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

Background: Scheuermann’s disease is the most common cause of hyperkyphosis of the thoracic spine during the adolescence period. It causes neck and lower back pain, restriction of lung expansion, traction of the spinal cord, increased vulnerability to vertebral fracture, and a hump. Patients with curves < 60° are treated conservatively, while surgery is used for patients with curves > 60°. The purpose of this prospective cohort study was to assess the quality of life and functional changes in conservatively or surgically treated Scheuermann’s disease patients with a curve size of 50°–65° in north Jordan. Methods: Sixty-three adolescent patients with Scheuermann’s kyphosis (aged between 10 and 18 years) were treated at our hospital between January 2014 and August 2018. All patients were investigated clinically, radiologically (Cobb’s angle), and functionally (Oswestry Disability Index [ODI], Scoliosis Research Society 22 revision [SRS-22r] questionnaire, and pulmonary function test [PFT]) preand post-treatment (final follow-up). Patients were randomly selected for treatment method (conservative versus surgical). Results: There were 31 patients (mean age, 15.48 ± 2.50 years) and 32 patients (mean age, 16.19 ± 1.51 years) treated conservatively and surgically, respectively. Mean ± standard deviation of ODI, SRS-22r, and Cobb’s angle of the surgical group improved from 16.8% ± 14.3%, 3.5 ± 0.5, and 58.75° ± 3.59°, respectively, pre-surgery to 13.4% ± 10.8%, 4.2 ± 0.5, and 41.53° ± 3.94°, respectively, post-surgery, while those of the conservative group became worse from 12.6% ± 13.4%, 3.9 ± 0.7, and 56.1° ± 3.3°, respectively, to 20.1% ± 13.6%, 3.5 ± 0.7, and 58.8° ± 5.8°, respectively. The surgical group showed better improvement in all scores than the conservative group (p < 0.05), as well as in PFT. Conclusions Surgical treatment of Scheuermann’s kyphosis with curves of 50°–65° resulted in better QOL, Cobb’s angle, and PFT than conservative treatment. This was because of lower patient cooperation in the conservative management group, which made the curve less flexible for exercises and bracing.

A 35-year-old female presented with episodes of frequent dizziness, ear fullness, and right ear tinnitus for 12 months. Head imaging revealed a right glomus tympanicum tumor. She underwent pre-operative endovascular embolization of the glomus tympanicum tumor with surgical, cyanoacrylate-based glue. Immediately after the procedure, she developed drowsiness and severe pain in the right temporal region. Further investigations revealed a right cerebellar stroke in the posterior inferior cerebellar artery territory. She was treated with intravenous heparin, followed by one year of oral anticoagulation. With rehabilitation, she significantly recovered from her post embolization stroke. However, the tumor was resected at another institution. Ten years later, follow-up imaging indicated a gradual increase in the size of the glomus jugulare tumor compressing the nearby critical vascular structures. She subsequently received radiation therapy to treat the residual tumor. Currently, she has no neurological deficit, but her mild dizziness, right ear tinnitus, and hearing impairment persist.

COVID-19 has caused extensive human casualties with significant economic impacts around the globe, and has imposed new challenges on health systems worldwide. Over the past decade, SARS, Ebola, and Zika also led to significant concerns among the scientific community. Interestingly, the SARS and Zika epidemics ended before vaccine development; however, the scholarly community and the pharmaceutical companies responded very quickly at that time. Similarly, when the genetic sequence of SARSCoV-2 was revealed, global vaccine companies and scientists have stepped forward to develop a vaccine, triggering a race toward vaccine development that the whole world is relying on. Similarly, an effective and safe vaccine could play a pivotal role in eradicating COVID-19. However, few important questions regarding SARS-CoV-2 vaccine development are explored in this review.

Stress is accepted as the accumulation of unpleasant state of physical, mental and emotion on a person. Medical education has been known as one of the most stressful academic curriculum. Hence, medical students may subjected to multiple psychological changes and challenges throughout the years of medical education. The aim of this study was to determine the prevalence of stress and its associated factors among medical students. This cross sectional study was conducted from April to May 2018 in medical school in Sabah. It involved 396 medical students through universal sampling. Self-administered questionnaires were used as an instrument for data collection. The questionnaires included were Sociodemographic Questionnaire, Depression, Anxiety and Stress Scales 21 (DASS-21) and Medical Student Stressors Questionnaire (MSSQ). Bivariate analysis (Chi Square test, Fisher’s Exact Test, Independent T test and Man-Whitney U test) were used to analyse the association. The response rate was 90.2%. The prevalence of stress among medical students were 33.3%. Significant associated factors include financial support inadequacy (p=0.010) and all categories of medical student stressors. The mean score of the academic related stressors was found to be at 2.117 (±0.758) which was the highest mean score among medical student stressors assessed by MSSQ. The result of this study can be used as a basis for implementation of preventive measures such as provision of comprehensive, integrated and responsive mental health care services in university-based settings.
Stress, stressor, medical students, medical education, mental health, DASS, MSSQ

Nurses’ job performance is defined as the effectiveness of a person in carrying out his or her duties related to patient care. Aim of this study is to measure job performance among nurses in a tertiary hospital and its associated factors. A cross-sectional study was conducted among nurses selected from four departments, which were Obstetrics & Gynecology (O&G), medical, surgical and Cardiac Care Unit (CCU)/High Dependency Unit (HDU). A Malay validated Six-Dimension Scale of Nursing Performance (6-DSNP) questionnaire was used to measure job performance. Nurses who have one child more compared to other nurses had significantly lower total mean score of job performance by -0.06 (95% CI 0.11, 0.01). Nurses working in medical department [adj.β=0.16 (95% CI 0.01, 0.30)] and CCU/HDU [adj.β= 0.33(95% CI: 0.17, 0.50)] had significantly higher total mean scores of jobs performance compared to O&G department. Effective strategies and re-examining work conditions are imperative for better job performance.
job performance ; associated factors ; nurses ; tertiary hospital

Introduction Tuberculosis (TB) a major global health challenge especially in low- and middle-income countries reflects improper, delayed or missed diagnosis. Contact screening should be utilized both as an efficient and effective targeted approach to intensify TB case finding.Methods Through a comprehensive systematic literature review of online database, this paper aims at providing an insight into the current practice of TB contact screening and to provide evidence based practice for formulation of appropriate policies in low- and middle-income countries. There are 24 articles included in this review from studies published from 2005 to 2014.Results Findings in literature varies substantially. Generally, contact screening is better intensified with clear operational guidelines, adequate training, include close contact outside household as appropriate and follow up at least for 1 year. Prioritizing high risk close contacts is helpful in resource limited setting. Tuberculin skin test is still of value as screening tool and intensified case finding must be accompanied with effective management protocol. Prophylaxis treatment is recommended especially for children especially less than 5 years old, unvaccinated, malnourished, living with person having HIV and close contact with MDR-TB.Conclusion Policy recommendations in improving TB management must incorporate complementary strategies to enhance case finding, effective management protocol for follow up or prophylaxis treatment, training for public health capacity and concerted dedication from various stakeholders.

Objective:To determine the total polyphenol content,antioxidant activity and antibacterial properties of the extracts of different Bangladeshi tea varieties such as flowery broken orange pekoe,broken orange pekoe,red dust and green tea.Methods:Total phenolic and flavonoid contents were determined by Folin-Ciocalteu and aluminum chloride colorimetric assay,respectively.The antioxidant capacity was determined by ferric ion reducing antioxidant power and phosphomolybdenum method.Antibacterial activity was evaluated by disc diffusion method in agar plate and subsequently,the minimum inhibitory concentration was determined by broth dilution method.Results:Total phenolic and flavonoid contents were significantly higher (P ＜ 0.05) in green tea compared to other three black tea varieties.The green tea also showed a higher free radical scavenging amd antioxidant activities than all the other tea varieties tested (P ＜ 0.05).In addition,the extracts of all four tea varieties showed inhibitory activity against several pathogenic bacteria and also the same trend of higher antimicrobial activity of green tea than other tea varieties was observed.Contusions:Taken together,the results of this study demonstrated that Bangladeshi tea,especially the green tea,may act as a substitute for natural antioxidants and as a promising antibacterial agent for bcncficial influence in human health.

Objective To determine the total polyphenol content, antioxidant activity and antibacterial properties of the extracts of different Bangladeshi tea varieties such as flowery broken orange pekoe, broken orange pekoe, red dust and green tea. Methods Total phenolic and flavonoid contents were determined by Folin–Ciocalteu and aluminum chloride colorimetric assay, respectively. The antioxidant capacity was determined by ferric ion reducing antioxidant power and phosphomolybdenum method. Antibacterial activity was evaluated by disc diffusion method in agar plate and subsequently, the minimum inhibitory concentration was determined by broth dilution method. Results Total phenolic and flavonoid contents were significantly higher (P < 0.05) in green tea compared to other three black tea varieties. The green tea also showed a higher free radical scavenging and antioxidant activities than all the other tea varieties tested (P < 0.05). In addition, the extracts of all four tea varieties showed inhibitory activity against several pathogenic bacteria and also the same trend of higher antimicrobial activity of green tea than other tea varieties was observed. Conclusions Taken together, the results of this study demonstrated that Bangladeshi tea, especially the green tea, may act as a substitute for natural antioxidants and as a promising antibacterial agent for beneficial influence in human health.

PURPOSE: No study had been conducted to assess the hospitals' environment for learning purposes in multicenter sites in Saudi Arabia. It aims to evaluate the environment of hospitals for learning purposes of pediatric residents. METHODS: We applied Postgraduate Hospital Educational Environment Measure (PHEEM) to measure the learning environment at six teaching hospitals in the Eastern Region of Saudi Arabia from September to December 2013. RESULTS: The number of respondents was 104 (86.7%) out of 120 residents and 37 females and 67 male residents have responded. The residents' response scored 100 out of 160 maximum score in rating of PHEEM that showed overall learning environment is favorable for training. There were some items in the social support domain suggesting improvements. There was no significant difference between male and female residents. There was a difference among the participant teaching hospitals (p<0.05). CONCLUSION: The result pointed an overall positive rating. Individual item scores suggested that their social life during residency could be uninspiring. They have the low satisfactory level and they feel racism, and sexual discrimination. Therefore, there is still a room for improvement.
Surveys and Questionnaires ; Discrimination (Psychology) ; Female ; Hospitals, Teaching ; Humans ; Internship and Residency* ; Learning ; Male ; Pediatrics ; Racism ; Saudi Arabia*