Bone Screws ; Child ; Device Removal ; methods ; Epiphyses, Slipped ; surgery ; Female ; Humans

Child ; Epiphyses, Slipped ; genetics ; Femur Head ; Humans ; Male

INTRODUCTIONSlipped capital femoral epiphysis is the most common hip problem in the adolescent age group. It can involve both hips, presenting itself bilaterally at first presentation or sequentially. The overall incidence of bilateral disease is variable, but the risk of occurrence is higher when there is underlying endocrinopathy, renal disease and obesity.

MATERIALS AND METHODSAmongst the 36 cases (44 hips) of slipped capital femoral epiphysis that we had, there were 8 cases of bilateral disease, of which 3 were bilateral sequential slips. A retrospective review of all case records and X-rays was done.

RESULTSAccording to Aadalen's criteria, the results were excellent or good in 37 hips, fair in 3 hips, and poor in 2 hips. Two patients were considered as treatment failure because of avascular necrosis. The incidence of bilateral slipped capital femoral epiphysis was 22.2%. The overall average age was 11.4 years. All cases of sequential involvement presented within 15 months of the initial slip. One patient had hypothyroidism (who also had a positive family history for slipped capital femoral epiphysis), while 91.6% were above the 75th percentile for weight. There was no statistically significant difference in age, sex, race, body mass index (BMI) and weight percentile distribution between patients with unilateral and bilateral disease.

CONCLUSIONSatisfactory outcomes can be expected in most patients treated for slipped capital femoral epiphysis. The risk of avascular necrosis is higher in unstable slips. The role of prophylactic contra-lateral pinning should be restricted to patients with hypothalamic-pituitary-ovarian axis disease, especially hypothyroidism.

Adolescent ; Bone Nails ; Child ; Epiphyses, Slipped ; complications ; prevention & control ; surgery ; Female ; Femur Head ; surgery ; Femur Head Necrosis ; etiology ; Humans ; Male ; Recurrence ; Treatment Outcome

INTRODUCTIONNecrotising fasciitis is a disease associated with high morbidity and mortality, and multi-focal necrotising fasciitis is uncommon. We present 2 cases of concurrent necrotising fasciitis of contralateral upper and lower limbs.

CLINICAL PICTUREBoth presented with pain, swelling, bruising or necrosis of the affected extremities. Traditional medical therapy was sought prior to their presentation.

TREATMENTAfter initial debridement, one patient subsequently underwent amputation of the contralateral forearm and leg. The other underwent a forearm amputation, but refused a below-knee amputation.

OUTCOMEThe first patient survived, while the second died.

CONCLUSIONTraditional medical therapy can cause bacterial inoculation, leading to necrotising fasciitis, and also leads to delay in appropriate treatment. Radical surgery is needed to optimise patient survival.

Aged ; Amputation ; Debridement ; Fasciitis, Necrotizing ; diagnosis ; drug therapy ; surgery ; Fatal Outcome ; Female ; Hand ; microbiology ; surgery ; Humans ; Leg ; microbiology ; surgery ; Male ; Medicine, East Asian Traditional ; Middle Aged ; Risk Factors

Among interbody implants used during anterior cervical discectomy and fusion (ACDF), structural allografts and polyetheretherketone (PEEK) are the most used spacers. Currently, no consensus has been established regarding the superiority of either implant, with US surgeons preferring structural allografts, whereas UK surgeons preferring PEEK. The purpose of this systematic review (level of evidence, 4) was to compare postoperative and patient-reported outcomes between the use of structural allografts PEEK interbody spacers during ACDF. Five electronic databases (PubMed, Embase, Scopus, Web of Science, and Cochrane) were searched for articles comparing the usage of structural allograft and PEEK interbody spacers during ACDF procedures from inception to April 10, 2023. The searches were conducted using the keywords “Spine,” “Allograft,” and “PEEK” and were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Subsequent quality and sensitivity analyses were performed on the included studies. Nine studies involving 1,074 patients were included. Compared with the PEEK group, the structural allograft group had comparable rates of postoperative pseudoarthrosis (p=0.58). However, when stratified according to the number of levels treated, the 3-level ACDF PEEK group was 3.45 times more likely to have postoperative pseudoarthrosis than the structural allograft group (p=0.01). Subsequent postoperative outcomes (rate of subsidence and change in the preoperative and postoperative segmental disc heights) were comparable between the PEEK and structural allograft groups. Patient-reported outcomes (Visual Analog Scale [VAS] of neck pain and Neck Disability Index [NDI]) were comparable. This study showed that for 3-level ACDFs, the use of structural allografts may confer higher fusion rates. However, VAS neck pain, NDI, and subsidence rates were comparable between structural allografts and PEEK cages. In addition, no significant difference in pseudoarthrosis rates was found between PEEK cages and structural allografts in patients undergoing 1- and 2-level ACDFs.

Lysosomal dysfunction plays an important role in neurodegenerative diseases, including Parkinson’s disease (PD) and possibly Parkinson-plus syndromes such as progressive supranuclear palsy (PSP). This role is exemplified by the involvement of variants in the GBA1 gene, which results in a deficiency of the lysosomal enzyme glucocerebrosidase and is the most frequently identified genetic factor underlying PD worldwide. Pathogenic variants in the SMPD1 gene are a recessive cause of Niemann–Pick disease types A and B. Here, we provide the first report on an association between a loss-of-function variant in the SMPD1 gene present in a heterozygous state (p.Pro332Arg/p.P332R, which is known to result in reduced lysosomal acid sphingomyelinase activity), with PSP-Richardson syndrome in three unrelated patients of Chinese ancestry.

Objectives: : We estimated the overall and age-specific percentages of the Korean population with presumed immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as of April 2022 using the national registry. Methods: : We used the national coronavirus disease 2019 (COVID-19) infection and vaccination registry from South Korea, as described to define individuals with a previous history of COVID-19 infection, vaccination, or both, as persons with presumed immunity. Results: : Of a total of 53,304,627 observed persons, 24.4% had vaccination and infection, 58.1% had vaccination and no infection, 7.6% had infection and no vaccination, and 9.9% had no immunity. The SARS-CoV-2 Omicron variant emerged at a time when the presumed population immunity ranged from 80% to 85%; however, nearly half of the children were presumed to have no immunity. Conclusion : We report a gap in population immunity, with lower presumed protection in children than in adults. The approach presented in this work can provide valuable informed tools to assist vaccine policy-making at a national level.

KMT2B-linked dystonia (DYT-KMT2B) is a childhood-onset dystonia syndrome typically beginning in the lower limbs and progressing caudocranially to affect the upper limbs with eventual prominent craniocervical involvement. Despite its recent recognition, it now appears to be one of the more common monogenic causes of dystonia syndromes. Here, we present an atypical case of DYT-KMT2B with oromandibular dystonia as the presenting feature, which remained restricted to this region three decades after symptom onset. This appears to be the first reported case of DYT-KMT2B from Southeast Asia and provides further supporting evidence for the pathogenic impact of the KMT2B c.6210_6213delTGAG variant.

INTRODUCTION: Arthroscopic Bankart repair is a widely accepted procedure to treat recurrent shoulder dislocation. This study aims to describe our experience with arthroscopic Bankart repair and its functional outcome. METHODS: 107 patients who underwent arthroscopic Bankart repair from 2008 to 2013 were followed up for a minimum of three years and reviewed by an independent observer. 80 consented to being interviewed using the Oxford Shoulder Instability Score (OSIS) and Simple Shoulder Test. RESULTS: 82 shoulders (two bilateral) were studied. Mean age at first dislocation was 19.4 ± 3.4 (12.0-31.0) years. Mean follow-up was 4.4 ± 1.3 (3.0-9.0) years and 2.5 ± 3.0 (0.1-15.4) years elapsed from first dislocation to surgery. 41 (50.0%) patients played overhead or contact sports and 44 (53.7%) played competitive sports before injury; 8 (9.8%) patients reported recurrence of dislocation, which was significantly associated with playing competitive sports before injury (p <0.039), 5 (6.1%) underwent revision surgery and 22 (26.8%) reported residual instability after surgery. 49 (59.8%) patients returned to playing sports, 75 (91.5%) were satisfied with their surgery and 79 (96.3%) were willing to undergo the surgery again. 74 (90.2%) patients had two-year good/excellent OSIS, which was significantly associated with playing competitive sports before injury (p = 0.039), self-reported stability after surgery (p = 0.017), satisfaction with surgery (p = 0.018) and willingness to undergo surgery again (p = 0.024). CONCLUSION Arthroscopic Bankart repair yields good functional outcomes and is associated with high patient satisfaction, although not all patients return to sports.
Humans ; Adolescent ; Young Adult ; Adult ; Shoulder Dislocation/complications* ; Joint Instability/surgery* ; Shoulder Joint/surgery* ; Return to Sport ; Patient Satisfaction ; Retrospective Studies ; Recurrence ; Arthroscopy/methods*