity for severe fibrosis, which can be revealed by subsequent cardiotoxin injuries. These results suggest that a past history of DUX4 expression leads to maintained pro-fibrotic alterations in the cellular physiology of muscle, with potential implications for therapeutic approaches.

Augmented Repair of Acute Total Achilles Tendon Rupture With Peroneus Brevis Tendon Transfer Using Oblique Transosseous Calcaneal Tunnel: A Prospective Case Series.

Acute Achilles tendon rupture is one of the most common tendon injuries. This prospective study aimed to evaluate the functional outcomes of augmented repair of acute Achilles tendon rupture with peroneus brevis tendon transfer and fixation to an oblique calcaneal transosseous tunnel. Functional evaluation was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and Achilles Tendon Total Rupture Score (ATRS). Postoperative complications were recorded. This study included 33 males and 9 females, with a mean age of 26.1 ± 4.2 years. The Achilles tendon ruptures were right in 24 patients and left in 18 patients. The cause of rupture was sports injuries in all patients. The mean distance from the calcaneal insertion to the tear site was 4.4 ± 1.3 cm. The mean time from injury to surgery was 2.4 ± 1.6 days. The mean follow-up time was 40.3 ± 4.9 months. The mean AOFAS and ATRS scores were 99.3 ± 1.2 and 95.9 ± 1.9, respectively, at 12 months of follow-up. The mean time to return to work was 12.1 ± 1.2 weeks. The mean time to return to light sports activities was 16.1 ± 1.8 weeks postoperatively. None of the patients developed re-rupture. Augmented repair of acute Achilles tendon ruptures with peroneus brevis tendon transfer is a robust repair with excellent functional outcomes and early weight-bearing and return to sports activities.

Outcome of Minimally Invasive Osteosynthesis for Displaced Intra-articular Calcaneal Fractures Using Cannulated Screws: A Prospective Case Series.

This prospective study sought to assess the functional and radiological outcomes of minimally invasive osteosynthesis using cannulated screws and to examine the effect of different parameters on the functional outcome. The Maryland foot score and the visual analog scale of pain were used to assess the functional outcomes and postoperative patient's satisfaction rate. Preoperative and postoperative Böhler's angle, angle of Gissane, calcaneal width, and height, were compared. The study included 46 fractures in 40 patients; 38 (95%) males and 2 (5%) females with a mean age of 34.8 ± 3 years. The mean time lapse to surgery was 3.2 ± 2.1 days. The mean duration of surgery was 39.8 ± 9.3 minutes. The mean follow-up period was 29.2 months. At final follow-up, the mean Maryland foot score was 85 ± 6.3. Satisfactory results were achieved in 91.3% of fractures, while unsatisfactory in 8.7%. The mean visual analog scale score of pain decreased from 7.3 ± 05 preoperatively to 1.2 ± 0.7 at the final follow-up, p <.001. Postoperatively, there was significant improvement of Böhler's angle, angle of Gissane, calcaneal width, and height, p < .001. Factors associated with better functional outcomes included reduced time lapse to surgery, p = .032, and more accurate restoration of the calcaneal parameters. Management of intra-articular calcaneal fractures by minimally invasive osteosynthesis using cannulated screws can achieve satisfactory functional and radiological outcomes. Better outcomes are associated with reduced time lapse to surgery, and accurate reduction and restoration of calcaneal angles, height, and width.

Intercostal Nerve Transfer in Management of Biceps and Triceps Cocontraction in Spontaneously Recovered Obstetric Brachial Plexus Palsy.

BACKGROUND: Obstetric brachial plexus palsy is caused by traction during birth. Most patients regain useful function with spontaneous recovery. In some cases, cross reinnervation occurs between the biceps and triceps muscles. In these cases, smooth active motion of the elbow joint is impaired by simultaneous biceps and triceps muscle contraction. The biceps and triceps muscle cocontraction could be treated by botulinum toxin type A injection, tendon transfer of the triceps to biceps, and intercostal nerves transfer to the musculocutaneous nerve (MCN) or to the motor branch of the radial nerve to the triceps muscle. PATIENTS AND METHODS: We present 16 cases (10 males and 6 females) with biceps and triceps cocontraction in spontaneously recovered obstetric brachial plexus palsy patients. They were treated by 3 intercostal nerves transfer to MCN without exploration of the remaining plexus. The mean age at surgery was 40.6 months (range, 24-65 months). Preoperative electromyography was done in all cases to confirm biceps and triceps cocontraction and to assess the contractile status of both muscles. RESULTS: The mean postoperative follow-up period was 51.7 months (range, 27-64 months). At the final follow-up, elbow flexion was graded 3 in 1 patient, grade 4 in 3 patients, grade 6 in 9 patients, and grade 7 in 3 patients using the 7-point Toronto scale. The mean active range of motion of the elbow (against gravity) increased from 38 degrees preoperatively (range, 0-75 degrees) to 96.8 °[Combining Ring Above] at the final follow-up (range, 60-140 degrees). CONCLUSIONS: Intercostal nerves transfer to MCN for management of biceps, and triceps cocontraction in spontaneously recovered obstetric brachial plexus injury is a good option with minimal morbidity and high success rate.

A Protocol for Percutaneous Transarticular Fixation of Sanders Type II and III Calcaneal Fractures With or Without an Added Mini-Open Approach.

Intra-articular fracture of the calcaneus is one of the most displeasing fractures if not properly managed. Open reduction and internal fixation have been associated with a high incidence of postoperative soft tissue complications. Closed reduction and percutaneous fixation have resulted in a greater incidence of postoperative subtalar osteoarthritis with improper reduction of the articular surface. In the present study, a mini-open approach was used in cases of failure of articular surface restoration with closed reduction. A total of 64 feet in 57 consecutive patients with an intra-articular calcaneal fracture underwent the proposed minimally invasive surgical protocol. Of the 57 patients, 7 (12.3%) had bilateral fractures. According to Sanders classification, 33 (51.6%) fractures were type II and 31 (48.4%) were type III. Seven (12.3%) patients had wedge fractures of the dorsolumbar spine without neurologic manifestations. The postoperative evaluation included radiographs and completion of the Maryland Foot Score and visual analog scale for pain. The mean follow-up period was 16 (range 12 to 36) months. The mean operative time was 42 (range 35 to 60) minutes. The mean period until union of the fracture was 12 (range 10 to 16) weeks. The clinical results according to the Maryland Foot Score revealed 52 (81%) with satisfactory (27 excellent and 25 good) and 12 (19%) with unsatisfactory (10 fair and 2 poor) results. The mean visual analog scale score was 1.5 ± 0.3 when radiographic fracture healing was observed. Six patients (9.4%) developed superficial pin tract infections that responded to local care and parenteral antibiotic therapy and resolved completely after removal of the Kirschner wires. In conclusion, the presented surgical protocol combining closed reduction with or without an added mini-open approach and percutaneous fixation improves the functional outcome and minimizes the incidence of complications.

Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears.

OBJECTIVE: Rotator cuff tears are one of the most common causes of chronic shoulder pain and disability. They significantly affect the quality of life. Reduced pain and improved function are the goals of conventional therapy, which includes relative rest, pain therapy, physical therapy, corticosteroid injections and surgical intervention. Tendons have a relative avascular nature; hence, their regenerative potential is limited. There is some clinical evidence that the application of autologous platelets may help to revascularize the area of injury in rotator cuff pathologies. PATIENTS AND METHODS: This prospective randomized controlled study was done to evaluate the results of subacromial injection of platelet-rich plasma (PRP) versus corticosteroid injection therapy in 40 patients with symptomatic partial rotator cuff tears. All patients were assessed before injection, 6 weeks, 3 and 6 months after injection, using the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the Constant-Murley Score (CMS), the Simple Shoulder Test (SST) and a Visual Analog Scale (VAS) for pain. An MRI was performed before and 6 months after the injection for all the included patients and was graded on 0-5 scale. RESULTS: Both injection groups showed statistically significantly better clinical outcomes over time compared with those before injection. There was a statistically significant difference between RPP group and corticosteroid group 12 weeks after injection, regarding VAS, ASES, CMS and SST in favor of the RPP group. MRI showed an overall slight nonsignificant improvement in grades of tendinopathy/tear in both groups, however, without statistically significant differences between the two groups. CONCLUSION: PRP injections showed earlier better results as compared to corticosteroid injections, although statistically significant better results after 6 months could not be found. Therefore, subacromial RPP injection could be considered as a good alternative to corticosteroid injection, especially in patients with a contraindication to corticosteroid administration. LEVEL OF EVIDENCE: II.

Modified technique for reconstructing reverse Hill-Sachs lesion in locked chronic posterior shoulder dislocation.

BACKGROUND: Among the uncommon and frequently missed orthopedics injuries is the posterior shoulder dislocation, accounting for about 2-4 % of all shoulder dislocations. Commonly, it is associated with the well-known reverse Hill-Sachs lesion. Several surgical treatment modalities such as transfer of subscapularis tendon or lesser tuberosity, humeral rotational osteotomy, osteochondral grafts were used to repair this defect. Hemiarthroplasty or total shoulder arthroplasty was used as salvage procedure in non-constructable defect or neglected old dislocation. PATIENTS AND METHODS: This study included 11 patients with locked chronic posterior shoulder dislocation and reverse Hill-Sachs defects falling in the target range (25-50 % of the head size). The mean age of the patients was 39 (range 31-49) years. Mean time from injury to surgery was 9 (range 3-18) weeks. Open reduction in the dislocated head with the transfer of subscapularis tendon and the attached lesser tuberosity was done to reconstruct the reverse Hill-Sachs defect. The transferred tuberosity was fixed with size 5 Ethibond sutures. RESULTS: The mean follow-up period was 29 (range 24-39) months. The median of the scores was much improved, reaching 30 (range 20-34) (satisfactory) compared with preoperative median of 24 (range 20-25) (unsatisfactory). This was statistically highly significant (P = 0.002). Postoperatively, 9 patients had no pain or restricted daily living activities. No patient had symptoms of shoulder instability. According to the modified UCLA shoulder rating scale, there were 4 patients rated excellent, 5 patients rated good, one patient rated fair and one patient rated poor. CONCLUSION: Reconstructing the reverse Hill-Sachs defect provides adequate stability, pain relief and function in patients with locked chronic posterior shoulder dislocation and a defect involving 25-50 % of the humeral head. The used technique is simple and cost effective with no need for subsequent hardware removal. LEVEL OF EVIDENCE: II.

Expanding horizons in pulmonary hypertension management: A systematic review and meta-analysis of non-pharmacological interventions.

BACKGROUND: Pulmonary hypertension (PH) is a progressive and life-threatening disorder characterized by elevated pulmonary arterial pressure, leading to right heart failure and reduced exercise capacity. Traditional pharmacological and surgical treatments offer limited efficacy and significant side effects, necessitating the exploration of alternative therapeutic options. OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of non-pharmacological interventions, including exercise, dietary modifications, and psychosocial therapies, in the management of pulmonary hypertension. METHODS: Comprehensive searches were conducted in PubMed, Cochrane Library, and Scopus up to 2024, identifying randomized controlled trials and observational studies examining non-pharmacological interventions for PH. Primary outcomes assessed included pulmonary arterial pressure, right heart function, exercise capacity, and quality of life, with secondary analysis on safety and adverse effects. Data synthesis was performed using random-effects meta-analysis. RESULTS: The review included 30 studies, totaling 2000 participants with various forms of PH. Meta-analysis demonstrated significant improvements in exercise capacity as measured by the 6 min walk distance (mean increase of 45 meters, 95 % CI: 30-60, p<0.001), enhanced quality of life scores, and reduction in pulmonary arterial pressure (mean reduction of 5 mmHg, 95 % CI: 3-7, p<0.01). Non-pharmacological therapies also showed a favorable safety profile, with minor adverse effects reported. CONCLUSION: Non-pharmacological interventions provide a viable and effective complement to traditional treatments for pulmonary hypertension, significantly improving functional capacity and hemodynamic parameters without severe adverse effects. These findings support the integration of tailored non-pharmacological strategies into the therapeutic regimen for PH patients, emphasizing the need for broader implementation and further research to optimize intervention protocols.

A meta-analysis of therapeutic trials of topical ruxolitinib cream for the treatment of vitiligo: therapeutic efficacy, safety, and implications for therapeutic practice.

Vitiligo, an autoimmune condition characterized by depigmented skin patches due to the loss of functional melanocytes, has been linked to dysregulation in the JAK-STAT signaling pathway, particularly in IFN-g signaling. The use of JAK inhibitors, such as ruxolitinib cream, a JAK1 and JAK2 inhibitor, presents a promising approach for vitiligo treatment. This study aims to systematically assess the effectiveness and safety of ruxolitinib cream in patients with vitiligo. We conducted a systematic review and meta-analysis following PRISMA guidelines to evaluate the efficacy and safety of ruxolitinib cream for the treatment of vitiligo. A comprehensive search of PubMed, Google Scholar, and Cochrane Library databases for randomized controlled trials (RCTs). Data selection, screening, extraction, and risk of bias assessment were meticulously performed. Statistical analysis was conducted using Review Manager Software, version 5.4, with significant heterogeneity addressed through appropriate methods. Our meta-analysis included 3 studies with 830 vitiligo patients. Significant improvements were observed in F-VASI, T-VASI, F-BSA, and T-BSA scores, with greater efficacy at 24 weeks compared to 12 weeks [MD -24.17, 95% CI (-31.78 to -16.56), P < 0.00001], [MD -14.12, 95% CI (-20.54 to -7.70); P < 0.0000], [MD -16.25, 95% CI (-22.20 to -10.31), P < 0.00001], [MD -9.19, 95% CI (-13.47 to -4.92); P < 0.00001]. Ruxolitinib showed increased risk ratios for F-VASI75, F-VASI90, and F-VASI50, indicating better outcomes with longer treatment durations [MD 2.9, 95% CI 1.88-4.49; P < 0.00001], [MD 4.66, 95% CI 2.09-10.39; P = 0.0002], [MD 2.53, 95% CI 1.84-3.46; P < 0.00001]. No significant differences were found in mild and moderate adverse events, while severe cases favored ruxolitinib. Placebo had a significant advantage in any adverse events, with no significant difference in drug-related adverse events. Serious adverse events did not significantly differ between groups. The findings strongly support the efficacy of ruxolitinib therapy in improving various parameters over time for treating vitiligo. However, thorough consideration of its safety profile, particularly concerning adverse events and potential side effects, is warranted. Further studies with larger sample sizes are needed to confirm these conclusions.

The Satellite Cell Colony Forming Cell Assay as a Tool to Measure Self-Renewal and Differentiation Potential.

The muscle satellite cell population is responsible for homeostatic maintenance of muscle fibers in response to muscle injury and normal wear and tear. This population is heterogeneous, and its capacity for self-renewal and differentiation can be altered either by mutation of genes that regulate these processes or with natural processes such as aging. The satellite cell colony assay is a facile way to extract information about the proliferation and differentiation potential of individual cells. Here, we provide a detailed protocol for the isolation, single cell plating, culture, and evaluation of colonies derived from single satellite cells. The variables of cell survival (cloning efficiency), proliferative potential (nuclei per colony), and differentiation propensity (ratio of nuclei within myosin heavy chain-positive cytoplasm to total nuclei) can thus be obtained.

Minimally Invasive Reduction of Intraarticular Calcaneal Fractures With Percutaneous Fixation Using Cannulated Screws Versus Kirschner Wires: A Retrospective Comparative Study.

BACKGROUND: Several minimally invasive techniques were developed for management of intraarticular calcaneal fractures. This study aimed to compare the functional and radiological outcomes of 2 minimally invasive reduction and fixation techniques using cannulated screws or Kirschner wires (K-wires) for fixation. METHODS: This study was a retrospective comparative review of patients with displaced intraarticular calcaneal fractures, who were treated with cannulated screws or K-wires techniques. Clinical and radiological data were collected and compared between both groups. Functional outcomes and patient satisfaction using the Maryland Foot Score (MFS) and the visual analogue scale (VAS) of pain, in addition to the complications, were compared between both groups. RESULTS: In total, 70 patients were included in the study: 34 in the cannulated screws group, with a mean age of 35.2 ± 4 years, and 36 in the K-wires groups, with a mean age of 33.4 ± 3 years. The operative time was shorter in the K-wires group (40.5 ± 5.6 minutes) compared to the cannulated screw group (49.5 ± 4.5 minutes), P < .001. There were no statistically significant differences between both groups regarding the radiological parameters, including Bohler's angle, angle of Gissane, calcaneal width, height, or length. The mean MFS, mean VAS, and complications were not different between the 2 groups. CONCLUSION: Treatment of displaced intraarticular calcaneal fractures with minimally invasive reduction and fixation using either cannulated screws or K-wires can achieve similar excellent functional and radiological outcomes, with high patient satisfaction. The use of K-wires has the advantage of reduced operative time than cannulated screws. LEVELS OF EVIDENCE: Level III: Retrospective comparative study.

Sacrococcygeal Morphologic and Morphometric Risk Factors for Idiopathic Coccydynia: A Magnetic Resonance Imaging Study.

STUDY DESIGN: Retrospective case-control study. OBJECTIVES: To evaluate the sacrococcygeal morphologic and morphometric features in idiopathic coccydynia using magnetic resonance imaging (MRI). METHODS: MRI scans from 60 patients with idiopathic coccydynia were compared with scans of 60 controls. Assessment of coccygeal morphology included coccygeal segmentation, coccygeal types, bony spicules, sacrococcygeal joint fusion, and intercoccygeal joint fusion and subluxation. Morphometric parameters included coccygeal straight and curved lengths, coccygeal curvature index, sacrococcygeal and intercoccygeal joint angles, sacral straight and curved lengths, sacral curvature index, sacral angle, sacrococcygeal straight and curved lengths, sacrococcygeal curvature index, and sacrococcygeal angle. RESULTS: The coccydynia group included 28 males and 32 females, with a mean age of 36.1 years. Type II coccyx and bony spicules were more common in coccydynia, P = 0.003 and 0.01, respectively. Sacrococcygeal joints were fused less commonly in coccydynia, P = 0.02. Intercoccygeal joint subluxation was more common in coccydynia, P = 0.007. The sacral angle was lower in coccydynia, P = 0.01. The sacrococcygeal curved length was higher in coccydynia, P < 0.001. The sacrococcygeal curvature index was lower coccydynia, P < 0.001. In females only, the coccygeal curvature index was lower in coccydynia patients, P = 0.04. In males only, the intercoccygeal angle was lower in coccydynia patients, P = 0.02. CONCLUSIONS: Type II coccyx, bony spicules, intercoccygeal joint subluxation were more common, and sacrococcygeal joint fusion was less common in coccydynia patients. Sacral angle and sacrococcygeal curvature index were lower, while sacrococcygeal curved length was higher in coccydynia patients. LEVEL OF EVIDENCE: Level 3. Case-control study.

Pattern and Frequency of Nosocomial Infections in the Pediatric Intensive Care Unit at East Jeddah General Hospital, Saudi Arabia.

Background Because of the use of invasive devices and procedures in critically sick patients, patients in the pediatric intensive care unit (PICU) are particularly vulnerable to nosocomial infections. Although a significant illness may necessitate admission to the PICU, infections can also emerge after admission. Nosocomial infection is a major public health issue related to increased morbidity, death, and healthcare costs. This study aimed to determine the pattern, frequency, and outcomes of nosocomial infections among children who were admitted to the PICU. Methodology This retrospective, cross-sectional study was conducted in the pediatric population aged from one month to 14 years old who acquired infections after 48 hours of admission to the PICU at East Jeddah General Hospital, Saudi Arabia from 2021 to 2022. The data were collected from medical and laboratory records. Results A total of 51 patients developed 145 nosocomial infections. Central line-associated bloodstream infections (CLABSIs) were the most commonly reported type of nosocomial infections (28.3%). The majority of the isolated organisms (58.7%) were gram-negative, followed by fungal infections (35.1%) and gram-positive organisms (6.2%). The death rate for patients with nosocomial infections was 29.4%. Increased death rates among individuals with CLABSIs and gram-negative isolates were observed to be significantly correlated (p = 0.001). Conclusions Our findings suggest that regular surveillance systems were necessary to assess the relationship between these well-known risk variables with PICU, implying that preventing these infections through particular treatments could be cost-effective and contribute to the safety of healthcare systems.

Outcomes of minimally invasive osteosynthesis of intertrochanteric fractures with dynamic hip screw: A prospective case series.

BACKGROUND: Intertrochanteric fractures are a public health concern, especially in geriatric patients. Early surgical management is crucial to allow early mobilization, which helps reduce the disability and increase patients' survival. In this article, we report the outcomes of minimally invasive osteosynthesis of intertrochanteric fractures with dynamic hip screw (DHS). METHODS: The present study was a prospective case series of patients who had intertrochanteric fractures treated with minimally invasive DHS technique. Postoperative patient satisfaction rate was evaluated using the visual analog scale (VAS) of pain. Functional outcomes were evaluated using the Harris hip score (HHS) and the Merle-d'Aubigne-Postel (MDP) scoring system at 12 months of follow-up. Satisfactory results were considered with HHS of ≥80 points and MDP scores of ≥15. Postoperative complications were noted. RESULTS: In this study, 70 patients were included, 41 (58.6%) males and 29 (41.4%) females, with an average age of 69.3 ± 8.3 years. The mean length of hospital stay was 2.1 ± 0.9 days. The average follow-up period was 23.9 ± 7.1 months. The mean time to radiological union was 16.8 ± 1.9 weeks. The mean postoperative VAS score for pain was 2.5 ± 1.1. The mean HHS was 87.1 ± 4.7 points and the mean MDP score was 15.6 ± 2.3 at 12 months follow-up. An average of 10.6 ± 2.9 weeks was required for full weight bearing. CONCLUSION: The minimally invasive DHS technique effectively treats intertrochanteric fractures with minimal incision, less bleeding, shorter operative time, early discharge from hospital, faster rehabilitation, and favorable functional outcomes.

Rehabilitation of severely-destructed endodontically treated premolar teeth with novel endocrown system: Biomechanical behavior assessment through 3D finite element and in vitro analyses.

OBJECTIVE: Rehabilitation of endodontically treated premolars with extensive coronal destruction through endocrown approach remains a controversial topic in reconstructive dentistry. There is no clear consensus in the literature which endocrown design with which material is the most effective restoration option for severely-destructed endodontically treated premolars. The aim of this study was to assess the biomechanical behavior of endodontically treated maxillary first premolars restored with a novel endocrown system compared to the conventional one varying the applied load type through finite element and in vitro analyses. MATERIALS AND METHODS: For finite element analysis, two models representing two endocrown systems used for restoration of severely-destructed endodontically treated maxillary first premolar tooth were generated: Model C for the conventional monolithic IPS e.max CAD endocrown and Model P for the novel bi-layered endocrown (PEKKTON ivory coping veneered with cemented IPS e.max CAD). Modified von Mises stress values on the remaining tooth structure, cement lines and restorative materials were evaluated separately under axial and oblique loading of 450 N. For in vitro analysis, forty sound human bifurcated maxillary first premolars were collected, endodontically-treated, and divided into 2 main groups (n = 20) according to the system used for endocrown fabrication; Group C: the conventional monolithic endocrowns and Group P: the novel bi-layered endocrowns. All specimens were subjected to an artificial thermomechanical aging protocol. Each main group was subdivided into two subgroups (n = 10) according to the loading type (axial and oblique) applied during the fracture resistance test. Qualitative analysis using Stereomicroscopy and Scanning Electron Microscopy was performed. Data were statistically analyzed at p-value ≤ 0.05. RESULTS: Regarding stress distribution pattern of remaining tooth structure (enamel and dentin), both endocrown systems and cement lines under both axial and oblique load application, Model P resulted in lower stresses than Model C. The oblique stress values of all analyzed structures were higher than corresponding values resulted axially. Considering failure load, a significantly higher load was recorded for Group P when axial or oblique loading was applied (p = 0.00). A significantly higher failure load was recorded with axial loading for both main groups. With regard to failure mode, a statistically significant difference was observed between main groups (p = 0.033), with more favorable failures detected for Group P axially. CONCLUSIONS: Compared to the conventional endocrown system, the studied novel system improved the biomechanical behavior within tooth/restoration complex of the restored severely-destructed endodontically treated maxillary first premolar teeth, whatever the applied load type. CLINICAL SIGNIFICANCE: The novel endocrown system using a PEKK coping veneered with cemented IPS e.max CAD can be considered a favorable promising option for restoration of severely-destructed endodontically treated premolar teeth, with more protection for residual tooth structure. It can be considered as a conservative alternative option to the conventional treatment modalities not only for normal clinical conditions, but also for parafunctional cases.