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Clinical neurorestorative therapies recently made great progress for patients with spinal cord injury (SCI). This paper systemically reviews historical perspectives, recent advancements and achieve ...

Osteoporosis is the most common bone disease in humans. With its related fragility fracture, it represents a major public health problem in our region, with a significant medical and socio-economic burden. The high prevalence rate of vitamin D deficiency, the increase in life expectancy, the low socioeconomic level and the significant restriction to access to health care in some countries represent the major causes for the increasing prevalence of osteoporosis and incidence of fragility fractures in the Arabic countries. Bone mineral density (BMD) assessment is the gold standard to diagnose osteoporosis. However, a clinical diagnosis of osteoporosis may be made in the presence of a fragility fracture, without BMD measurement. Dual energy x-ray absorptiometry (DXA) is the preferred method for screening bone mineral density. For screening site of measurement, DXA of hip and spine is suggested. BMD assessment is recommended in all women 65 years of age and older and men 70 and older regardless of risk factors. Younger subjects with clinical risk factors and persons with clinical evidence of osteoporosis or diseases leading to osteoporosis should also be screened. These guidelines are aimed to provide to health care professionals in the region of an updated process for the diagnosis and treatment of osteoporosis. It includes risk factors for osteoporosis and the indications for screening, diagnosis of osteoporosis, treatment of osteoporosis in postmenopausal and premenopausal women, and men; in addition to prevention and treatment of glucocorticoid-induced osteoporosis.

Background: Female sexual dysfunction (FSD) and the associated risk factors are less studied in the Middle East. This study is designed to determine the prevalence of FSD and its associated risk factors in Jordan. Materials and Methods: A group of women were interviewed using detailed questionnaire on several aspects of FSD including desire, arousal, lubrication, orgasm, satisfaction, and pain disorders. They underwent sociodemographic investigation. Prevalence and risk factors of FSD are calculated in different age groups. Results: A total of 470 women aged 32.6 ± 9.6 years are included in this study. Desire problems were detected in 49.4% (232/470) of the studied women, while an arousal problem in 31.9% (150/470) and lubrication problem in 39.2% (184/470). An orgasm problem was detected in 39.57% (186/470) of the studied women, while satisfaction problem was detected in 43.82% (206/470) and pain problem during sexual relation in 19.2% (90/470). There was positive significant correlation between each domain of the FSD and the studied women's age except pain. FSD was found to be significant in women with more than four children (83.3%, P < 0.02), those who had been married for more than 10 years (76.7%, P < 0.02), in women with chronic medical diseases (76.7%, P < 0.02), in unemployed women (76.7%, P < 0.02), and in women not using contraception (75.2%, P < 0.005). There was no significant correlation with the level of education (P < 0.34) and monthly income (P < 0.24). Conclusion: The prevalence of FSD in Jordan is about 64.7%, the desire disorders are the most prevalent domain of FSD, and age is the most significant risk factor for FSD. Further research is needed with larger and more comprehensive sample to estimate the magnitude of FSD and to confirm its relationship with different risk factors.

Cell therapy has been shown to be a key clinical therapeutic option for central nervous system diseases or damage. Standardization of clinical cell therapy procedures is an important task for professional associations devoted to cell therapy. The Chinese Branch of the International Association of Neurorestoratology (IANR) completed the first set of guidelines governing the clinical application of neurorestoration in 2011. The IANR and the Chinese Association of Neurorestoratology (CANR) collaborated to propose the current version “Clinical Cell Therapy Guidelines for Neurorestoration (IANR/CANR 2017)”. The IANR council board members and CANR committee members approved this proposal on September 1, 2016, and recommend it to clinical practitioners of cellular therapy. These guidelines include items of cell type nomenclature, cell quality control, minimal suggested cell doses, patient-informed consent, indications for undergoing cell therapy, contraindications for undergoing cell therapy, documentation of procedure and therapy, safety evaluation, efficacy evaluation, policy of repeated treatments, do not charge patients for unproven therapies, basic principles of cell therapy, and publishing responsibility. Refereed/Peer-reviewed

Objectives: To investigate the frequency of medical complications in spinal cord injury patients, their demographic characteristics, extent and causes of their injury. Methods: The medical records of 190 patients with spinal cord injury patients who were admitted during 2008-2012 were enrolled in this study. Their demographic data, causes and extent of injury were analyzed. The American Spinal Injury Association impairment scale was used to categorize injury level and severity. The causes of morbidities surveyed were cardiovascular, respiratory, renal complications, pressure sores, spasticity and neurogenic pain. Results: A total of 190 cases were reviewed. The majority were predominantly males 152 (80%). The male/female ratio was 4:1, the mean age at the time of injury was 32 years. Their age ranged from (13-70 years). The vast majority was traumatic causes (n=167,88%) of which road traffic accidents were the main cause of their injury. Non-traumatic causes were recorded in 23 (12%) patients. Among the morbidities studied, pain was the dominant cause (45%) followed by urinary tract infection (30%), pressure sores (25%), spasticity (23%), thromboembolic complications (18%) and respiratory complications (10%). Conclusions: The most common causes of morbidity were pain followed by urinary tract infection and pressure sores. Effective prevention strategies should be applied as early as possible to reduce their occurrence in spinal cord injury patients. This study showed that traumatic causes and particularly road traffic accidents are the leading cause of spinal cord injury.

Currently, there is a lack of effective therapeutic methods to restore neurological function for chronic complete spinal cord injury (SCI) by conventional treatment. Neurorestorative strategies with positive preclinical results have been translated to the clinic, and some patients have gotten benefits and their quality of life has improved. These strategies include cell therapy, neurostimulation or neuromodulation, neuroprosthesis, neurotization or nerve bridging, and neurorehabilitation. The aim of this consensus by 31 experts from 20 countries is to show the objective evidence of clinical neurorestoration for chronic complete SCI by the mentioned neurorestorative strategies. Complete chronic SCI patients are no longer told, “nothing can be done.” The clinical translation of more effective preclinical neurorestorative strategies should be encouraged as fast as possible in order to benefit patients with incurable CNS diseases. This manuscript is published as part of the International Association of Neurorestoratology (IANR) special issue of Cell Transplantation.

Paediatric calcified tendinitis is a rare entity. Although trauma is a triggering factor, the aetiology is unknown. Conservative management is the treatment of choice with most patients experiencing symptom resolution within six weeks. We describe the case of a six-year-old male child with persistent wrist pain despite conservative treatment. Exploration revealed involvement of the extensor carpi radialis brevis, and complete recovery after surgical excision of the lesion identified on X-ray.

To design a medical decision support system (MDSS) that would accurately predict the rehabilitation protocols prescribed by the physicians for patients with knee osteoarthritis (OA) using only their demographic and clinical characteristics. The demographic and clinical variables for 170 patients receiving one of three treatment protocols for knee OA were entered into the MDSS. Demographic variables in the model were age and sex. Clinical variables entered into the model were height, weight, BMI, affected side, severity of knee OA, and severity of pain. All patients in the study received one of three treatment protocols for patients with knee OA: (a) hot packs, followed by electrotherapy and exercise, (b) ice packs, followed by ultrasound and exercise and (c) exercise alone. The resilient back propagation artificial neural network algorithm was used, with a ten-fold cross-validation. It was estimated that the MDSS is able to accurately predict the treatment prescribed by the physician for 87% of the patients. We developed an artificial neural network-based decision support system that can viably aid physicians in determining which treatment protocol would best match the anthropometric and clinical characteristics of patients with knee OA.

The objective of this study was to assess the relative association between body weight, body mass index (BMI), lean mass (LM) and fat mass (FM), and bone mineral density (BMD) in a group of Jordanian postmenopausal women and investigate if this possible association changes with age. A total of 3256 patients had dual-energy X-ray absorptiometry (DXA) scan in the period from January 2009 till January 2012 at the Radiology and Nuclear Medicine Department of Jordan University Hospital. Only 584 women met the selection criteria. Age has been recorded, and patients were divided into subgroups according to age. Body weight and height were measured, and BMI was calculated. Body composition (LM, FM, percentage of android fat, and percentage of gynoid fat) was assessed by DXA. BMD of the lumbar spine (L1-L4) and femoral neck was measured by DXA. Weight, BMI, FM, LM, percentage of android fat, and percentage of gynoid fat were positively correlated to BMD at both lumbar spine and femoral neck. However, this correlation disappeared at the age of 70 yr at lumbar spine and 75 yr at femoral neck. This study suggests that both FM and LM are important determinants of BMD in Jordanian postmenopausal women, and this correlation disappears after the age of 70 yr at lumbar spine and 75 yr at femoral neck.

To survey the situation of traumatic spinal cord injuries (SCI) in Jordan and for a future nationwide epidemiological survey, a retrospective study was conducted at the Royal Jordanian Rehabilitation Centre (RJRC) King Hussein Medical Centre (KHMC) Amman-Jordan, where all traumatic cases within this centre in addition to a few nontraumatic spinal injury patients are referred to the spinal unit which has a capacity of 30 beds. 151 traumatic SCI patients who were admitted to the spinal unit at RJRC during the period January 1988 to December 1993 were reviewed. The estimated annual incidence was 18 per million population. The majority were predominantly males (85.4%) the male/female ratio was 5.8:1. The mean age at the time of injury was 33 being 30.9 years for males and 34.8 years for females. There were 68% (n = 103) with paraplegia and 32% (n = 48) with tetraplegia (Frankel A-D). The commonest aetiology was motor vehicle accidents (44.4% n = 67), next came bullet injuries (25.8% n = 39), followed by accidental falls (21.2% n = 32). Other causes of SCI, and also the importance of preventive measures are discussed. Language: en

A 50 year old man was undergoing a coronary angiogram in preparation for possible cardiac bypass surgery at Queen Alia Heart Institute (QAHI) in King Hussein Medical Centre (KHMC) in Amman, Jordan. At the end of the procedure, he suddenly developed low back pain and weakness of both lower limbs. Neurological examination revealed incomplete paraplegia below L1 with urinary retention. Urgent MRI scan suggested ischaemia of the lower part of the spinal cord. Literature search revealed that no such complication of this procedure, which is a common investigation in cardiac centres, has, to date, been reported. The possible causes of this patient's paraplegia are discussed.

Ali H Otom, M Rami Al-AhmarRheumatology and Rehabilitation Department, Royal Rehabilitation Centre, King Hussein Medical Centre, Amman, JordanBackground: The purpose of this study was to evaluate the pattern of bone loss and its consequences in a group of spinal cord injury (SCI) patients managed at the Spinal Unit-Royal Rehabilitation Centre, King Hussein Medical Centre, and its correlation with level and extent of injury, age, and time since injury.Methods: Bone mineral density (BMD) was measured by dual energy x-ray absorptiometry at the lumbar spine and femoral neck in a group of patients who had suffered an SCI a mean of 8.6 (range 1–31) years earlier and had completed their medical and rehabilitation program during the period July 2003 to December 2013. The patients were diagnosed to have osteoporosis according to World Health Organization criteria and their fracture risk was estimated from this score using published data. The severity of their spinal injuries ranged from class A to D according to American Spinal Injury Association criteria.Results: Of the 55 patients included in the study, 45 were male and ten were female, with a male to female ratio of 4.5:1. Their mean age was 39.5 (range 13–61) years. Bone loss indicated by low BMD revealed that the femoral region was predominantly affected, with relative preservation of the lumbar spine. Abnormal BMD values were detected in 83.6% of subjects, and fractures occurred in 16.4% following minor trauma. A positive correlation was noted between time since injury and degree of osteoporosis. Individuals with complete lesions showed lower BMD values than those with incomplete lesions. No significant correlation was found with age or sex.Conclusion: SCI patients are at high risk of developing osteoporosis, which can lead to significant morbidity, particularly lower extremity fractures without significant trauma. Prevention and early treatment of bone loss are important in this patient group to avoid further functional impairment.Keywords: osteoporosis, spinal cord injury, bone loss, bone mineral density, American Spinal Injury Association