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This study aims to investigate whether arthroscopy-assisted minimally invasive percutaneous plate osteosynthesis (MIPPO) provided more favorable early functional recovery and reduced surgical trauma compared to traditional open reduction and internal fixation (ORIF). A total of 84 patients with Schatzker type I-IV tibial plateau fractures treated between January 2021 and January 2024 were retrospectively analyzed. The MIPPO group (n = 41) underwent arthroscopy-assisted reduction plus MIPPO, while the ORIF group (n = 43) received conventional ORIF. Allocation was chronological, with ORIF predominant in the first two years and MIPPO in the latter two years. Operative parameters, postoperative drainage, radiographic outcomes (Rasmussen radiological score), functional recovery (Hospital for Special Surgery [HSS] score), range of motion (ROM), fracture healing time, hospital stay, and complications were compared. Of a total of 84 patients, 28 were male and 56 were female of 49.4 &#xb1; 9.0 (range, 27 to 69) years. The arthroscopy-assisted MIPPO group had significantly longer operative time (96.0 &#xb1; 18.2 vs. 84.0 &#xb1; 13.9 min, p = 0.001) but shorter incision length (3.9 &#xb1; 0.7 vs. 6.2 &#xb1; 0.9 cm, p < 0.001), less intraoperative blood loss (56.5 &#xb1; 9.6 vs. 72.6 &#xb1; 10.1 mL, p < 0.001), and lower postoperative drainage volume (47.1 &#xb1; 7.5 vs. 59.0 &#xb1; 7.0 mL, p < 0.001) than the ORIF group. The arthroscopy-assisted MIPPO group also achieved higher Rasmussen radiological scores (15.4 &#xb1; 1.4 vs. 14.0 &#xb1; 1.6, p < 0.001) and better HSS scores at one, three, and six months postoperatively (all p < 0.001). At six months postoperatively, the MIPPO group also demonstrated significantly improved knee ROM (118.5&#xb0; &#xb1; 8.2&#xb0; vs. 107.3&#xb0; &#xb1; 9.1&#xb0;, p < 0.001), a difference exceeding the clinically meaningful threshold for activities of daily living. However, no significant differences were found in hospital stay (p = 0.051), fracture healing time (11.4 &#xb1; 1.3 vs. 11.1 &#xb1; 1.3 weeks, p = 0.340), or the excellent-and-good rate of HSS score at final follow-up (95.1% vs. 97.7%, p = 0.746). Complication rates were similar between the groups (p = 1.000). For Schatzker type I-IV tibial plateau fractures, arthroscopy-assisted MIPPO provides more favorable early functional recovery and radiological reduction quality compared to conventional ORIF, with less surgical trauma and comparable early functional recovery and similar complication rates during follow-up. Although operative time is longer, this minimally invasive approach is a safe and effective option for managing these complex fractures. Its principal advantage is accelerated early recovery, particularly in knee ROM, enabling patients to reach clinically meaningful thresholds for activities of daily living sooner.

Background and objective Extra-articular fractures of the proximal third of the tibia are technically demanding injuries due to the complex deforming muscular forces and frequently compromised soft tissue envelope. The optimal treatment strategy for this fracture subtype remains unsettled, particularly regarding the choice between minimally invasive percutaneous plate osteosynthesis (MIPPO) and intramedullary interlocking nailing (IMILN). This study was undertaken to compare these two treatment modalities and determine their relative effectiveness. Methods A single-center, prospective, comparative study employing alternating allocation was conducted at IMS and SUM Hospital, Bhubaneswar, with patient recruitment carried out from September 2024 to February 2025, and final clinical and functional follow-up at 12 months completed by March 2026. Fifty-two adults aged 20-60 years with AO/OTA 41A2 fractures, including Gustilo-Anderson grade I and II open injuries, were sequentially allocated to either MIPPO (n = 26) or IMILN (n = 26). The primary outcomes included time to radiological union and 12-month functional assessment using the Knee Society Score (KSS), Lower Extremity Functional Scale (LEFS), and Johner and Wruhs grading scale. Continuous variables were compared using the independent-samples t-test, while categorical variables were analyzed using the chi-square or Fisher's exact test as appropriate. Statistical analyses were performed using IBM SPSS Statistics version 21.0 (IBM Corp., Armonk, NY). Results Forty-six patients completed the one-year follow-up (MIPPO, n = 24; IMILN, n = 22). Mean radiological union time was 16.1 weeks (MIPPO) versus 16.9 weeks (IMILN) (mean difference: -0.8 weeks, 95% CI: -4.0 to 2.4; p = 0.62). Final union rates were 23/24 (95.8%) and 21/22 (95.5%), respectively. Malreduction > 5&#xb0; occurred in 4/26 (15.4%, MIPPO) and 5/26 (19.2%, IMILN) (p = 0.71). Mean KSS was 80.2 versus 80.8 (mean difference: -0.6, 95% CI: -7.0 to 5.8; p = 0.85), and mean LEFS was 65.2 versus 67.3 (mean difference: -2.1, 95% CI: -6.6 to 2.4; p = 0.35). Excellent or good Johner and Wruhs grades were achieved in 18/24 (75.0%, MIPPO) and 18/22 (81.8%, IMILN). Partial weight-bearing was initiated earlier in the IMILN group (two to three postoperative days vs. three to four weeks; p < 0.001). Intraoperative adjuncts were required in 13/26 (50.0%) of IMILN versus 3/26 (11.5%) of MIPPO procedures (p = 0.005). Conclusions Within the limitations of this small, single-center cohort study, MIPPO and IMILN demonstrated comparable union rates and one-year functional outcomes for AO/OTA 41A2 fractures. IMILN facilitated earlier mobilization but necessitated adjunct procedures more frequently and was associated with anterior knee pain. MIPPO was associated with minimal knee-related morbidity, albeit with a more gradual rehabilitation timeline. Implant selection should therefore be guided by fracture morphology, soft-tissue condition, and locally available instrumentation rather than an absolute preference for either construct.

This study aims to evaluate the midterm clinical outcomes of patients with complex clubfoot treated using the Ponseti method and to assess the sustainability of deformity correction over time. Between January 2016 and January 2021, a total of 38 feet in 26 patients with complex clubfoot treated using the modified Ponseti method were retrospectively analyzed. The patients were divided into two groups: those treated entirely in our institution (study center group) and those referred from external centers after unsuccessful initial treatment (external center group). Clinical severity was assessed using the Pirani score, and ankle dorsiflexion (DF) was measured during follow-up. Functional outcomes were evaluated using the Pirani-Based Score (PBS) and the Oxford Ankle Foot Questionnaire (OxAFQ). Relapse rates, additional procedures, and treatment success were analyzed. Independent predictors of outcomes were identified. Of a total of 26 patients included in the study, 2 were male and 24 were female with a mean age of 6.78 &#xb1; 1.29 (range, 5 to 8) years. Of these patients, 14 (53.8%) had unilateral involvement, while 12 (46.2%) had bilateral deformity. The external clinic group presented at a significantly later age than the study center group (p < 0.001), while baseline deformity severity was comparable. Pirani scores and DF measurements improved significantly in both groups, with no intergroup differences during follow-up (p > 0.05). Functional outcomes showed a significant difference in PBS scores, which were higher in the external clinic group (p = 0.045), indicating worse functional performance, while the OxAFQ scores were similar between groups (p = 0.911). Relapse rates were higher in the own clinic group but did not reach statistical significance (p = 0.254). Multivariate analysis revealed that age was the only independent predictor of treatment success (odds ratio [OR] = 2.067, p = 0.019), while referral status was not an independent determinant. The modified Ponseti method provides effective midterm correction in complex clubfoot regardless of referral status. Although referred patients present later and may demonstrate worse functional outcomes, referral source does not independently influence treatment success. Early recognition and appropriate application of modified Ponseti principles remain critical for optimal outcomes.

This study aims to evaluate the mid-term clinical and functional outcomes of juxta-epiphyseal fractures of the proximal phalanx in pediatric patients. Between July 2013 and December 2023, a total of 23 pediatric patients treated for juxta-epiphyseal fractures of the proximal phalanx were retrospectively analyzed. Functional outcomes were assessed using four subtests of the Jebsen-Taylor Hand Function Test. To compare the Jebsen-Taylor Hand Function Test, a control group of healthy children (n = 23) from the outpatient clinic was formed. Patients were treated either with closed reduction and splinting or with closed reduction followed by Kirschner wire (K-wire) fixation according to fracture displacement and stability. Radiographs were evaluated for residual deformity and malunion using Campbell's lines. Of a total of 23 patients, 13 were male and 10 were female with a mean age of 7.24 &#xb1; 2.21 (range, 6 to 13) years. The fifth digit was the most commonly affected (n = 14), followed by the fourth (n = 5), middle (n = 2), and thumb (n = 2). In 15 patients, the injury occurred on the non-dominant hand. No malunions were detected. One patient demonstrated a pseudo-claw deformity. Hand function tests revealed statistically significant delays in patients with dominant-hand injuries compared to healthy controls (p < 0.05). Seven patients reported a change in hand dominance after injury. Our study results suggest that appropriate reduction techniques, including closed or K-wire-assisted fixation, offer favorable outcomes with minimal complications. However, functional impairment can be more notable, when the dominant hand is involved. Taken together, these findings emphasize the need for early intervention, close follow-up, and consideration of hand dominance during recovery planning.

Multiple-choice questions (MCQs) are test items that are essential to assess the competency of medical students in forensic medicine. However, the psychometric quality of these test items in Nepali medical colleges remains largely unexplored. This study evaluated the difficulty index, discrimination index, and distractor effectiveness of forensic medicine MCQs to identify areas requiring improvement. This cross-sectional study evaluated 30 MCQs from the end-of-semester forensic medicine examination which was administered to 100 third-year medical students. The item difficulty, the discrimination index (via Kelley's 27% method), and performance of the distractor were calculated for each question. The students showed high performance, with a mean score of 23.25&#xb1;3.61 out of 30. Difficulty analysis showed that majority of the items (60%) fell within an acceptable difficulty range (70-90% correct), while 16.7% were very easy and 6.6% were difficult. Discrimination was good in 43.3% of the items, moderate in 23.3%, and poor in 33.3%. Distractor analysis identified non-functional distractors in a large proportion of items, including nine items (30%) with at least one zero-response option. Overall, 44 of 90 distractors (48.9%) across all items were non-functional. A statistically significant negative correlation was found between item difficulty and discrimination index (&#x3c1; = -0.4265, p = 0.019); items of moderate difficulty (50-69% correct) showed the highest mean discrimination, with both moderate- and acceptable-difficulty items outperforming items at the extremes of difficulty. The examination revealed adequate student performance; however, item quality analysis demonstrated the need for improvement, with approximately one-third of the items failing to meet the desired standard and therefore requiring revision due to poor discrimination or non-functional distractors. Structured faculty training in item-writing principles and regular psychometric evaluation may help improve assessment quality in Nepali medical education.

Perioperative management of patients with immune thrombocytopenia (ITP) is particularly challenging when complicated by recent coronary stenting requiring dual antiplatelet therapy (DAPT), due to competing risks of bleeding and thrombosis. We report the case of an 80-year-old male with refractory ITP and recent drug-eluting stent placement who underwent elective laparoscopic splenectomy. Although preoperative optimization with corticosteroids and intravenous immunoglobulin increased platelet count from <&#x2009;20&#x2009;&#xd7;&#x2009;109/L to 177&#x2009;&#xd7;&#x2009;109/L, functional hemostatic adequacy remained uncertain given concurrent ITP and ongoing antiplatelet therapy. Thromboelastography (TEG) was performed using the TEG 6s system with a Global Hemostasis Cartridge. Standard TEG parameters demonstrated preserved clot initiation, formation, and strength across multiple channels, supporting progression to surgery. Laparoscopic splenectomy was completed under general anesthesia without complications or need for transfusion. The patient recovered on the general surgical ward and was discharged on Postoperative Day 3 with a platelet count of 139&#x2009;&#xd7;&#x2009;109/L. Platelet count 2&#x2009;weeks postoperatively was 343&#x2009;&#xd7;&#x2009;109/L. This case highlights the utility of TEG as a tool to guide perioperative decision-making in patients with ITP receiving antiplatelet therapy. By providing a functional assessment of coagulation, TEG can help individualize perioperative management in patients with complex hematologic conditions, facilitating safe surgical intervention.

Background Document control is a core requirement of laboratory quality management and accreditation, including under the College of American Pathologists (CAP), International Organization for Standardization (ISO) 17025, ISO 15189, the Association for the Advancement of Blood & Biotherapies (AABB), and the Central Board for Accreditation of Healthcare Institutions (CBAHI). Before 2024, many Saudi laboratories relied on paper-based systems or imported platforms that lacked Arabic-language functionality, local hosting, and explicit alignment with Saudi regulatory and governance requirements. Objective To describe the development, standards-based internal validation, and early multisite implementation of the Makeen Document Control System (Makeen DCS), a Saudi-built laboratory document control platform designed for accreditation-oriented use in Saudi Arabia, and to assess early feasibility and user-perceived acceptability rather than comparative effectiveness. Methods This descriptive implementation and feasibility study was conducted from October 2024 to January 2026. System requirements were derived from CAP, ISO 17025, ISO 15189:2022, AABB, CBAHI, FDA 21 CFR Part 11, and Saudi Personal Data Protection Law (PDPL) requirements and translated into software specifications. Development followed staged requirements definition, prototyping, workflow refinement, internal validation, and pilot deployment. Internal validation used 126 structured test cases across user access, document creation and upload, approval workflow, version control, retrieval, audit trail behavior, and administrative functions. Early implementation was undertaken in seven purposively selected pioneer laboratory sites. User feedback was collected through an internally developed implementation survey completed by eight participants from pilot sites. Results The Makeen DCS provided end-to-end document lifecycle management, role-based access control, bilingual Arabic-English interfaces, dynamic master document lists, searchable retrieval, audit-oriented reporting, and a personnel-documentation module. The system supported both Saudi-hosted cloud deployment and on-premises implementation. Functional alignment was mapped against selected CAP, ISO 17025, ISO 15189:2022, CBAHI, AABB, FDA Part 11, and PDPL requirements.&#xa0;Among 126 validation test cases, 109/126 (86.5%) passed on first execution, and 17/126 (13.5%) failed initially; all failed items were corrected and retested, resulting in a final pass rate of 100% (126/126). Early deployment was achieved across seven diverse sites, of which six were fully active, and one remained partially implemented by study cut-off. Median active users across sites were 80 (range: 30-200), median configured departments were 10 (range: 5-15), and median migrated or newly created controlled documents were 76 (range: 10-274) across six sites with available data. User feedback was favorable, with a mean satisfaction score of 9/10, 7/8 (87.5%) respondents willing to recommend the platform, and 8/8 (100.0%) perceiving improved inspection readiness and reduced manual or paper-based workload. Conclusions Makeen DCS was feasible as a Saudi-built/bilingual/locally hosted lab platform for accreditation workflows. Internal validation, pilot use, and small-sample feedback show readiness/acceptability, not operational effectiveness; independent longitudinal evaluation is needed.

This study aims to evaluate the feasibility, safety, and peri-implant bone formation of augmenting a proximal femoral nail (PFN) helical blade with a calcium sulfate/hydroxyapatite (CaS/HA) biomaterial combined with systemic zoledronic acid (ZA). This single-center, two-arm, parallel-group, randomized-controlled pilot study included a total of 20 patients with osteoporotic trochanteric fractures (TFs) between December 2023 and January 2025. The patients were randomized into a control group receiving standard PFN or an intervention group receiving PFN augmented with CaS/HA biomaterial. All patients received cefazoline and doxycycline for infection prophylaxis. On postoperative Day 7, both groups received a single intravenous infusion of ZA. The primary outcome was the change in bone mineral density (BMD) defined by previously published peri-implant regions-of-interest at one week and six months postoperatively. Secondary outcomes included tip-apex distance (TAD) for assessing blade migration and the Harris Hip Score (HHS) for functional evaluation. Of a total of 20 patients included in the study, 6 were male and 14 were female with a median age of 81 (range, 65 to 90) years. Regarding intervention delivery, all 10 randomly assigned patients received their intended treatment. While 19 of the 20 randomly assigned patients received the intended treatment; one patient died within the first week and did not receive ZA. The required data for clinical analysis (change in peri-implant BMD, TAD, fracture union, and HHS) could only be extracted for five patients in the control group and five patients in the intervention group. There were no intraoperative complications, and no adverse effects related to the CaS/HA biomaterial were reported. Ten patients were included for the outcome analysis. The intervention group demonstrated a more pronounced increase in peri-implant BMD compared to controls. Additionally, TAD changed more in the control group. Functional evaluation revealed that the intervention group demonstrated a slightly greater HHS improvement. Our study results suggest that augmentation using the CaS/HA and ZA is a feasible and safe procedure for patients with osteoporotic TF. Preliminary findings indicate a potential trend toward enhanced peri-implant bone formation in the intervention group.

This study aims to compare the clinical and radiological outcomes of the direct anterior approach (DAA) and the traditional posterior-lateral approach (PLA) for total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS). Between July 2001 and May 2024, a total of 137 patients (117 males, 20 females; mean age: 40.21 &#xb1; 13.28 years; range, 17 to 73 years) with AS who underwent THA using the DAA or PLA were retrospectively analyzed. Using propensity score-matching, we retrospectively analyzed data on 164 hips with AS for which THA was performed, with 41 and 123 hips in the DAA and PLA groups, respectively. Preoperative baseline characteristics, surgical data, clinical and radiological outcomes at follow-up were collected and compared between the two groups. The mean follow-up was 68.05 &#xb1; 38.09 months. There were no significant intergroup differences in terms of surgical data, postoperative complications, clinical scores, or patient satisfaction (p > 0.05). Compared to the PLA group, the DAA group had a significantly higher rate of achieving hip flexion over 90&#xb0; (82.93% vs. 60.98%, p = 0.010), with fewer patients in the group reporting difficulty with putting on socks (p = 0.003). The DAA group exhibited a smaller acetabular anteversion (17.10 &#xb1; 6.60&#xb0; vs. 20.68 &#xb1; 8.73&#xb0;, p = 0.031), with a higher proportion of acetabular components positioned within the Lewinnek safe zone (82.93% vs. 60.16%, p = 0.008). Although both surgical approaches are effective for managing hip involvement in ankylosing spondylitis undergoing THA, the DAA may offer functional benefits and improved prosthetic alignment. These advantages support its consideration as a favorable surgical option in appropriately selected patients.

Injuries to the medial collateral ligament (MCL) and the posterior oblique ligament (POL), isolated or associated with cruciate ligament tear, are common in cases of knee sprains and often cause valgus instability. Although there are many surgical techniques for MCL reconstruction, not all are anatomical, and not all involve reconstruction of the deep and superficial bundles of the MCL and POL with an autologous autograft. We propose this technique in cases of chronic anterior cruciate ligament (ACL) tear associated with POL and MCL injury grade III according to the Hughston-Eilers classification. This technique involves an on-lay anatomical reconstruction of the superficial and deep bundles of the MCL and POL using hamstring tendons. The patient is in a supine position with the knee flexed at 90&#xb0;. An incision is made in the medial compartment of the knee, at the level of the medial collateral ligament, after which the hamstring tendons are harvested with an open tendon stripper so that they can be left inserted at their tibial insertion. Three soft tissue self-punching anchors are positioned at the anatomical insertion of the MCL and POL bundles. Care must be taken not to involve the joint surface, which is easily visible through a needle. The tendons are secured using the previously positioned anchors to reconstruct the MCL and POL. After 5 months, the patient returned to her daily activities, fully recovered knee range of motion, and achieved good recovery of muscle strength without discomfort or functional limitations. This technique provides an anatomical reconstruction of the MCL and POL using on-lay all suture anchors for chronic lesions. Hastring autografts are used for MCL and POL reconstruction, leaving other autografts available for ACL reconstruction. There is no need for an additional tunnel for MCL and POL reconstruction, thus avoiding tunnel convergence in multiligament reconstructions. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Traumatic crown-root fractures involving previously endodontically treated anterior teeth can present substantial restorative difficulties, particularly when the fracture line extends below the alveolar crest and compromises the remaining tooth structure. Preservation of the alveolar ridge following extraction is essential to facilitate future implant-supported rehabilitation and optimize aesthetic outcomes. This report describes the management of a 17-year-old male who presented with pain and mobility of the maxillary right central incisor following dental trauma. The tooth had undergone prior root canal treatment but lacked a definitive coronal restoration. Clinical and radiographic evaluation revealed a horizontal crown-root fracture extending subcrestally, accompanied by a defect in the labial cortical plate. Owing to the unfavorable restorative prognosis, limited residual tooth structure, and inability to establish a predictable ferrule, the tooth was considered nonrestorable and extracted atraumatically. Socket preservation was performed using sticky bone prepared from injectable platelet-rich fibrin, advanced platelet-rich fibrin, and xenograft particles, followed by provisional rehabilitation with a Maryland bridge. Radiographic assessment after three months demonstrated adequate preservation of ridge architecture, permitting placement of a 3.5 &#xd7; 13 mm dental implant with simultaneous guided bone regeneration. Definitive prosthetic rehabilitation was subsequently completed. This case highlights the potential benefit of combining autologous platelet concentrates with xenograft material for ridge preservation after the extraction of nonrestorable traumatized teeth, thereby supporting predictable implant placement and favorable functional and aesthetic outcomes in adolescent patients.

Mycobacterium abscessus complex is a rapidly growing non-tuberculous mycobacterium(NTM) associated with difficult-to-treat pulmonary and extrapulmonary infections. Clinical management is complicated by intrinsic antimicrobial resistance, inducible macrolide resistance, and genomic heterogeneity. This study characterised five clinical pulmonary M. abscessus&#xa0;isolates from India using whole-genome sequencing (WGS)-based genomic, phylogenetic, and antimicrobial resistance analysis. Five clinical isolates recovered from pulmonary specimens were sequenced using the Illumina NovaSeq platform (Illumina, Inc., San Diego, California, United States) with paired-end 151 bp chemistry. Reads were quality filtered using fastp v1.0.1. Reference-guided alignment and consensus generation were performed using Burrows-Wheeler Aligner (BWA)-Maximal Exact Match (MEM) and SAMtools-based workflows. Genome annotation was conducted using Prokka v1.14.6, functional annotation using eggNOG-mapper, variant analysis using Genome Analysis Toolkit (GATK) HaplotypeCaller and SnpEff, and antimicrobial resistance gene detection using the Comprehensive Antibiotic Resistance Database (CARD).&#xa0;Phenotypic antimicrobial susceptibility findings and GenoType NTM-drug resistance&#xa0;(DR) Line Probe Assay Version 1.0 results (Bruker Corporation, Billerica, Massachusetts, United States) were used to support the interpretation of macrolide resistance-associated findings. The isolates generated 0.92-1.24 Gb of high-quality sequencing data, with Q30 values exceeding 95%. Genome coverage at &#x2265;30&#xd7; depth exceeded 91%, and average sequencing depth ranged from 44.16&#xd7; to 149.59&#xd7;. Annotation identified 4,457-4,751 coding sequences, 45-48 tRNA genes, three rRNA genes, and one tmRNA gene per isolate. Reference alignment ranged from 24.86% to 64.22%, supporting isolate-level genomic heterogeneity. MAB &#x3b2;-lactamase (blaMab) gene was detected in all isolates, while erm(41) was detected only in LIN. WGS-enabled isolate-level characterisation of pulmonary&#xa0;M. abscessus&#xa0;isolates from India demonstrated conserved genomic features with measurable heterogeneity. blaMab supports intrinsic &#x3b2;-lactam resistance, while erm(41) in LIN was consistent with an inducible macrolide resistance pattern supported by available phenotypic antimicrobial susceptibility testing.

Adult patients with inherited metabolic diseases are often overlooked. Limited data on this population hinder adequate planning of their clinical and social care. In this retrospective, observational, cross-sectional service evaluation study, we reviewed the electronic medical records of adult patients with inherited neurometabolic diseases (NIMD) managed at Sk&#xe5;ne University Hospital between 2020 and 2024. Sk&#xe5;ne University Hospital, located in Region Sk&#xe5;ne in Southern Sweden, is one of three specialized tertiary centers for inherited metabolic diseases in Sweden. The aim of this study was to characterize these patients demographically and clinically and to describe their treatment profiles, functional status, and social support. We identified 59 patients. Most patients had disorders of intermediary energy metabolism (21/59; 35.6%) or lipid metabolism (14/59; 23.7%), including 10 patients (16.9%) with adrenoleukodystrophy. Disease-specific treatments were provided to 65.4% of patients, and 83.6% were under continuous follow-up. Sixteen patients (27.1%) were fully independent, lived in their own homes, did not require societal support nor mobility aid, and worked/studied full time/retired due to old age. More than half of the patients (50.8%) received no disability or social support. In conclusion, adult patients with NIMD represent a heterogeneous group with variable clinical and social needs. Despite the rarity of individual NIMDs, disease-specific treatments were commonly used in our center. Further studies, particularly long-term follow-up studies, are required to better understand NIMD clinical trajectories and to optimize both medical management and social support for adults with NIMD.

In this study, we aimed to compare the clinical and radiological outcomes of patients undergoing arthrodesis and trapeziectomy with ligament reconstruction and tendon interposition (T + LRTI) for thumb carpometacarpal (CMC) osteoarthritis and to investigate whether patient-specific decision-making could offer advantages over LRTI or arthrodesis as a surgical approach. Between August 2014 and January 2025, a total of 40 patients who underwent surgical treatment for thumb CMC osteoarthritis were retrospectively analyzed. The patients were divided into two groups as the T + LRTI group (n = 22) and arthrodesis group (n = 18). Clinical outcomes were assessed using the Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), grip strength (kg), and pinch strength (kg) measurements. Of the patients, 7 were male and 33 were female with a mean age of 62.9 &#xb1; 6.5 years in T + LRTI group, 60.1 &#xb1; 7.4 years in arthrodesis group (range, 40 to 75 years). Both groups demonstrated significant improvement in VAS and QuickDASH scores postoperatively (p < 0.001). The mean postoperative VAS scores were 2.7 &#xb1; 2.0 in the T + LRTI group and 1.9 &#xb1; 0.9 in the arthrodesis group (p = 0.267), while QuickDASH scores were 26.4 &#xb1; 17.3 and 19.1 &#xb1; 3.2, respectively (p = 0.085). No significant differences were observed in grip strength (p = 0.358), palmar pinch (p = 0.104) and key pinch strength (p = 0.097) between the groups. The overall complication rate was 12.5% in both groups, indicating no statistically significant difference (p = 0.642). Our study results suggest that both T + LRTI and arthrodesis provide effective and comparable pain relief and functional outcomes in the surgical management of thumb CMC osteoarthritis and can be considered reliable surgical options.

In this meta-analysis, we discuss the clinical efficacy of closed reduction with in situ fixation for valgus-impacted femoral neck fractures (VIFNFs) by contrasting postoperative functional recovery and complication profiles. We performed a systematic literature search in PubMed, Embase, Web of Science, the Cochrane Library, and ScienceDirect for publications up to October 2025. The search targeted original studies which directly compared the surgical outcomes of closed reduction and in situ internal fixation for valgus-impacted femoral neck fractures. Search terms included combinations of: valgus-impacted (or valgus impaction), femoral neck fracture, in situ, reduction, and internal fixation. Pooled data were analyzed using mean differences (MD) with 95% confidence intervals (CIs) for continuous outcomes and risk differences (RD) with 95% CIs for dichotomous outcomes. The final analysis included a total of 447 patients extracted from five studies that met the predetermined inclusion criteria. The meta-analysis demonstrated that the closed reduction group exhibited a statistically significant reduction in postoperative femoral neck shortening (FNS) compared with the in situ fixation group (MD: 4.05; 95% CI: 2.68 ~ 5.42; p < 0.00001). For the caput-collum-diaphysis (CCD) angle, the closed reduction group showed a borderline significant improvement relative to the in situ fixation group (MD: 9.79; 95% CI: 0.19 ~ 19.39; p = 0.05). The in situ fixation group was associated with a substantially lower reoperation rate (RD: -0.08; 95% CI: -0.16 ~ -0.01; p = 0.04). No statistically significant intergroup differences were detected for the Harris Hip Score (HHS) (MD: -4.13; 95% CI: -9.37 ~ 1.11; p = 0.12), incidence of femoral head necrosis (RD: -0.05; 95% CI: -0.14 ~ 0.05; p = 0.36), or fixation failure rate (RD: -0.05; 95% CI: -0.17 ~ 0.06; p = 0.37). Closed reduction yields a statistically significant advantage in reducing postoperative FNS and a borderline significant benefit in maintaining the CCD. In contrast, in situ fixation is associated with a lower reoperation rate. The two strategies show comparable outcomes for the HHS, femoral head necrosis incidence, and fixation failure rate. Thus, surgical approach should be individualized based on patient-specific profiles.

This paper aims to evaluate the perceived value of the drug prevention activities in Malaysia's high-risk areas. The drug prevention activities involved are counseling, outreach, workshop, and program. A quantitative method is employed in this study to investigate the participants' perception on the programs. A cross-sectional survey of 332 participants across seven selected high-risk regions in Peninsular Malaysia were selected for their proximity to international borders and high drug-related crime statistics. The results revealed compelling insights, showing that emotional and social values were strongly correlated with program effectiveness, while functional value showed only marginal influence. These findings challenge conventional policy approaches by demonstrating that community-based interventions fostering emotional support networks and social cohesion yield substantially greater impact than traditional information-driven or enforcement-focused strategies. The study also has theoretical contributions by validating the applicability of perceived value theory in substance abuse prevention contexts, while offering practical recommendations for policymakers to redesign interventions with greater emphasis on psychosocial support mechanisms. Limitations include the cross-sectional design and regional focus, suggesting opportunities for future longitudinal studies across broader geographical areas to assess program sustainability and cultural adaptability.

Polycystic ovary syndrome (PCOS) is a common endocrinopathy affecting reproductive-aged women, characterised by metabolic abnormalities, polycystic ovaries, hyperandrogenism, and chronic anovulation. This pathology has been attributed to hormonal imbalances, including elevated levels of insulin, growth hormone (GH), ghrelin, LEAP-2, GnRH, LH/FSH ratio (>2:1), androgenic hormones, and estrogen. While puberty-associated gingival enlargement is primarily triggered by dental plaque, systemic hormonal fluctuations can significantly exacerbate the tissue response. A 17-year-old female presented with spontaneous gingival bleeding and generalized gingival overgrowth persisting for one year. Clinical examination revealed fair oral hygiene and extensive inflammatory swelling of the marginal, interdental, and attached gingiva with bleeding upon probing, but no evident bone loss. Medical evaluation confirmed PCOS based on irregular menses, weight gain, acne, elevated serum testosterone, an increased LH/FSH ratio, hyperinsulinemia, and polycystic ovarian morphology. Initial management consisted of non-surgical periodontal therapy, including scaling, root planing, and oral hygiene instructions combined with gynaecological care for PCOS, which successfully reduced acute inflammation. Residual fibrotic enlargement was subsequently treated via surgical gingivectomy and gingivoplasty. Postoperative healing was uneventful, yielding satisfactory functional, aesthetic, and periodontal outcomes. This case highlights that PCOS may contribute to or exacerbate gingival enlargement through hormonal and inflammatory alterations rather than being a direct etiological factor. Early interdisciplinary diagnosis and co-management between dental and medical professionals are crucial for optimizing both periodontal and systemic health outcomes in adolescent patients.