Modulation of back geometry in children with spastic diplegic cerebral palsy via hippotherapy training

Background and purpose: Controlled hippotherapy environment provides a foundation for improved neurologic function and sensory processing. This foundation can be generalized to a wide range of daily activities, making the horse a valuable therapeutic tool for rehabilitation. The purpose of this study was to examine the effects of a once weekly, twelve-week hippotherapy program on back geometry in children with spastic diplegic cerebral palsy.Subjects: Thirty spastic diplegic children from both sexes, ranging in age from six to eight years represented the sample of this study. The degree of spasticity ranged from 1 to 1+ according to the modified Ashworth scale. They were divided randomly into two groups of equal number A (control) and B (Study).Procedures: Evaluation of back geometry parameters was conducted for each child of the two groups before and after three months of treatment via using Formetric instrument system. Group A received a designed exercise program, while group B received hippotherapy training in addition to the same exercise program given to group A.Results: No significant difference was noticed when comparing the pre-treatment results of the two groups, while significant improvement was observed in all the measuring variables of the two groups when comparing their pre and post-treatment mean values. Significant difference was also observed when comparing the post-treatment results of the two groups in favor of group B.Discussion and conclusion: Hippotherapy utilizes the movement of the horse to provide sensory feedback and may be used as a therapeutic intervention for improving back geometry in children with spastic diplegia.Keywords: Cerebral palsy; Diplegia; Back geometry; Hippotherap

Conservative therapy versus intra-gastric balloon in treatment of Prader-Willi Syndrome morbid obesity

Background and purpose: Prader-Willi Syndrome (PWS) is a complex multisystemic disorder characterized by hyperphagia, severe obesity and muscular hypotonia. So, it is essential to seek an ideal program to help in solving such a widespread problem. The purpose of this study was to investigate the effect of conservative therapy (diet and exercises) versus intra-gastric balloon in PWS patients. Ten children born with PWS from both sexes ranging in age from 8 to 15 years were assigned into two groups of equal number. Study group I received conservative therapy in the form of diet regimen (a low caloric diet) and aerobic exercises on a stationary bicycle while study group II underwent intra-gastric balloon. Evaluation procedures in the form of initial evaluation and measurement of Body mass index (BMI) and lipid profile parameters were conducted for each child of the two groups before and after 6 months of treatment. The results revealed no significant difference when comparing the  pre-treatment mean values of the two study groups (I and II), while significant improvement was observed in all the measuring variables of the two groups when comparing their pre- and post-treatment mean values. Significant difference was also observed when comparing the  post-treatment results of the two groups in favor of the study group I. It concluded that conservative therapy could be the first choice of treatment of PWS morbid obesity, while BioEnterics Intra-gastric balloon (BIB) came in the second choice

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Osteocutaneous thermal necrosis of the leg salvaged by TSF/Ilizarov reconstruction. Report of 7 patients

Injudicious reaming of the tibial shaft can lead to extreme local hyperthermia, which in turn can result in the rare but catastrophic complication of segmental bone and soft tissue necrosis (osteocutaneous thermal necrosis). This is a retrospective study showing osteocutaneous thermal necrosis occurring after tibial intramedullary reaming salvaged by Ilizarov reconstruction in seven patients from the collective experience of four limb reconstruction centres. All patients were males, with an average age of 51.8 years (range, 30–70 years), who had undergone intramedullary reaming during the treatment of closed tibial fractures. In all patients, circumferential bone and variable contiguous soft tissue necrosis developed a few days after reaming. Bone and soft tissue reconstruction was subsequently performed using a circular external fixator (Ilizarov apparatus or Taylor spatial frame) a mean of four months after injury in six patients; in one case, reconstruction was undertaken four years after the original injury. Two complications (secondary tissue breakdown at a bone transport site; premature consolidation) necessitated cessation of bone transport at one of two bone transport levels in two patients. All patients eventually healed with a good functional result after an average of 11.5 months in the fixator (range, 10–13 months)

Perspectives of frontline professionals on Palestinian children living with sibling and parental drug use in the UNRWA camps, Jordan

Context: The occupied Palestinian territories (oPt) consists of the non-contiguous West Bank including East Jerusalem and the Gaza Strip. It is densely populated within these confines, and has a unique socio-economic context characterized by political and economic tensions. Around 2.2 million Palestinians are displaced and living in the ten UNRWA refugee camps in Jordan. Palestinian communities are exposed to a double burden of disease caused by the severe economic, social and health consequences of Israeli occupation and resultant displacement. Exposure to political violence, economic hardship, fragmentation of Palestinian families, unemployment, trauma and community stress underpin a reported rise in drug abuse.. Method: A qualitative study using focus groups (n=3) with a convenience sample of health care and educational professionals was conducted in two UNRWA camps (Al-Zarka, Al-Wehdat) in Jordan. Guided discussions explored the experiences of these professionals in working with Palestinian families and children affected by substance/drug use and drug use disorder in the home. Data were analysed using thematic analysis (TA). Results: Five themes emerged from the TA. These were: 1)Access to drugs was perceived to be relatively easy in the camps; 2) Attitudes towards drugs appear to have desensitised, yet stigma persists; 3) Families of drug users are affected by fear, social and economic poverty, with significant physical and psychological cost to children; 4) Causes of substance/drug use in Palestinian communities living in Jordanian UNRWA camps is multifactorial; 5) Solutions are multi-faceted and indicative of the need for prevention and support for those at risk, and affected. Conclusions: Threats to UNRWA from the current political climate and the reducing investment in services may exacerbate this public health and security issue. For an evidence based approach to have credibility in the camp communities, there is a need for accurate, factual information, along with robust epidemiological data, relating to the extent, characteristics and harms associated with drug use