Surgical management of femoral shaft fractures with intramedullary nails has become the standard of care, with multiple options for entry point described, including piriformis entry, trochanter entry and retrograde femoral nails. Our present review describes the surgical anatomy of the proximal and distal femur and its relation to different entry points for intramedullary femoral nails. In addition, we reviewed relative indications for each technique, difficulties associated and possible complications.
Humans ; Femoral Fractures/surgery* ; Bone Nails ; Femur/surgery* ; Fracture Fixation, Intramedullary/methods* ; Lower Extremity

Macroamylasemia is a rare condition characterized by the formation of an amylase–globulin complex that is too large to be readily excreted by the kidneys and leads to elevated serum amylase levels. It is a benign condition lacking severe signs and symptoms that does not require treatment. This paper presents a case of a middle-aged man with unexplained elevated serum amylase levels. Despite an initially elevated triglyceride level, clinical findings, laboratory test results, and radiological findings were not suggestive of pancreatitis. The ratio of renal amylase clearance to creatinine clearance was calculated at <1%, consistent with macroamylasemia. No specific treatment was given, and he was monitored periodically. Nevertheless, macroamylasemia is a diagnostic challenge because of the need to differentiate it from other causes of hyperamylasemia to avoid unnecessary tests and treatments.

Objectives: This study aimed to adapt the survey questionnaire designed by Moens et al. (2021) and determine the validity and reliability of the Arabic version of the survey in a sample of the Saudi population experiencing teleworking. Methods: The questionnaire includes 2 sections. The first consists of 13 items measuring the impact of extended telework during the coronavirus disease 2019 (COVID-19) crisis. The second section includes 6 items measuring the impact of the COVID-19 crisis on self-view of telework and digital meetings. The survey instrument was translated based on the guidelines for the cultural adaptation of self-administrated measures. Results: The reliability of the questionnaire responses was measured by Cronbach’s alpha. The construct validity was checked through exploratory factor analysis followed by confirmatory factor analysis (CFA) to further assess the factor structure. CFA revealed that the model had excellent fit (root mean square error of approximation, 0.00; comparative fit index, 1.0; Tucker-Lewis index, 1; standardized root mean squared residual, 0.0). Conclusions The Arabic version of the teleworking questionnaire had high reliability and good validity in assessing experiences and perceptions toward teleworking. While the validated survey examined perceptions and experiences during COVID-19, its use can be extended to capture experiences and perceptions during different crises.

PURPOSE: This study aimed to evaluate the effect of incorporating zirconium oxide nanoparticles (nano-ZrO 2 ) in polymethylmethacrylate (PMMA) denture base resin on flexural properties at different material thicknesses. MATERIALS AND METHODS: Heat polymerized acrylic resin specimens (N = 120) were fabricated and divided into 4 groups according to denture base thickness (2.5 mm, 2.0 mm, 1.5 mm, 1.0 mm). Each group was subdivided into 3 subgroups (n = 10) according to nano-ZrO2 concentration (0%, 2.5%, and 5%). Flexural strength and elastic modulus were evaluated using a three-point bending test. One-way ANOVA, Tukey’s post hoc, and two-way ANOVA were used for data analysis (α = .05). Scanning electron microscopy (SEM) was used for fracture surface analysis and nanoparticles distributions. RESULTS: Groups with 0% nano-ZrO2 showed no significant difference in the flexural strength as thickness decreased (P = .153). The addition of nano-zirconia significantly increased the flexural strength (P < .001). The highest value was with 5% nano-ZrO2 and 2 mm-thickness (125.4± 18.3 MPa), followed by 5% nano-ZrO2 and 1.5 mm-thickness (110.3 ± 8.5 MPa). Moreover, the effect of various concentration levels on elastic modulus was statistically significant for 2 mm thickness (P = .001), but the combined effect of thickness and concentration on elastic modulus was insignificant (P = .10). CONCLUSION Reinforcement of denture base material with nano-ZrO2 significantly increased flexural strength and modulus of elasticity. Reducing material thickness did not decrease flexural strength when nano-ZrO2 was incorporated. In clinical practice, when low thickness of denture base material is indicated, PMMAano-ZrO2 could be used with minimum acceptable thickness of 1.5 mm.

PURPOSE: This study aimed to evaluate the effect of incorporating zirconium oxide nanoparticles (nano-ZrO 2 ) in polymethylmethacrylate (PMMA) denture base resin on flexural properties at different material thicknesses. MATERIALS AND METHODS: Heat polymerized acrylic resin specimens (N = 120) were fabricated and divided into 4 groups according to denture base thickness (2.5 mm, 2.0 mm, 1.5 mm, 1.0 mm). Each group was subdivided into 3 subgroups (n = 10) according to nano-ZrO2 concentration (0%, 2.5%, and 5%). Flexural strength and elastic modulus were evaluated using a three-point bending test. One-way ANOVA, Tukey’s post hoc, and two-way ANOVA were used for data analysis (α = .05). Scanning electron microscopy (SEM) was used for fracture surface analysis and nanoparticles distributions. RESULTS: Groups with 0% nano-ZrO2 showed no significant difference in the flexural strength as thickness decreased (P = .153). The addition of nano-zirconia significantly increased the flexural strength (P < .001). The highest value was with 5% nano-ZrO2 and 2 mm-thickness (125.4± 18.3 MPa), followed by 5% nano-ZrO2 and 1.5 mm-thickness (110.3 ± 8.5 MPa). Moreover, the effect of various concentration levels on elastic modulus was statistically significant for 2 mm thickness (P = .001), but the combined effect of thickness and concentration on elastic modulus was insignificant (P = .10). CONCLUSION Reinforcement of denture base material with nano-ZrO2 significantly increased flexural strength and modulus of elasticity. Reducing material thickness did not decrease flexural strength when nano-ZrO2 was incorporated. In clinical practice, when low thickness of denture base material is indicated, PMMAano-ZrO2 could be used with minimum acceptable thickness of 1.5 mm.

A panel of stroke experts from the Gulf and Iran region convened a consensus meeting to discuss how the Covid-19 pandemic has affected stroke care in the region. Lower stroke admissions were observed locally, but acute stroke care has largely been maintained in their centres despite the challenges of staff and resource shortages, and public fear of the virus. This article provides a snapshot of the pandemic in the region, its impact on local stroke care, highlights the approaches and practices shared between panellists in order to protect stroke care pathways during this uncertain period, and provides a guideline that is simple and easily adaptable to different locations. The intent is to protect stroke care pathways through Covid-19 risk stratification, infection control measures, and ensuring that all stroke patients have a full Covid-19 diagnostic assessment. Opportunities for increasing the use of telemedicine to reduce physical contact between patients and healthcare workers is also discussed.

BACKGROUND: It is still unclear the ideal vitamin D dosage once the deficiency and insufficiency is treated. Once deficiency was corrected we prospectively treated patients with 2,000 IU of vitamin D3 to check whether this dosage is enough to keep them above the 30 ng/mL of 25-hydroxy-vitamin D (25[OH]D). METHODS: One hundred and thirty-five Saudi Arabian men and women treatment naïve for the vitamin D deficiency and insufficiency were part of this study. History and clinical examination were done to rule out any metabolic bone disease. Weight and height was taken to calculate the body mass index (BMI). Patients who were vitamin D deficient (≥30 ng/mL), a standard treatment of 50,000 IU of vitamin D3 weekly for 3 months, a blood test for the vitamin D levels at the end of 3 months, maintenance dose of 2,000 IU of vitamin D3 for 3 months and a third blood sample after 3 months. RESULTS: The data for 128 patients was available for analysis. The average age was 44.95±12.97 years with the mean BMI of 29.60±2.59 kg/m2. The baseline 25(OH)D level was 13.16±3.30 ng/mL. The increase in the level of 25(OH)D on 50,000 IU weekly was significant from 13.16±3.3 ng/mL to 36.97±4.67 ng/mL (P < 0.001) and then 2,000 IU daily for next 3 months, the level of 25(OH)D dropped top 20.38±5.42 ng/mL (P < 0.001). CONCLUSIONS: Our study indicates that the maintenance dose of 2,000 IU of vitamin D is not enough for patients to keep the 25(OH)D levels above 30 ng/mL.
Body Mass Index ; Bone Diseases, Metabolic ; Calcifediol ; Cholecalciferol ; Dietary Supplements ; Female ; Hematologic Tests ; Humans ; Male ; Prospective Studies ; Vitamin D Deficiency ; Vitamin D* ; Vitamins*

Cryptosporidium species is an important cause of gastrointestinal infections globally. This study aimed to shed light on its role in diarrheic immunocompetent patients in Beni-Suef, Egypt and to compare three diagnostic methods. Two hundred diarrheic patients, 37±16.8 year old, were enrolled. Stool samples were examined by light microscopy, using modified Ziehl-Neelsen stain (MZN) for Cryptosporidium spp. oocysts. Coproantigens were detected by sandwich ELISA. DNA molecular diagnosis was done by nested PCR. PCR yielded the highest detection rates (21.0%), compared to ELISA (12.5%) and MZN staining method (9.5%). The higher infection rates were in 20–40 year-old group, followed by 40–60 year-old. Association between epidemiologic factors was statistically not significant; positivity and gender, clinical manifestations, residence, source or water, or contact with animals. Cryptosporidiosis is an important enteric parasitic infection in Beni-Suef and PCR remains the gold standard for diagnosis.
Animals ; Cryptosporidiosis ; Cryptosporidium ; Diagnosis ; DNA ; Egypt ; Enzyme-Linked Immunosorbent Assay ; Epidemiologic Factors ; Epidemiology ; Humans ; Methods ; Microscopy ; Oocysts ; Polymerase Chain Reaction ; Water

BACKGROUND AND OBJECTIVE: Sickle cell disease (SCD) is quite common in eastern Saudi Arabia and Avascular necrosis of femoral head (ANFH) occurs in 30% of the young patients leading to early joint arthroplasty. This study was conducted to assess the benefits of injection of osteoblasts in the avascular lesions of the head of femur. PATIENTS AND METHODS: A preset technique was used, 10 CC of bone marrow aspiration was performed under local anesthesia and aseptic technique. Osteoblasts were separated from the bone marrow cells. The avascular area was drilled and 10 million osteoblasts were transplanted at the lesion site. Patients were seen in the out patient clinic after two weeks for removal of the suture and addressed the questionnaire and examined for the range of movement. The follow up MRI was performed at 4 months. RESULTS: The average age was 20.2±3.9 years. The mean hemoglobin S was 81.6±4.8 percent. Quality of Life Score for Chronic Hip Disease was assessed and found at 8.6 (1 being the severe limitation and 10 being normal), whereas Harris hip score improved from 41.7±5.1 to 88.93±3.6 (p < 0.001). MRI of pre and post osteoblast implantation showed robust new bone formation and disappearance of the avascular lesions. CONCLUSIONS: The short term results were good and we believe the injection of osteoblast in the avascular lesion of head of femur is a less invasive procedure devoid of any untoward complications and merits such treatment in large patient group with longer follow up.
Anemia, Sickle Cell* ; Anesthesia, Local ; Arthroplasty ; Bone Marrow ; Bone Marrow Cells ; Femur ; Follow-Up Studies ; Head* ; Hemoglobin, Sickle ; Hemoglobins ; Hip ; Humans ; Joints ; Magnetic Resonance Imaging ; Necrosis* ; Osteoblasts ; Osteogenesis ; Quality of Life ; Saudi Arabia ; Stem Cells* ; Sutures

Objective: To evaluate the ameliorating effects of Raphanus sativus leaves (RSL) against sodium arsenite(Sa)-induced adverse effects through mice experiments. Methods: Swiss albino mice were divided into four equal groups: control, Sa, RSL, RSL + Sa. Sa (10 mg/kg body weight/day), and powder form of RSL (50 mg/kg body weight/day) were provided as food supplement orallty. Blood indices were measured using commercially available kits through colorimetric methods. Results: It was observed that lactate dehydrogenase, alkaline phosphatase, alanine aminotransferase,and aspartate aminotransferase activities were significantly(P<0.05) higher in Sa-treated mice than those in the control group.RSL significantly reduced Sa-induced elevation of the activities of these enzymes in serum significantly (P < 0.05). Serum butyrylcholinesterase activity and high density lipoproteins cholesterol levels in Sa-treated mice were significantly (P < 0.05) lower than the control group, and the food supplementation of RSL could significantly(P<0.05)prevent the reduction of Sa-mediated serum butyryl cholinesterase activity and high density lipoproteins cholesterol levels.RSL could also reduce the Sa-induced elevation of serum urea level significantly(P<0.05). Conclusions: Results of this study suggest the protective or ameliorating effects of RSL on Sa-induced perturbation of blood indices are related to the hepatic,cardiovascular and kidney dysfunction.Therefore,RSL may be useful to reduce arsenic toxicity in human in the future.