Lower limb deformities in patients with hypophosphatemic rickets are multi-apical and require multiple osteotomies for correction. Intramedullary nails (IMNs) are used to fix multiple osteotomies. Authors of this studyaimed to assess the clinical and radiographic outcomes of using IMNs for correcting lower limb deformity in adolescents with hypophosphatemic rickets. This prospective study included patients with hypophosphatemic rickets who underwent deformity correction between November 2020 and November 2023 using IMNs, with a minimum follow-up of 2 years. Clinical outcomes were assessed using the Lower Limb Deformity-Scoliosis Research Society (LD-SRS) score. Radiographic outcomes measured included the mechanical tibiofemoral angle (mTFA), mechanical axis deviation (MAD), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and Stevens’ knee joint zoning. Twenty patients (25 limbs and 35 bones) were included (mean age: 16 years; range: 13–22 years). The LD-SRS score improved from 3.2 ± 0.4 preoperatively to 4.3 ± 0.7 postoperatively. Preoperative mechanical tibiofemoral angle was 27.8° ± 12.1° and 17.33° ± 7.9° in the varus and valgus groups, respectively, improving to 3.4° ± 6.4° and 2° ± 5.2°, respectively. Preoperative mechanical axis deviation was 82.2 ± 35.6 mm and 41.8 ± 22.2 mm in the varus and valgus groups, respectively, improving to 9.2 ± 20.1 mm and 4.6 ± 12.6 mm, respectively. Preoperative mechanical lateral distal femoral angle was 102.4° ± 9.7° and 77.9° ± 9.8° in the varus and valgus groups, respectively, improving to 89.9° ± 3.1° and 88.1° ± 3.1°, respectively. Preoperative mechanical medial proximal tibial angle was 78.7° ± 8° and 89.7° ± 3.9° in the varus and valgus groups, respectively, improving to 88.6° ± 3.4° and 88.2° ± 2.9°, respectively. Preoperative Stevens’ knee joint zoning was Zone 3 in all patients, improving to Zone 1 in 16 limbs, Zone 2 in eight limbs, and Zone 3 in one limb. Correction of severe frontal plane lower limb deformities in adolescents with hypophosphatemic rickets using IMNs yields good clinical and radiographic outcomes at 2-year follow-up.
Chronic and postoperative wounds remain challenging to manage, with high risks of infection, delayed healing and increased costs. Manuka honey offers antibacterial, anti-inflammatory, antioxidant and tissue-regenerative properties through methylglyoxal, phenolic compounds, high sugar content and low pH. The main objective is to review the mechanisms, clinical outcomes and applications of Manuka honey in wound care. A narrative review of PubMed, Scopus and Google Scholar identified studies on surgical site management, graft or flap bed preparation, chronic wounds and novel delivery systems, prioritising randomised controlled trials and high-quality observational data. Results have shown that Manuka honey demonstrates broad-spectrum antimicrobial and antibiofilm effects, supports non-traumatic debridement and modulates inflammation to promote granulation and re-epithelialisation. Clinical studies show reduced bacterial load, faster healing and improved comfort in surgical and chronic wounds. Operative uses include pre-grafting bed conditioning, adjunctive treatment for infected wounds and integration with negative pressure wound therapy. Emerging delivery approaches, such as bioengineered honey-collagen dressings and nanofibrous scaffolds, show promise for enhancing postoperative outcomes. To conclude, Manuka honey is a versatile and promising adjunct in modern wound care management. Standardised application protocols and robust, high-quality surgical trials are urgently needed to confirm its effective role in perioperative clinical practice.
Background: Recurrent pregnancy loss (RPL) and infertility are associated with significant psychological morbidity, including stress, anxiety, and depression. While these impacts are well-documented globally, their prevalence and severity in the Omani population remain unexplored. This study investigates the mental health outcomes of Omani women with RPL and infertility compared to fertile controls. Objectives: The objectives of this study are to assess the prevalence of stress, anxiety, and depression in women with recurrent pregnancy loss (RPL) and infertility and compare these rates to women with no fertility concerns in an Omani population. Design: This is a prospective, cross-sectional study. Setting: This study's setting consisted of Sultan Qaboos University Hospital and Royal Hospital in Muscat, Oman. Participants: This study included 111 women with RPL, 131 women with infertility, and 210 antenatal controls with no fertility issues. Interventions: No clinical interventions were administered as this was an observational study. Participants completed validated psychological assessments (DASS-42 and BDI-II). Primary and secondary outcome measures: Primary outcomes were the prevalence rates of stress, anxiety, and depression assessed using DASS-42 and BDI-II. Secondary outcomes included sociodemographic correlates and risk factors Results: This study included 111 women in the RPL group, 131 in the infertility group, and 210 controls. Among RPL patients, 31% reported stress, ranging from mild to extremely severe, while 35.9% of infertility patients reported stress, compared to 17.1% in the control group (p = 0.003). Anxiety was present in 45% of RPL patients, 45.5% of infertility patients, and 28.1% of controls (p = 0.019). Depression, measured by DASS-42, was the most prevalent in the RPL group (34.2%), followed by the infertility group (33.6%) and controls (13.8%) (p < 0.001). Similar results were observed with BDI-II, with depression rates of 23.4% in the RPL group, 19.1% in the infertility group, and 7.6% in controls (p = 0.02). Conclusions: Women with RPL and infertility in Oman experience significantly higher levels of stress, anxiety, and depression compared to women without fertility concerns. This study did not assess the mental health of male partners, highlighting the need for further research on the psychological impact on both partners. Future studies should focus on developing psychological support interventions and evaluating their impact on patient outcomes.
Asthma has been associated with early vascular changes that elevate the risk of atherosclerosis and cardiovascular diseases. Carotid intima-media thickness (CIMT) serves as a non-invasive marker for subclinical atherosclerosis and cardiovascular risk. However, existing literature presents conflicting results regarding CIMT measurements in asthmatic patients. This study aims to evaluate whether CIMT is elevated in asthma patients compared to healthy controls and to explore potential modifiers. We conducted a systematic review following PRISMA guidelines, performing a literature search across PubMed, Web of Science, ScienceDirect, and the WHO VHL. We calculated pooled standardized mean differences (SMD) with 95% confidence intervals (CI) to assess the differences in CIMT values. Heterogeneity was evaluated using the I² statistic, and subgroup analyses and meta-regression were utilized to identify sources of heterogeneity. Our review included a total of 10 studies. The analysis indicated significantly higher CIMT values in asthma patients compared to healthy controls, with a pooled SMD of 0.65 (95% CI: 0.19 to 1.12, p = 0.005). A limited number of studies addressed various factors, such as disease severity and the use of inhaled corticosteroids, which may influence CIMT measurements. Notably, asthmatic patients, particularly children and adolescents, exhibited higher CIMT values compared to healthy controls, suggesting a potential association with subclinical atherosclerosis in this demographic. However, these findings should be interpreted with caution due to the observational nature of the included studies and the risk of residual confounding. Further longitudinal research is necessary to elucidate the effects of disease characteristics and treatment on vascular health.
While heterotopic ossification (HO) around the hip is frequently cited as a late complication leading to stiffness or technical difficulty during reconstructive surgery, its role as a primary mechanical impediment to the reduction of acute intertrochanteric fractures is rarely documented. We present the case of a 45-year-old male with a significant history of polytrauma, traumatic brain injury, and conservatively managed bilateral acetabular fractures. The patient presented with mature peritrochanteric and periacetabular HO and an acute, comminuted right intertrochanteric femur fracture following a low-speed motor vehicle collision. Preoperative imaging confirmed extensive ossification bridging the greater trochanter and lateral acetabulum. Intraoperatively, standard closed reduction on a traction table proved impossible, as the proximal femoral fragment was anchored by a rigid, extra-articular bony block. To achieve reduction, a limited osteotome-assisted release of the obstructing HO bridge was performed without requiring radical excision. This maneuver restored proximal femoral mobility, facilitating successful reduction and internal fixation. The postoperative course was unremarkable; follow-up imaging confirmed fracture union and stable hardware. This case emphasizes that mature periarticular HO can act as a definitive mechanical block to closed reduction. Surgeons should utilize CT-based preoperative planning to identify such obstacles early, allowing for a targeted surgical release when standard reduction maneuvers fail.
