Publications by authors named "Ahmed Khalifa"

58 Publications

Anthropometric measurements of non-arthritic knees in an Egyptian population: an MRI-based study.

J Orthop Surg Res 2021 Sep 8;16(1):552. Epub 2021 Sep 8.

Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt.

Background: Knee anthropometric characteristics were evaluated for different ethnicities; however, data from North African populations are deficient. The primary aim was to investigate the Egyptian knees' anthropometric characteristics as a representative of North African populations. Secondary aims are as follows: (1) to study the anthropometric gender difference, (2) to compare results with other ethnic groups, and (3) to study the mismatch in comparison to geometric characteristics of modern TKA implant designs.

Methods: Two hundred normal knee MRI scans (100 females and 100 males, aging from 18 to 60) were obtained for analysis. Linear measurements (anteroposterior (AP), mediolateral (ML), and aspect ratio (AR)) of the planned cut surface of the distal femur (f) and the proximal tibia (t) were evaluated.

Results: A significant difference between both sexes was found, males had larger measurements in anteroposterior [fAP: 60.97 ± 3.1 vs 54.78 ± 3.3 (P < 0.001), tAP: 46.89 ± 3.0 vs 41.35 ± 2.9 (P < 0.001)] and mediolateral [fML: 74.89 ± 3.2 vs 67.29 ± 3.7 (P < 0.001), tML: 76.01 ± 3.0 vs 67.26 ± 3.2 (P < 0.001)], the mean femoral and tibial AP and ML measurements were different from other ethnic groups. None of the seven studied TKA systems matched the largest ML or the smallest AP dimensions of the distal femur in the current study population.

Conclusion: A significant difference was found between males' and females' knee anthropometric characteristics. Some of the commonly used TKA implants in our area could not provide a perfect fit and coverage.

Trial Registration: ClinicalTrials.gov identifier: NCT03622034 , registered on July 28, 2018.
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http://dx.doi.org/10.1186/s13018-021-02708-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8425145PMC
September 2021

Safety and efficacy of surgical hip dislocation in managing femoral head fractures: A systematic review and meta-analysis.

World J Orthop 2021 Aug 18;12(8):604-619. Epub 2021 Aug 18.

Department of Orthopaedic, Assiut University Hospital, Assiut 71515, Egypt.

Background: Femoral head fractures (FHFs) are considered relatively uncommon injuries; however, open reduction and internal fixation is preferred for most displaced fractures. Several surgical approaches had been utilized with controversial results; surgical hip dislocation (SHD) is among these approaches, with the reputation of being demanding and leading to higher complication rates.

Aim: To determine the efficacy and safety of SHD in managing FHFs by reviewing the results reported in the literature.

Methods: Major databases including PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched to identify studies reporting on outcomes of SHD utilized as an approach in treating FHFs. We extracted basic studies data, surgery-related data, functional outcomes, radiological outcomes, and postoperative complications. We calculated the mean differences for continuous data with 95% confidence intervals for each outcome and the odds ratio with 95% confidence intervals for binary outcomes. < 0.05 was considered significant.

Results: Our search retrieved nine studies meeting our inclusion criteria, with a total of 129 FHFs. The results of our analysis revealed that the average operation time was 123.74 min, while the average blood loss was 491.89 mL. After an average follow-up of 38.4 mo, a satisfactory clinical outcome was achieved in 85% of patients, with 74% obtained anatomical fracture reduction. Overall complication rate ranged from 30% to 86%, with avascular necrosis, heterotopic ossification, and osteoarthritis being the most common complications occurring at an incidence of 12%, 25%, and 16%, respectively. Trochanteric flip osteotomy nonunion and trochanteric bursitis as a unique complication of SHD occurred at an incidence of 3.4% and 3.8%, respectively.

Conclusion: The integration of SHD approach for dealing with FHFs offered acceptable functional and radiological outcomes with a wide range of safety in regards to the hip joint vascularity and the development of avascular necrosis, the formation of heterotopic ossification, and the development of posttraumatic osteoarthritis; however, it still carries its unique risk of trochanteric flip osteotomy nonunion and persistent lateral thigh pain.
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http://dx.doi.org/10.5312/wjo.v12.i8.604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8384609PMC
August 2021

Effect of the COVID-19 Pandemic on the Management of Acute Cholecystitis and Assessment of the Crisis Approach: A Multicenter Experience in Egypt.

Asian J Endosc Surg 2021 Sep 1. Epub 2021 Sep 1.

Cairo University Teaching Hospital, Cairo, Egypt.

Introduction: The covid-19 pandemic has had a drastic impact on all medical services. Acute cholecystitis is a serious condition that accounts for a considerable percentage of general surgical acute admissions. Therefore, the Royal College of Surgeons' Commissioning guidance' recommended urgent admission to secondary care and early cholecystectomy. During the first wave of hospital admissions associated with COVID-19, most guidelines recommended conservative treatment in order to limit the admission rates and free up spaces for COVID-19-infected patients. However, reviews of this approach have not been widely done to assess the results and, in turn, planning our future management approach when future pressures on in-patient admissions are inevitable.

Methods: Our study included all acute cholecystitis patients who needed surgical intervention in one Centre in the UK over three distinct periods (pre-COVID-19, during the first lockdown, and lockdown ease). Comparison between these groups were done regarding intraoperative and postoperative results.

Results: The conservative management led to a high rate of readmission. Moreover, delayed cholecystectomy was associated with increased operative difficulties such as extensive adhesions, intraoperative blood loss, and/or complicated gall bladder pathologies such as perforated or gangrenous gall bladder (29.9%, 16.7%, and 24.8%, respectively). The resulting postoperative complications of surgical and nonsurgical resulted in a longer hospital stay (13.5 d).

Conclusion: The crisis approach for acute cholecystitis management failed to deliver the hoped outcome. Instead, it backfired and did the exact opposite, leading to longer hospital stays and extra burden to the patient and the healthcare system.
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http://dx.doi.org/10.1111/ases.12980DOI Listing
September 2021

Treatment of genu valgum by a novel percutaneous transverse metaphyseal osteotomy of the distal femur in children and adolescents.

Eur J Orthop Surg Traumatol 2021 Aug 14. Epub 2021 Aug 14.

Klinik Für Unfallchirurgie, Medizinische Hochschule, Hannover, Germany.

Purpose: To evaluate the outcomes of a novel percutaneous medial supracondylar femoral osteotomy and above-knee cast technique in children and adolescents as a minimally invasive surgical intervention for treatment of genu valgum.

Methods: In this prospective study, 60 patients (70 knees) with a tibiofemoral angle more than 15° were treated with a novel medial percutaneous supracondylar femoral osteotomy and above-knee cast and followed up for an average of 29 months. The radiological outcome was measured with MAD, TFA, and mLDFA. The functional outcome was evaluated by a modified Böstman score.

Results: The preoperative mean MAD, TFA, and mLDFA were 2.9 cm, 16.3°, and 79.2° respectively. The Böstman score averaged preoperatively 23.1. There was a significant improvement of all radiological and clinical outcome measures (P < 0.001). Per Böstman score, 2 knees in one patient (3%) showed an unsatisfactory result, while 14 (20%) and 54 (77%) knees had a good or excellent result, respectively. Two patients (three limbs) needed early re-casting. Other complications were not encountered.

Conclusion: In experienced hands, percutaneous transverse metaphyseal femoral osteotomy and above-knee casting appear to be a safe, supracondylar cost-effective, and reliable minimally invasive acute correction technique in genu valgum in children and adolescents.

Level Of Evidence: Level IV-therapeutic.
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http://dx.doi.org/10.1007/s00590-021-03093-yDOI Listing
August 2021

A Protocol to Systematic Radiographic Assessment of Primary Total Knee Arthroplasty.

Orthop Res Rev 2021 17;13:95-106. Epub 2021 Jul 17.

Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt.

Although total knee arthroplasty (TKA) is considered one of the most successful procedures, however, a subset of patients are unsatisfied with the results, even with the introduction of new technologies and implant designs. Radiological assessment of TKA is still considered the most prevalent imaging modality for evaluating the knee joint pre-and postoperatively. Assessment of various angles and indices which could be measured in different radiographic views of the knee provides valuable information about the alignment of the entire limb and the individual prosthetic components, more so in the light of recent nuanced concepts of technique, alignment, and balance. This review article aims to present a comprehensive yet systematic approach to the most useful radiographic parameters for assessing the knee preoperatively and post-TKA by explaining the tools and techniques used for measuring various angles, indices and ratios in the coronal, sagittal and axial planes for diagnosis, preoperative planning, postoperative assessment, and routine follow-up. The protocol we followed in this review entailed first reporting the possible applications and software which could help in measuring these variables, then we mentioned the required series of knee radiographs. For the desired variables, we divided the assessment according to each plane, and in each, we reported the optimum position of the desired radiographic view followed by determining the axis and lines which will later form the desired angles to be measured; finally, we collected all the measurements in a table with the native knee values and the most accepted values after TKA.
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http://dx.doi.org/10.2147/ORR.S320372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8294812PMC
July 2021

Comparison with Navigation of a Novel Three-Step Technique for Improving Accuracy of the Distal Femoral Resection during Conventional TKA: A Case-Control Study.

J Knee Surg 2021 Jul 8. Epub 2021 Jul 8.

National Institute of Health and Family Welfare, Baba Gang Nath Marg, Munirka, New Delhi, India.

Correct placement of the femoral component in the coronal plane during primary total knee arthroplasty (TKA) is related to long-term survival. The aim of this radiographic study was to determine the accuracy of a novel three-step technique for improving the accuracy of the distal femoral cut during conventional technique and compare it with computer navigation during TKA. A total of 458 TKAs were retrospectively analyzed (178 conventional TKAs with the novel technique and 280 navigated TKAs) for postoperative femoral component coronal alignment and compared between the two groups. Mean femoral component coronal alignment was not significantly different ( = 0.314) between the two groups. There was no significant difference in the mean femoral component coronal alignment between varus and valgus knees. The number of outliers (90 ± 3 degrees) for femoral component coronal alignment was not significantly different between the two groups when assessed separately for varus and valgus deformities. The mean value of femoral component alignment using the conventional technique in knees with varus deformity <10 degrees was 88.8 degrees, in knees with varus deformity 10 to 20 degrees was 89.4 degrees, and in those with varus deformity >20 degrees was 90.2 degrees. Femoral component alignment in knees with varus <10 degrees was significantly different from those >20 degrees ( = 0.006); there was no significant difference between knees with varus <10 degrees and those with 10 to 20 degrees varus ( = 0.251), nor between 10 and 20 degrees varus knees and those with varus >20 degrees ( = 0.116). Using the novel three-step technique during conventional TKA to perform the distal femoral cut can help achieve femoral component coronal alignment comparable to the navigation technique.
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http://dx.doi.org/10.1055/s-0041-1731458DOI Listing
July 2021

Profiling Inflammatory Cytokines in a Cohort Study of Egyptian Patients with COVID-19 Infection.

Clin Lab 2021 Jun;67(6)

Background: Coronavirus disease 2019 (COVID-19) pandemic is an international public health emergency with major disruptions and devastating health consequences resulting from the associated cytokine storm syndrome. The aim of our research was to assess the inflammatory biomarkers and risk factors associated with severity of (COVID-19) patients.

Methods: A cross-sectional study was conducted and included 150 Egyptian patients with COVID-19. Patients were classified into mild, moderate, and severe according to the clinical and CT chest findings. Blood samples were collected from patients for laboratory assessment of inflammatory biomarkers.

Results: Our results showed significant negative correlation between oxygen saturation percent and serum levels of inflammatory markers. The correlations were statistically significant with IL-6, CRP, ferritin, LDH, and D-dimer which can be used as sensitive biomarkers for assessment of the risk of severity of infection in COVID 19 patients.

Conclusions: The study revealed that the risk factors associated with severity of COVID 19 infection included older age, male gender, presence of underlying chronic disease, and increased levels of inflammatory biomarkers: CRP, LDH, ferritin, IL-6, and D-dimer.
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http://dx.doi.org/10.7754/Clin.Lab.2021.210420DOI Listing
June 2021

Two-Year Outcomes After Total Ankle Replacement With a Novel Fixed-Bearing Implant.

Foot Ankle Int 2021 Aug 22;42(8):1002-1010. Epub 2021 May 22.

Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada.

Background: The Integra Cadence total ankle replacement (TAR) is a fourth-generation anatomic, fixed-bearing implant requiring minimal tibial and talar resection, which has been in clinical use since June 2016. The primary purpose of this study is to assess its short-term clinical and radiographic outcomes after TAR using this prosthesis.

Methods: This is a prospective case series of consecutive patients that underwent TAR using this novel fourth-generation prosthesis between June 2016 and November 2017. The primary outcome of interest was the Ankle Osteoarthritis Scale (AOS). Secondary outcomes included Short Form Health Survey-36 (SF-36) scores, radiographic alignment, complications, reoperations, and revisions.

Results: In total, 69 patients were included in our study. Fifty-one patients (73.9%) required a total of 91 ancillary procedures. Postoperatively, AOS pain scores decreased significantly by an average of 17.8±30.1 points from 45.9±18.2 to 28.4±27.3 ( < .001). AOS disability scores also decreased significantly following surgery by an average of 22.0±30.5 points from 53.9±18.5 to 32.5±27.9 ( < .001). The SF-36 physical component summary score improved 10.4±9.8 points from 33.1±9.1 to 42.6±9.1 ( < .001). Radiographic analysis demonstrated significant improvement to neutral coronal plane alignment, which was achieved in 97% of patients ( < .01) with no cyst formation at 2 years. There was 1 reported complication, 9 reoperations, and no metal or polyethylene component revisions. Overall, the 2-year implant survivorship was 100% in our cohort. Eighteen patients (26.1%) demonstrated fibrous ingrowth of the tibial component. However, outcome scores for these patients did not demonstrate any negative effects.

Conclusion: In our hands, this TAR system demonstrated excellent early clinical and radiographic outcomes. Patients reported improved physical health status, pain, and disability in the postoperative period. Total ankle instrumentation allowed for accurate and reproducible implantation with correction of coronal and sagittal plane deformities. Early results for the clinical use of this TAR system are promising, but further long-term prospective outcome studies are necessary.

Level Of Evidence: Level IV, case series.
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http://dx.doi.org/10.1177/10711007211005781DOI Listing
August 2021

Medial displacement calcaneal osteotomy versus lateral column lengthening to treat stage II tibialis posterior tendon dysfunction, a prospective randomized controlled study.

Foot (Edinb) 2021 Jun 7;47:101798. Epub 2021 Apr 7.

Orthopedic Department, Assiut University Hospital, Assiut, Egypt. Electronic address:

Purpose: Adult-acquired flatfoot deformity (AAFD) requires optimum planning that often requires several procedures for deformity correction. The objective of this study was to detect the difference between MDCO versus LCL in the management of AAFD with stage II tibialis posterior tendon dysfunction regarding functional, radiographic outcomes, efficacy in correction maintenance, and the incidence of complications.

Patient And Methods: 42 Patients (21 males and 21 females) with a mean age of 49.6 years (range 43-55), 22 patients had MDCO while 20 had LCL. Strayer procedure, spring ligament plication, and FDL transfer were done in all patients. Pre- and Postoperative (at 3 and 12 months) clinical assessment was done using AOFAS and FFI questionnaire. Six radiographic parameters were analyzed, Talo-navicular coverage and Talo-calcaneal angle in the AP view, Talo- first metatarsus angle, Talo-calcaneal angle and calcaneal inclination angle in lateral view and tibio-calcaneal angle in the axial view, complications were reported.

Results: At 12 months, significant improvement in AOFAS and FFI scores from preoperative values with no significant difference between both groups. Postoperative significant improvements in all radiographic measurements in both groups were maintained at 12 months. However, the calcaneal pitch angle and the TNCA were better in the LCL at 12 months than MDCO, 17̊±2.8 versus 13.95̊±2.2 (p=0.001) and 13.70̊±2.2 versus 19.05̊±3.2 (p<0.001) respectively. 11 patients (26.2%) had metal removal, seven (16.6%) in the MDCO, and four (9.6%) in the LCL. Three (7.1%) in the LCL group had subtalar arthritis, only one required subtalar fusion.

Conclusion: LCL produced a greater change in the realignment of AAFD, maintained more of their initial correction, and were associated with a lower incidence of additional surgery than MDCO, however, a higher incidence of degenerative change in the hindfoot was observed with LCL.
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http://dx.doi.org/10.1016/j.foot.2021.101798DOI Listing
June 2021

Evaluating distal femoral torsion and posterior condylar line reliability for adjusting femoral component rotation in TKA, Egyptian population radiographic study.

J Clin Orthop Trauma 2021 Feb 5;13:99-105. Epub 2020 Dec 5.

Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt.

Background: Femoral component rotational alignment is critical for successful TKA. The primary study objective is to measure the preoperative distal femoral torsion (DFT) of an Egyptian patient's cohort using a seated posteroanterior (PA) knee radiograph. The secondary objectives are to check the intraoperative reliability of using the posterior condylar line (PCL) as a reference for rotation and to measure postoperative component rotation using the same radiographic technique.

Methods: 100 arthritic knees, 22 males, 78 females, 95 Varus and five valgus. A long anteroposterior radiograph [Hip to knee to ankle (HKA)] for coronal alignment assessment, and the anatomical posterior condylar angle (aPCA) between the anatomical transepicondylar axis (aTEA) and the PCL was measured in the seated PA knee radiographs for evaluating the DFT and component rotation. Intraoperative rotation was adjusted to 3° external rotation to the PCL.

Results: HKA improved from a preoperative mean 170.4° ± 6.2 to a postoperative mean 178.3° ± 1.5 (p < 0.005). DFT was internal in all knees; the mean aPCA was -4.5 ± 2.4 (0° to -9°), femoral component rotation significantly changed to a mean aPCA of -3.6 ± 2.3 (0° to -7°) (p = 0.005). Acceptable intraoperative patellar tracking in 94%, and patellar subluxation needed a lateral retinacular release in 2% (two valgus knees). The preoperative DFT was not affected by sex or direction of coronal deformity; more external DFT noticed in severe varus deformity.

Conclusions: All keens had an internal DFT not affected by sex, or coronal deformity direction. Using PCL as a guide to adjust femoral component rotation is a valid technique in our population.
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http://dx.doi.org/10.1016/j.jcot.2020.12.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920017PMC
February 2021

Comparing the gender diversity and affiliation trends of the authors for two orthopaedics journals from the Arab world.

J Taibah Univ Med Sci 2021 Feb 11;16(1):1-8. Epub 2021 Jan 11.

Khasab Hospital, Khasab, Musandam, Oman.

Objectives: Authorship trends, female authors' contributions, and the collaboration among institutions have been a concern in the medical field. This study primarily aims to report and compare the number of authors per article and the prevalence of female authors by comparing two orthopaedics journals from the Arab world. The secondary objective of this study is to evaluate the characteristics of the authors' affiliations and the pattern in institutions' collaborations and contributions to the published articles.

Methods: This cross-sectional study reviewed all articles (until July 2020) published in the Archives of the Egyptian Orthopaedic Journal (EOJ) (the official journal of the Egyptian Orthopaedic Association) and the Journal of Musculoskeletal Surgery and Research (JMSR) (the official journal of the Saudi Orthopaedic Association).

Results: We evaluated 383 and 122 articles from the EOJ and JMSR, respectively. The average number of authors per article was significantly higher for JMSR (4.3 ± 1.7) than EOJ (2.0 ± 1.0);  = 0.000. There was a significantly larger number of contributions by female authors in JMSR (75, 14.2%) than EOJ (2, 0.3%);  = 0.000. The average number of institutions per article was significantly larger for JMSR (2.1 ± 1.2) than EOJ (1.1 ± 0.3);  = 0.000. For the JMSR, the incidence of national institutions' cooperation (27.9%) and international institutions' contributions (53.3%) were significantly higher than their counterparts for the EOJ-6% and 4.7%, respectively;  = 0.000.

Conclusion: The JMSR showed superiority regarding the number of authors per article and the prevalence of female authors. The incidence of national institutions' cooperation and international contributions were higher in the JMSR compared with the EOJ.
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http://dx.doi.org/10.1016/j.jtumed.2020.12.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7858029PMC
February 2021

Letter to the editor: Modified Stoppa as an alternative surgical approach for fixation of anterior fracture acetabulum: a randomized control clinical trial.

Authors:
Ahmed A Khalifa

J Orthop Surg Res 2021 01 29;16(1):96. Epub 2021 Jan 29.

Orthopaedic and Traumatolgy Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt.

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http://dx.doi.org/10.1186/s13018-021-02231-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847153PMC
January 2021

Prediction of leg length change (LLC) after correcting varus and flexion deformity in patients undergoing TKA.

Eur J Orthop Surg Traumatol 2021 Aug 9;31(6):1199-1205. Epub 2021 Jan 9.

Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt.

Purpose: Patients with varus and fixed flexion deformity (FFD) undergoing TKA may have a significant leg length change (LLC) after surgery. We aimed to determine the correlation between changes in HKA or FFD and leg length in patients undergoing TKA, the combined effect of coronal and sagittal plane deformity correction on LLC, and the possibility of estimating LLC mathematically.

Materials And Methods: This was a prospective radiographic evaluation of 242 knees, which had undergone primary unilateral TKA for advanced OA with varus and FFD. Full-length standing calibrated anteroposterior radiographs were used to measure the hip-knee-ankle axis (HKA) and functional leg length after adjusting for magnification. Clinical evaluation of FFD was done using a handheld goniometer.

Results: 224 knees (92.6%) showed increased limb length after TKA averaging 10.7 mm (SD 9.5 mm, P = .000). There was a significant correlation between the change in HKA and FFD from preoperatively to postoperatively with the amount of LLC (ρ 0.326 and 0.346, respectively, P = .000). FFD improvement from preoperatively to postoperatively was 8.1° to 1° (P = .000), respectively. A linear relationship was established between LLC and changes in HKA and FFD, where 10° improvement in HKA would result in an LLC of nearly 4 mm, and 10° improvement in FFD would result in a LLC of nearly 8 mm.

Conclusion: LLC may be substantial after correcting varus and FFD with unilateral TKA, it correlates with the change in HKA and FFD and can be mathematically estimated. CLINICAL TRIALS .

Gov Identifier: NCT03502382.
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http://dx.doi.org/10.1007/s00590-020-02853-6DOI Listing
August 2021

Technical Note on Using Intraoperative Smartphone Applications to Adjust Cup Inclination Angle during Total Hip Arthroplasty (THA).

Arch Bone Jt Surg 2020 Nov;8(6):734-738

Orthopaedic epartment, Assiut niversity ospital, Assiut, Egypt.

Acetabular cup optimum position is paramount for total hip arthroplasty (THA) good outcomes. Although controversial, Lewinnek proposed safe zone for cup placement still the most widely accepted target. Cup placement can be improved using specific anatomical landmarks, computer navigation system and handheld navigation devices. As using a smartphone on daily bases became popular among orthopedic surgeons, in this technical note, we describe how to use smartphone specific applications intraoperatively during total hip arthroplasty to adjust cup inclination angle, which we believe to be easy, cheap and beneficial for young less experienced surgeons.
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http://dx.doi.org/10.22038/abjs.2020.44466.2217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7718568PMC
November 2020

Corrigendum to "Biomechanical aspects of reinforced implant overdentures: A systematic review" [J. Mech. Behav. Biomed. Mater. 91 (2019) 202-211].

J Mech Behav Biomed Mater 2021 Feb 16;114:104199. Epub 2020 Nov 16.

Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku, Turku, Finland; Welfare Division, City of Turku, Turku, Finland.

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http://dx.doi.org/10.1016/j.jmbbm.2020.104199DOI Listing
February 2021

Microsporidia infection in patients with autoimmune diseases.

Indian J Med Microbiol 2020 Jul-Dec;38(3 & 4):409-414

Department of Medical Parasitology, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.

Purpose: Microsporidium is a spore-forming intracellular parasite that affects a wide range of hosts including humans. The tumor necrosis factor alpha (TNF-α) plays a key role in the immunity to infection with microsporidia. Recently, the TNF-α antagonists have proven successful in treating variable autoimmune diseases. In the current study, we aimed to investigate the impact of using TNF-α antagonists as a therapeutic regimen in the prevalence of infections with microsporidia.

Materials And Methods: Diarrheal patients with distinct autoimmune diseases (n = 100) were assigned to the study. Patients taking anti-TNF-α medications (n = 60) were allocated to Group 1A and those undergoing non-TNF-α inhibitor treatment (n = 40) to Group 1B. Furthermore, patients with diarrhea without autoimmune disorders (n = 20) were allocated as controls. Stool specimens, 3 per patient, were collected and microscopically examined for microsporidia spores. A microsporidia-specific stool polymerase chain reaction was used to confirm the microscopic findings.

Results: Microsporidia infection was identified in 28.3% (17/60), 10% (4/40), and in 5% (1/20) of patients in Group 1A, Group 1B, and in the control group, respectively. Overall, infection was significantly high in cases compared to the controls and in patients receiving TNF-α antagonists compared to patients not given TNF-α inhibitors (P < 0.05). Finally, infection was significantly higher in cases treated with TNF-α antagonists for ≥2 months compared to cases treated for <2 months of duration (P < 0.05).

Conclusion: There was a significant increase in microsporidia infection in autoimmune disease patients undergoing treatment with TNF-α antagonists, and the duration of treatment is one of the risk factors. The study highlights the importance of microsporidia testing in immunocompromised patients, particularly those undergoing treatment with anti-TNF-α drugs and emphasises the need for awareness among clinicians regarding this opportunistic parasite.
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http://dx.doi.org/10.4103/ijmm.IJMM_20_325DOI Listing
November 2020

The Outcome of Posterior-Stabilized, Rotating Platform Total Knee Arthroplasty at a Minimum Ten-Year Follow-up, a Middle East Institution Experience.

J Knee Surg 2020 Oct 30. Epub 2020 Oct 30.

Department of Orthopaedics, Assiut University Hospital, Assiut, Egypt.

Posterior-stabilized, rotating platform knee prosthesis design was aimed to decrease polyethylene wear for the sake of improving implant survivorship. The purpose of the present prospective study was to evaluate the long-term clinical and radiographic results as well as the survival rate after using a rotating platform, posterior-stabilized knee prosthesis at a minimum of 10 years at a Middle East institution. We compared the results with reports in the literature on western populations. From January 2002 to June 2008, 96 patients (106 knees) underwent total knee arthroplasty (TKA) using a cemented rotating platform posterior-stabilized knee prosthesis. At a mean of 11.5 ± 1.3 years, 85 patients (95 TKAs) were available for clinical, radiographic, and implant survival analysis. At the final follow-up, 78.9% of the patients had excellent Knee Society Scoring system score, the average knee flexion was 110 ± 17 degrees, the average anatomical knee coronal alignment was 186 ± 2 degrees and 187 ± 3 degrees for varus and valgus knees, respectively. Five (5.2%) knees were revised of these: two for bearing dislocation, two for aseptic loosening, and one for infection. The Kaplan-Meier survival rate was 94.7% for all revisions and 97.8% when only revision for aseptic loosening considered as the end point. At a long-term follow-up, reasonable clinical and radiographic outcomes had been achieved after using a rotating platform, posterior-stabilized knee prosthesis in our population with acceptable survival rate reaching up to 95%, which is comparable to reports from the western population.
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http://dx.doi.org/10.1055/s-0040-1716850DOI Listing
October 2020

Management of femoral head fractures through surgical hip dislocation (SHD): a demanding but safe technique.

Arch Orthop Trauma Surg 2021 Oct 28;141(10):1701-1710. Epub 2020 Oct 28.

Orthopaedic Department, Assiut University Hospital, Assiut, Egypt.

Introduction: Femoral head fractures considered to be rare injuries. Surgical intervention is indicated for major fragment displacement or in the presence of instability. Surgical management can be achieved through either Anterior, posterior, and trans-trochanteric surgical approaches. Surgical hip dislocation (SHD) has been advocated by many authors to be a safe and effective alternative way of management. The aim of this study was to report on the accuracy of fracture reduction, procedure safety, and outcomes of using SHD in the management of femoral head fractures.

Patients And Methods: Between 2011 and 2017, 31 patients presented with femoral head fracture were treated through SHD. At a mean follow-up of 48 months, 27 patients were available for the study with a mean age of 33.8 years. Patient demographics, clinical evaluation according to modified Harris hip score and modified Merle d'Aubigne and Postel score, radiographic fracture reduction according to Matta's criteria, and any complications were reported.

Results: Excellent and good clinical outcomes were reported in 25 (92.6%) and 24 (89%) patients according to the modified Harris hip and modified Merle d'Aubigne and Postel scores, respectively. Anatomic fracture reduction was achieved in 21 (77.8%) patients. Two (7.4%) patients developed AVN, one (3.6%) patient developed hip OA (grade 3 according to Tönnis classification), and five (18.5%) patients developed asymptomatic Brooker stage I heterotopic ossification. No infection or trochanteric flip osteotomy fragment non-union was reported.

Conclusions: SHD offers a safe and efficient approach for femoral head fractures management with acceptable clinical outcomes as well as complication rates. Giving the advantage of fully exposing the femoral head and the acetabulum which enables the surgeon to anatomically reduce the fracture and treat any associated injuries, SHD is recommended besides other approaches for the management of femoral head fractures.
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http://dx.doi.org/10.1007/s00402-020-03666-2DOI Listing
October 2021

Posterior cruciate ligament tibial insertion avulsion, management by open reduction and internal fixation using plate and screws through a direct posterior approach.

Injury 2021 Mar 29;52(3):594-601. Epub 2020 Sep 29.

Orthopaedic Department, Assiut university hospital, Assiut, Egypt.

Purpose: The purpose of our study was to evaluate the clinical and radiological outcomes after ORIF of PCL tibial insertion avulsion through the modified direct posterior approach using a small set plate and screws.

Methods: Between January 2017 to September 2019, 31 patients with isolated PCL tibial insertion bony avulsion were identified. Twenty-one (68%) patients presented within one week of the injury, 8 (26%) patients presented after injury by a mean 7.5 weeks (range 3:12), and two (6%) patients presented late at 7- and 9-months after injury.

Results: The mean age was 28.3 ± 6.3 years, 26 (84%) males, and 5 (16%) females. The mean operative time was 39.8 ± 7.9 min. In all patients, a one-third tubular plate was used. Fracture union was achieved in all patients after a mean 8 ± 2.1 weeks. The mean knee flexion at last follow up was 120.7° ± 4.3 with full extension in all patients. The knee Lysholm scoring was excellent in 27 (87%) patients, good in 3 (10%) patients, and fair in one (3%); the mean score was 93.4 ± 3.9. The PDT was positive in 4 patients (13%), three grade I, and one grade II. No neurovascular bundle or hardware related complications were reported. Two (6.5%) patients had a superficial wound infection with no further intervention.

Conclusion: Using small set plates and screws for ORIF of PCL tibial avulsion fractures through a direct posterior approach revealed good results in terms of surgical exposure, safety, radiological and clinical outcomes.
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http://dx.doi.org/10.1016/j.injury.2020.09.058DOI Listing
March 2021

Evaluation of the short-term results of closed reduction and percutaneous K-wires fixation of displaced intra-articular calcaneal fractures (DIACF).

Foot (Edinb) 2020 Dec 9;45:101740. Epub 2020 Sep 9.

Orthopedics and Traumatology Department, Aswan Faculty of Medicine, Aswan University, Aswan, Egypt. Electronic address:

Purpose: Optimum management of displaced intra-articular calcaneal fractures (DIACF) still controversial. Open surgery carries the risk of wound complications, while non-operative management has a high incidence of arthrosis. To avoid these complications, minimally invasive and percutaneous fixation was introduced. The purpose of this study was to prospectively evaluate the short term clinical and radiological outcomes after closed reduction and percutaneous fixation of DIACF using K-wires.

Patients And Methods: Outcomes of twenty patients were evaluated at the final follow up. A functional assessment using the AOFAS scoring system. Radiological parameters recorded included three angles (Böhler's, Gissane and posterior facet inclination angles) and three distances (calcaneal length, height and width). Any complications were reported at any follow-up.

Results: The mean patient's age was 33 ± 15.2 years, 8 (40%) patients with type II fractures, 10 (50%) patients with type III fractures, and 2 (10%) with type IV fracture according to Sanders classification. After a mean follow-up of 9 months, the mean AOFAS score was 84, excellent in 9 patients (45%), good in 9 (45%), and fair in 2 (10%). At the final follow-up the Böhler's angle, Gissane angle and PFIA was 25.1° ± (5.2), 119.9° ± (9.4) and 51.7° ± (5.9) respectively and the calcaneal height, length and width was 41.8 mm ± (2.1), 75.1 mm ± (3.01) and 40.9 mm ± (2.6) respectively. We had no cases of deep infection, 20% had significant subtalar arthritis.

Conclusion: The closed reduction and percutaneous fixation technique for DIACF management offered acceptable clinical and radiographic outcomes, with fewer complications when compared to other management options.
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http://dx.doi.org/10.1016/j.foot.2020.101740DOI Listing
December 2020

How fast is the peer-review process for orthopaedic publications related to the Covid-19 pandemic?

J Clin Orthop Trauma 2021 Jan 12;12(1):9-15. Epub 2020 Sep 12.

Orthopaedic and Traumatolgy Department, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egypt.

Purpose: This study's primary objective is to evaluate the time spent in the peer-review process for orthopaedic publications related to the Covid-19 pandemic. The secondary objective is to evaluate the countries' and journals' contributions in these publications.

Materials And Methods: We carried a search on August 1st, 2020, in one database (PubMed) using limited search terms to identify the orthopaedic publications related to the Covid-19 pandemic. After a filtration process, we evaluated the eligible article to identify the prevalence of different articles types, different countries, and journal contributions in these publications. The evaluation of the time spent in the peer-review process was done by obtaining the submission and acceptance dates.

Results: Of the 231 articles eligible for initial assessment, review articles were the most common article type published (51%), 48 countries published articles in a unique 78 journals. Evaluation of the peer-review process in 147 articles revealed that the mean time from submission to acceptance was 14.3 ± 15.8 days (range from 0 to 74), the peer-review process took less than 30 days in 127 (86.4%) articles, 15 (10.2%) articles were accepted within the first day of submission.

Conclusion: Orthopaedic community contributed significantly to the publications related to the Covid-19 pandemic, with a contribution from many countries and journals. The peer-review process was notably shortened for some articles.
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http://dx.doi.org/10.1016/j.jcot.2020.09.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7486289PMC
January 2021

Treatment of non-united femoral neck fracture by a novel subtrochanteric angulation lateral translation valgus osteotomy (SALVA osteotomy).

Int Orthop 2020 11 12;44(11):2421-2430. Epub 2020 Jun 12.

Orthopedics and Trauma Department, Cairo University, Cairo, Egypt.

Purpose: The ideal treatment of non-united and neglected fracture neck femur in the young adult still remains unclear and is characterized by many biological and biomechanical challenges.

Methods: Twenty-one patients with non-united or neglected fracture neck femur aged between 19 and 50 years were treated by a novel subtrochanteric valgus osteotomy and were followed up for a mean of 26.7 months. Patients were assessed by radiological parameters, the Harris Hip Score, Oxford Knee Score, and Askin Bryan Criteria to categorize the overall outcome of the patients at 24 months. Other outcome measures included the occurrence of AVN, adductor lever arm, leg length discrepancy, and mechanical implant failure.

Results: All patients treated with the SALVA osteotomy consolidated and displayed a marked improvement of functional and radiological outcome measures. Nevertheless, there were 2 mechanical failures in patients with marked osteopenia and three developed AVN.

Conclusions: In patients with un-united/neglected fracture neck femur, SALVA osteotomy appears to be reliable and reproducible. It also restores the abductor lever arm and improves the leg length discrepancy. Technically less demanding conversion to arthroplasty remains still possible prospectively.
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http://dx.doi.org/10.1007/s00264-020-04527-8DOI Listing
November 2020

Experimental implementation of a new non-redundant 6-DOF quadrotor manipulation system.

ISA Trans 2020 Sep 11;104:345-355. Epub 2020 May 11.

Department of Mechatronics and Robotics Engineering, Egypt-Japan University of Science and Technology, Egypt. Electronic address:

The experimental validation of a new quadrotor-manipulator is tackled in this paper. In this system, a two-DOF robotic arm is attached to the bottom center of a quadcopter. The arm is designed with a certain topology such that its end-effector can follow a six-DOF desired trajectory which makes our proposed system superior over the others. It can track an arbitrary six-DOF trajectory in the task space with minimum possible actuators. To test the proposed system feasibility, a quadrotor is selected with high enough payload, then an identification experiment is carried out to estimate its parameters. The mathematical model of the whole system is built. An indoor measurement and state estimation schemes are designed and implemented to get the accurate pose of the platform. A motion control system is designed based on a nonlinear PID technique. A realistic simulation framework is built in MATLAB/SIMULINK. Furthermore, a showcase scenario is carried out by real-time tests. Results show the feasibility and efficiency of the proposed system in achieving the position holding and transferring an object to a certain target pose.
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http://dx.doi.org/10.1016/j.isatra.2020.05.013DOI Listing
September 2020

Asian Study of Cerebral Venous Thrombosis.

J Stroke Cerebrovasc Dis 2019 Oct 24;28(10):104247. Epub 2019 Jul 24.

Department of Medicine, Aga Khan University, Karachi, Pakistan.

Background/objective: Most of the studies and registries related to cerebral venous thrombosis (CVT) are reported from European countries and the United States. The objective of the present study is to identify risk factors, presentation, and outcome of CVT in Asian patients.

Methods: Asian CVT registry is a prospective multinational observational study that included patients (aged > 16 years) with symptomatic CVT.

Results: Eight hundred and twelve patients (59% women) from 20 centers in 9 Asian countries were included. Mean age of the patients was 31 years. Motor weakness in limbs was present in 325 (40%) patients. One hundred and eighty (22.1%) patients had a normal Glasgow coma scale (GCS) at presentation, and another 529 patients (65%) had GCS between 11 and 14. The rest (103; 13%) had a GCS of less than 10 at presentation. Permanent risk factors were present in 264 (33%) patients, transient in 342 (42%) patients, both in 43 (5%) patients and no risk factors were found in 163 (20%) patients. Anemia was present in 51%, use of oral contraceptive pills (OCP) was present in 12% women and a hypercoaguable state was present in more than 40% of those tested. One hundred and forty-three cases (18%) were in women who were either pregnant (18; 2%) or in the puerperium (up to 6 weeks postpartum; N = 125; 15%). A total of 86 (10.5%) patients were diagnosed with infection in any part of the body. The most common MRI finding was local brain edema or ischemia (53.3%) followed by hemorrhage (26.7%). Twenty-seven patients (3.3%) died during hospital stay. The mRS score at discharge was available for 661 (81%) patients. Of these, 577 (87.3%) had good functional outcome at discharge. Motor weakness at presentation, GCS of 9 or less and mental status disorder were the strongest independent predictors of mortality at last follow-up among patients with CVT.

Conclusions: Important differences were identified as compared to western data including younger age, high frequency of anemia, low use of OCP, and high frequency of hypercoaguable states. Functional outcome at discharge was good.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2019.06.005DOI Listing
October 2019

Post-operative hip centre restoration and migration after impaction bone grafting in revision and complex primary hip arthroplasty.

Eur J Orthop Surg Traumatol 2019 Oct 3;29(7):1411-1417. Epub 2019 Jun 3.

Orthopaedic and Traumatology Department, Assuit University Hospital, Assuit, Egypt.

Introduction/objectives: Although impaction grafting proved efficacy in the reconstruction of acetabular defects in primary and revision hip arthroplasty, its role in large segmental defects is still debatable. Our objective is to determine hip centre restoration and last follow-up migration after acetabular reconstruction with impaction grafting in different types of acetabular defects.

Methods: This is a single-centre retrospective radiographic study of (107) total hip arthroplasty (42 primary and 65 revision) in (104) patients using impaction grafting. The available radiographs were examined for normal, preoperative, immediate postoperative, and last follow-up vertical (Y) and horizontal (X) hip centre. Maximum acetabular defect distance (MADD), presence, and size of the mesh were recorded.

Results: In type I and II AAOS defects, the post-operative hip centre was not significantly different from the normal hip centre on the contralateral healthy side. In type III defects, there was a significant variation between the normal hip centre and the post-operative hip centre (P value 0.034 and 0.001 for Y and X, respectively). At 44-month follow-up of 36 hips, 31 (86%) hips migrated. The mean migration ± SD was 5.72 ± 3.7, 2, 4.15 ± 1.2, and 11.26 ± 3.9 mm for types I, II, and III, respectively (P value 0.211). Hips with MADD > 15 mm, especially with large mesh sizes migrate significantly more (P value = 0.042, 0.037, and 0.039, respectively).

Conclusion: Hip centre restoration was better, and migration was less for type I and II AAOS rather than for type III. Other options for reconstruction should be considered.
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http://dx.doi.org/10.1007/s00590-019-02458-8DOI Listing
October 2019

Real-world treatment persistence of golimumab in the management of immune-mediated rheumatic diseases in Europe: a systematic literature review.

BMJ Open 2019 05 28;9(5):e027456. Epub 2019 May 28.

Medical Affairs Immunology, MSD Switzerland, Lucerne, Switzerland.

Objectives: To summarise real-world data from studies reporting golimumab persistence in European immune-mediated rheumatic disease (IMRD) populations and to report pooled estimates.

Design: Systematic literature review.

Data Sources: Relevant literature was identified through searching Medline and Embase via Ovid as well as the conference databases of European League Against Rheumatism and American College of Rheumatology-Association of Rheumatology Health Professionals.

Eligibility Criteria: We screened records using predefined patients, interventions, comparators, outcomes and study design criteria. Eligible studies included reports of persistence among adult IMRD patients in Europe receiving treatment with subcutaneous golimumab. Clinical trials, randomised controlled trials, literature reviews, editorials, guidelines and studies with <20 patients receiving golimumab were excluded.

Data Extraction And Synthesis: Following double screening by two independent reviewers, 27 studies out of 578 identified records were selected for inclusion and subsequent data extraction. Persistence was most commonly reported at 12and 24 months; hence, pooled persistence estimates were calculated for these two time points and reported according to indication.

Results: Persistence ranged between 58.1% (psoriatic arthritis (PsA) patients regardless of treatment line) and 75.7% (biological-naïve rheumatoid arthritis patients) at 12 months; at 24 months, the range was 43% (axial spondyloarthritis (AxSpA) patients regardless of treatment line) and 69.6% (biological-naïve PsA patients). On the basis of data from 12 studies, persistence with golimumab treatment was either significantly higher or not significantly different from other tumour necrosis factor inhibitors (TNFi).

Conclusions: Golimumab persistence at 24 months approximates 50%, with a lower persistence among AxSpA (43%) patients. However, as the number of studies in these populations was low, they warrant further research. In 12 studies comparing various TNFi treatments, golimumab was shown to have significantly better or equal persistence to its comparators.
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http://dx.doi.org/10.1136/bmjopen-2018-027456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549706PMC
May 2019

The use of pararectus approach for Type 3B Paprosky acetabular defect with intrapelvic cup migration. Case report.

SICOT J 2019 1;5:11. Epub 2019 Apr 1.

Orthopedic Department, Assiut University Hospital, Assiut, Egypt.

Case: A case of Type 3B Paprosky acetabular defect with intrapelvic cup migration where anterior column plating and cup extraction was done through an abdominal pararectus approach. A male patient 63 years old reported progressive pain and walking disability after five years of cementless THR for right hip AVN. CT pelvis showed loose intrapelvic migrated cup, extensive osteolytic acetabular defects, and pelvic discontinuity. Pararectus approach was used to remove the cup and the head with concomitant plating of the anterior column Conclusion: The pararectus approach is a valid option for intrapelvic cup extraction and pelvic discontinuity fixation.
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http://dx.doi.org/10.1051/sicotj/2019008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442451PMC
April 2019

Biomechanical aspects of reinforced implant overdentures: A systematic review.

J Mech Behav Biomed Mater 2019 03 11;91:202-211. Epub 2018 Dec 11.

Department of Biomaterials Science and Turku Clinical Biomaterials Centre-TCBC, Institute of Dentistry, University of Turku, Turku, Finland; Welfare Division, City of Turku, Turku, Finland.

Purpose: The purpose of this systematic review was to investigate the effect of reinforcement on the mechanical behaviour of implant overdenture (IOD) bases and its cumulative biological effect on the underlying supporting structures (implants and the residual ridge).

Material And Methods: The required documents were collected electronically from PubMed and Web of Science databases targeting papers published in English that focused on denture base reinforcement for IOD prostheses in order to recognize the principal outcomes of reinforcement on the mechanical and biological properties of overdentures. Such biological outcomes as: strains on implants, peri-implant bone loss, residual ridge resorption, and strain on the residual alveolar ridge.

Results: A total of 269 citations were identified. After excluding any repeated articles between databases and the application of exclusion and inclusion criteria, only 13 publications fulfilled the inclusion criteria. Three publications investigated the mechanical properties of fibre and/or metal-reinforced implant overdentures while another 3 articles investigated the effect of metal reinforcement on stress distribution and strains transmitted to the underlying implants. In addition, 3 in vitro studies investigated the effect of metal reinforcement on overdenture base strain and stresses. Stress distribution to the residual ridge and strain characteristics of the underlying tissues were investigated by 2 in vitro studies. Five clinical studies performed to assist the clinical and prosthetic maintenance of metal-reinforced IOD were included. Data concerning denture base fracture, relining, peri-implant bone loss, probing depth, and implant survival rates during the functional period were extracted and considered in order to evaluate the mechanical properties of the denture base, residual ridge resorption and implant preservation rates, respectively.

Conclusion: The use of a denture base reinforcement can reduce the fracture incidence in IOD bases by enhancing their flexural properties and reducing the overdenture base deformation. Strains on the underlying supporting structures of overdenture prostheses including dental implants and the residual ridge can be decreased and evenly distributed using a metal reinforcement.
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http://dx.doi.org/10.1016/j.jmbbm.2018.12.006DOI Listing
March 2019

Agreement between two raters' evaluation for integrated Traditional Prosthodontic Practical Exam with Directly Observed Procedural Skills in Egypt.

J Educ Eval Health Prof 2018 27;15:23. Epub 2018 Sep 27.

Department of Prosthodontic, Mansoura Dental School, Mansoura University, Mansoura, Egypt.

Purpose: It aimed to determine the agreement between two raters evaluating students at prosthodontic clinical practical exam integrated with directly observed procedural skills (DOPS).

Methods: A sample of 76 students was monitored by two raters to evaluate the process and the final registered maxillomandibular relation for completely edentulous patient in Mansoura Dental School, Egypt at practical exam of the Bachelor students on May 15, till June 28, 2017. Each registered relation was evaluated from total 60 marks subdivided to three score-categories: occlusal plane orientation (OPO), vertical dimension registration (VDR), and centric relation registration (CRR). The marks of each category included mark of DOPS. The marks of OPO and VDR for both raters were compared by graph method to measure reliability using the Bland and Altman analysis. The reliability of CRR marks was evaluated by Krippendorff's alpha ratio.

Results: The results revealed similarity between raters for OPO (mean = 18.1) and closes of limits of agreement (0.73 and -0.78). For VDR, there were closeness of means (mean= 17.4 and 17.1 for examiner 1 and 2 respectively); with limits of agreement (2.7and-2.2). There was a strong correlation (Krippendorff's alpha ratio= 0.92; 95% CI [0.79-0.99]) among raters at evaluating CRR.

Conclusion: The two raters' evaluation of clinical traditional practical exam integrated with directly observed procedural skills revealed not to be different to evaluate candidate at the end of the clinical prosthodontic course. The limits of agreement between raters would be optimum at exclusion subjective evaluation parameters and complicated cases from examination procedures.
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http://dx.doi.org/10.3352/jeehp.2018.15.23DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249138PMC
January 2019

Continuous Clinical Response Is Associated With a Change of Disease Course in Patients With Moderate to Severe Ulcerative Colitis Treated With Golimumab.

Inflamm Bowel Dis 2019 01;25(1):163-171

MSD Switzerland, Luzern, Switzerland.

Background: Responders to induction treatment sustain continuous clinical response (CCR) through 1 year in about 50% of patients in PURSUIT-M trial with golimumab maintenance in ulcerative colitis (UC). This post hoc analysis of PURSUIT-M describes the 1-year clinical, endoscopic, quality of life (QoL), and biomarker and 4-year clinical outcome in patients with sustained response to golimumab therapy for UC.

Methods: We compared clinical, endoscopic, QoL, and calprotectin outcomes in CCR and non-CCR patients through 54 weeks in PURSUIT-M. Persistence on golimumab therapy and clinical response at 4 years was assessed for CCR and non-CCR patients. The relationship of colectomy with CCR status was determined.

Results: Among patients receiving golimumab maintenance, greater proportions of patients with vs without CCR at week 54 achieved clinical remission (67.1% vs 1.9%), corticosteroid-free remission (61.6% vs 1.9%), endoscopic remission (Mayo endoscopy score 0 [47.9% vs 1.3%]), and normal QoL (inflammatory bowel disease questionnaire score ≥170 [75.0% vs 24.4%]). CCR but not non-CCR patients maintained normalized calprotectin levels during maintenance. Among patients who entered the long-term extension study, a greater proportion of patients with vs without CCR maintained PGA 0 through week 216 (58% vs 42%). Colectomy was performed in 47 induction nonresponders and in 13 induction responders. None of the patients going onto colectomy achieved CCR through 54 weeks in PURSUIT-M.

Conclusions: Continuous clinical response is associated with favorable short- and long-term clinical, endoscopic, QoL, and biomarker responses that may result in changing the course of disease and may prevent colectomy in patients with moderate to severe UC treated with golimumab. 10.1093/ibd/izy229_video1izy229.video15806022773001.
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http://dx.doi.org/10.1093/ibd/izy229DOI Listing
January 2019
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