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Neglected or late presenting femoral neck stress fractures are often associated with varus deformity, with potential risks of nonunion and osteonecrosis. We proposed a surgical technique whereby a wedge osteotomy was performed at the basal part of the neck, on the tensile surface, keeping the inferomedial femoral neck as a hinge. The femoral shaft was abducted to close the osteotomy site and it was fixed with three cannulated cancellous screws. Three military recruits who presented with neglected femoral neck stress fracture with varus deformity were operated on with the proposed modified femoral neck valgus osteotomy. All the fractures united without any complications and the patients resumed their professional activity. [ABSTRACT FROM AUTHOR]

Abstract: Background: Femoral neck fractures in young adults is an unsolved problem and neglected femoral neck fractures presents more challenge to the orthopaedics surgeon if femoral head salvage is attempted. We reviewed the operative results of neglected femoral neck fractures in young adults with fixation with dual fibular bone grafting Purpose of study was evaluation of epidemiological, clinical, functional, rehabilitative outcome and complications in such patients. Methods: Twentyeight patients in age group 18–50 years were operated having fracture neck femur by dual fibular bone grafting in the Department of Orthopaedics, S.N. Medical College, Agra in (May 2005–February 2008) and divided into two groups. Group A: comprised of 8 patients treated by dual fibular bone grafting alone and Group B: comprised of 18 patients treated by dual fibular bone grafting with single cancellous hip screw. Results: All the patients of the present series were having neglected intracapsular fracture, neck femur which were treated by dual fibular bone grafting with or without cancellous hip screw fixation. Majority of the patients had good to fair result according to Larson method with average time of union 16 weeks. All patients had useful range of movement at hip. Satisfactory union was achieved in all patients except two. Conclusion: Double bone grafting is a simple and cost effective modality of treatment for late femoral neck fracture with good results. It is a stable and biological method of fixation with preservation of natural femoral head with fewer complications. [Copyright &y& Elsevier]

Abstract: Background: Femoral neck fractures in young adults have always presented a difficult problem with high rates of non-union and avascular necrosis. At our centre we have been using the traditional Pauwels intertrochanteric osteotomy for neglected un-united femoral neck fractures in young adults. We have made certain modifications in this procedure to suit our resources and so we evaluated the outcome of this procedure at our institute. Methods: The study included fifty consecutive cases of neglected femoral neck fractures treated at our centre between February 1996 and October 2012. Patients in whom internal fixation had failed were excluded. The average age of the patients was 37 years (range: 17–55 years). Eleven of the patients were female & Thirty-nine were male. Fifteen patients belonged to Pauwels grade 1, Twenty-six patients belonged to grade 2, and nine belonged to grade 3. The interval between the injury and operation ranged from 1 to 12months (average: 4.3 months). The cases were operated on a normal table using a Watson Jones Approach. The fracture ends were freshened and fixed using a 6.5mm screw followed by a valgus osteotomy which was fixed by a double angle (120 degree) blade plate. Results: A fracture union rate of 90% (45 cases) was achieved. Two of the healed cases developed avascular necrosis. Results were graded using Askin and Bryan's criteria. Overall, an excellent result was seen in 35 patients, good in 5, fair in 5 and poor in 5. Of the five patients having poor result (3 non-union, 1 implant breakage, 1 implant cut out), two refused revision surgery. In remaining three, one underwent total hip arthroplasty and in two revision osteotomy was performed. Conclusion: We believe that intertrochanteric osteotomy provides a good outcome for neglected femoral neck fractures. Performing the procedure on a routine table, with Watson Jones approach and fixing with double angle blade plate is a good option. [Copyright &y& Elsevier]

Abstract: Isolated absence of the patella is an extremely rare condition. Absence or hypoplasia of the patella is usually associated with genetic disorders and lower limb malformations. In this paper, an isolated absence of the patella without any other deformities is described. A 21-year-old male patient referred to our clinic presented with walking difficulty in the past 6 months and deformity of both knees. Except for these complaints, he had no problems. Isolated aplasia of the patella may cause no major dysfunction, and surgical or major treatment is not always required. The most interesting point of this case is that the patient had not experienced any complaints for over 20 years, nor was he aware of his knee deformity. This appears to be the first report of neglected bilateral patellar aplasia in a 21-year-old male patient. [Copyright &y& Elsevier]

A global interest in therapies for neglected diseases is rising, but traditional biopharma research and development ( R& D) process is prohibitively expensive to justify cost of their development. Vitiligo is a multifactorial orphan disease that affects at minimum 35 million people worldwide, yet no therapeutic solutions exist. The present authors describe a budget-minded pursuit of the new therapy development for vitiligo, which includes a multidiscipline collaboration and effective bridging between academic research, biobanking, and bioinformatics. The present authors anticipate that the present authors' 'theoretically induced and empirically guided' discovery process will enable development of more leads, with a much greater probability of success and under tighter budgets compared with those of the biopharma company. Ultimately, the multidisciplinary approach described below facilitates the collaborative development of personalized treatments for different patient subpopulations in vitiligo and other neglected diseases. [ABSTRACT FROM AUTHOR]

Children are prone to injury with foreign bodies, partly due to their ebullient nature. They may not always give an accurate history, which can lead to delay in diagnosis and treatment. Primary care givers need to be vigilant in eliciting a history of foreign body injury in children. Radiologists should be aware that a neglected foreign body lying close to the bone in the distal femur can evoke a massive periosteal reaction, which can mimic a bone neoplasm. Although metallic foreign bodies are detected with ease on radiographs, detection of wooden foreign bodies remains a challenging task for both the radiologist and the care-giving physician. Wood foreign bodies may induce errors in diagnosis. The paper includes an analysis of the different radiographic methods currently available and their main features. This report would be of relevance to primary care physicians, those concerned with trauma care, and for radiologists who screen for these injuries. [ABSTRACT FROM AUTHOR]

Introduction: Management of neglected perilunate dislocations is controversial. The various procedures such as open reduction and internal fixation (ORIF), proximal row carpectomy, lunate excision, and wrist arthrodesis have been advocated. The aim of our study was to evaluate the functional outcome of neglected perilunate dislocations managed by ORIF. Materials and Methods: Over a period of 10 years (1996 to 2006), 14 patients with neglected perilunate dislocations (undiagnosed or untreated for 6 weeks or more) were managed by ORIF. Six patients had dorsal trans-scaphoid perilunate dislocation, 6 patients had volar lunate dislocation while the remaining two had a dorsal perilunate dislocation The results were evaluated by clinical scoring system of Cooney et al. Results: The average followup was 4.1 years (range 2-12 years). All except one of the patients operated earlier than 5 months had good results. Of the four patients operated after 5 months, two had a fair result while two had a poor outcome. Chondral damage to the capitate was noted intraoperatively in both the cases with poor outcomes. The two patients were found to have avascular necrosis (AVN) of the lunate; however, functional outcome was fair in both, and both were able to return to their profession. Conclusion: We observed favorable functional results of ORIF in neglected perilunate dislocations up to 5 months after injury. The development of AVN or midcarpal arthritis was not a major disabling factor as long as stability of wrist has been restored. Beyond 5 months, an alternative surgical procedure such as proximal row carpectomy should be contemplated as results of ORIF have not been good uniformly. [ABSTRACT FROM AUTHOR]

This is a rare case report of persistent PIN palsy following a case of neglected Monteggia fracture dislocation in a 7-year-old boy. The patient had presented with prominence around the elbow and inability to abduct the thumb, extend the thumb at interphalangeal joint, and inability to extend the fingers at the metacarpophalangeal joints. The index procedure of ulnar osteotomy and closed reduction of radial head did not yield satisfactory results; subsequently, patient underwent a second surgery for open reduction of radial and exploration of the PIN with simultaneous sural nerve grafting. To the best of our knowledge, this is the first case from India describing the use of sural nerve as a cable graft for neglected Monteggia fracture dislocation with nerve palsy. [ABSTRACT FROM AUTHOR]

Abstract: Background: Neglected ruptures of the tendoachilles pose a difficult surgical problem. There are no data to determine the optimal positioning of the FHL tendon to the calcaneus. Methods: Two computer programmes (MSC.visualNastran Desktop 2002™ and Solid Edge® V19) were used to generate a human ankle joint model. Different attachment points of FHL tendon transfer to the calcaneus were investigated. Results: The lowest muscle force to produce plantarflexion (single stance heel rise) was 1355N. Plantarflexion increased for a more anterior attachment point. The maximum range of plantarflexion was 33.4° for anterior attachment and 24.4° for posterior attachment. There was no significant difference in range of movement when the attachment point was moved to either a medial or lateral position. Conclusions: A more posterior attachment point is advantageous in terms of power and the arc of motion (24.4°) is physiological. We recommend that FHL is transferred to the calcaneus in a posterior position. [Copyright &y& Elsevier]

Abstract: The aim of this study was to evaluate the results of valgus osteotomy in patients with neglected or failed internal fixation of intracapsular fracture neck femur. Thirty patients in the age group from 17 years to 55 years were treated with valgus osteotomy and fixation with double angled blade plate. One additional 6.5 mm cannulated cancellous screw was also used. The average duration between injury and surgery was 11.3 weeks. The union at fracture site was achieved in 26 patients at an average period of 22 weeks. The union at osteotomy site was achieved at 8.6 weeks. The osteotomy site united in all cases. The complications of surgical procedure included 2 cases of blade cut through, 2 cases of joint penetration, 4 cases of avascular necrosis and 2 cases of nonunion. There was one case of superficial infection which was controlled by antibiotics. The results were clinically graded using and Harris hip score which was good to excellent in 80% of cases, fair in 7%, and poor in 13% of cases. Valgus intertrochanteric osteotomy for neglected or ununited intracapsular fracture of neck of femur and its fixation with double angled blade plate gives satisfactory results in most cases. [Copyright &y& Elsevier]

Neglected dislocations of the hip are uncommon and open reduction is usually followed by avascular necrosis and subsequent coxarthrosis. We present a rare case of neglected, locked, obturator type of inferior hip dislocation in a young adult presenting 6 months after initial trauma treated with a cementless total hip arthroplasty which, to the best of our knowledge, has not been reported previously. Technical aspects of total hip arthroplasty and other treatment options in this scenario are discussed. [ABSTRACT FROM AUTHOR]

The paper signifies research findings regarding Street Children in Pirwadhai, Rawalpindi, in the province of Punjab, Pakistan. This study explains the changing family structures due to which children are compelled to leave their homes and adopt the life as street children. It was noticed that troubled family were the main factor behind pushing the children to the street. Such infighting deprived children from basic needs and making them vulnerable to street threats. Such families abandon their children and they remain devoid of social nurturing which is the first step for the child to be accepted in the society as a respectable member. When street children were denied of their basic needs for a long period they reacted in an antagonistic and insensitive way towards social values in general and family set up in particular. As a result they run away from their homes and fall into the hands of criminal elements. This study depicts, inter-alia, street children's life in terms of their family milieu, the course of action to take to street life and their experiences on the street. [ABSTRACT FROM AUTHOR]

Abstract: Neglected elbow dislocation is a rare injury but is still frequent in our country. Authors report 12 cases of neglected elbow dislocation with stiffness in extension. All patients were treated by open reduction using a posterior approach and plasty of tricipital tendon. Authors describe the interest of the posterior approach for treatment of neglected elbow dislocation with stiffness in extension. [ABSTRACT FROM AUTHOR]

The purpose of this research was to establish the existence of gender differences in peers relationships and their relationship to prosocial and antisocial behavior at elementary, secondary and university education. Participants were 464 children and young people from primary school (n = 140), high school (n = 200) and university (n = 124) from different public and private educational institutions in the city of Valledupar (Colombia). The information about the peers relationship and prosocial and antisocial behavior were collected through peer nominations. We found that female tends to be more popular, whereas the male gender seems to be more rejected and excluded. Moderate correlations were found between prosocial and antisocial behavior and social preference and social impact. It was also found that women are more prosocial and have greater social preference in elementary, but the trend changes at the university, where men have a higher social preference and are more prosocial. [ABSTRACT FROM AUTHOR]

Background: Chronic rupture of the Achilles tendon is a surgical challenge, owing to the presence of a gap between the retracted ends, which renders direct repair almost impossible. Purpose: In this study, 2 intratendinous distally based flaps fashioned from the proximal gastrocnemius-soleus complex are used to bridge the gap between the retracted edges of the ruptured Achilles tendon. The flaps are placed in the same line of pull of the ruptured tendon, in an effort to make the graft mimic the original biomechanics as much as possible. Study Design: Case series; Level of evidence, 4. Methods: Eleven patients (9 male and 2 female) with neglected ruptures of the Achilles tendon with retracted ends were included in this study. Two flaps fashioned from the proximal gastrocnemius-soleus complex were rotated over themselves, passed through the proximal stump, and then securely inserted into a previously prepared bed in the distal stump. Results: The patients were followed up for a period of 6 to 9 years. At the final follow-up, all patients were able to return to their preinjury level of activity within a period of 6 to 9 months. The mean preoperative American Orthopedic Foot and Ankle Society score was 42.27, whereas it was 98.91 at the final follow-up, with a range of 88 (in 1 patient) to 100 points (in 10 patients). All 11 patients showed statistically significant improvement according to the Holz rating system. Conclusion: This technique allows for a bridging of the defect present in chronic ruptures of Achilles tendons, with a minimum of complications and a good final outcome. [ABSTRACT FROM AUTHOR]

Abstract: The standard treatment for breast cancer patients with untreated locally advanced breast cancer is neo-adjuvant chemotherapy or hormonal treatment. In some cases, this treatment is followed by surgery and/or radiotherapy when the multidisciplinary approach is present. In some cases of patients presenting metastatic diseases, the radiotherapy is forgotten or proposed late when the local disease is extremely advanced with symptoms and decreased quality of life. Two cases of extremely advanced non operable T4 stage breast cancer are reported and the importance of multidisciplinary approach is discussed. The place and the right time of radiotherapy in this multidisciplinary strategy is reported. [Copyright &y& Elsevier]

Chronic Achilles tendon ruptures are often challenging to repair because of muscle and tendon atrophy, retraction, and short distal stumps. We undertook a retrospective investigation of 14 patients who were treated with the Ligament Advanced Reinforcement System (LARS) ligament for the treatment of chronic, neglected rupture of the Achilles tendon. The patients pursued a course of early functional rehabilitation, and postoperative outcome scores were obtained at 3, 6, and 12 months, based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scoring system, and the Tegner Activity score. The minimum duration of follow-up was 36 months. After a minimum of 28 months postoperative, and up to 41 months postoperative, there was no observed incidence of rerupture or recurrent pain. The mean time to return to full activity was 18.3 ± 2.7 weeks, and >90% of the patients scored ≥80 points on the AOFAS scoring scale. Specifically, the mean AOFAS score increased from 48.64 ± 12.67 to 85.86 ± 6.6 after the operation, and this difference was statistically significant (P = .001). Furthermore, the Tegner activity scale score improved from 2.58 ± 0.31 to 1.73 ± 0.29 after the operation, and this difference was also statistically significant (P = .001). The results of this retrospective clinical study suggest that augmentation with the LARS ligament offers a satisfactory reconstructive option for the neglected Achilles tendon rupture. Level of Clinical Evidence: 4 [Copyright &y& Elsevier]

Posterior dislocation of the shoulder is an unusual injury that most often occurs secondary to a highenergy trauma. Unfortunately the diagnosis is commonly missed, thus making its treatment a challenge. Neglected posterior dislocation is mainly characterised by an impression fracture on the anterior articular surface of the humeral head, which makes the dislocation often difficult to reduce. Diagnosis is based upon a careful history assessment, physical examination and radiological findings. Several treatment approaches have been described. The modified MacLaughlin procedure in our hands has been shown to be a reproducible technique allowing good results at medium- and long-term follow-up. According to our experience it is possible to adopt this technique also in patients with a locked posterior dislocation older than 6 months or in cases with a humeral head defect up to 50% when a shoulder prosthesis is not a good indication. Poorer results should be expected in patients with an associated fracture of the proximal humerus. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic had serious impact on health care sector. During reprioritisation of the services, elective and non-emergency procedures were suspended, with gradual resumption of services after lockdown was over. In this study we assessed the impact of pandemic on our clubfoot program at a tertiary care institute. Also, we discussed the future challenges and strategies to re-start our clubfoot program. Data was collected retrospectively regarding registrations, demography and procedures done at our clubfoot centre. Study period was 25 March to 31 December 2020 and it was compared with same duration from previous years 2019 and 2018. After the data analysis, the findings were discussed on departmental committee meeting, future challenges were considered and strategies were charted out for re-establishing the clubfoot program at our Institute. When compared to previous year, we noted 46% decline in paediatric outpatient registrations and 60% decline in new clubfoot registrations at our centre. The clubfoot follow-up visits reduced by 30% in the pandemic year 2020. 80% of clubfoot registrations were local residents during pandemic year, which was 54%, 58% in year 2019 and 2018 respectively. The percentage of neglected cases remained stable, however, share of relapse cases increased during pandemic year. There was 80% decline in number of tenotomies and 90% decline in other clubfoot surgeries performed during pandemic year 2020 compared to year 2019. COVID-19 pandemic had definite disruptive impact on our clubfoot program. With decreased new registrations, follow-up visits and increased relapses, we anticipate a significant increase in clubfoot cases in need of casting & treatment. To deal with pent-up demand and an anticipated wave of relapse and neglected clubfoot cases, we have proposed strategies to re-establish clubfoot program in post-pandemic new-normal. We hope these will prepare us for any adversaries we face. [ABSTRACT FROM AUTHOR]

Background: Neglected femoral neck fracture in adults still poses a formidable challenge. Existing treatment options varies from osteotomy (with or without graft) to osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularized, and nonvascularized fibula). The aim of this study was to assess outcome of nonvascularized fibular strut graft and cancellous screw fixation in neglected femoral neck fractures in the younger age group. Materials and Methods: Medical records of 32 patients of neglected femoral neck fracture, in the age group of 22-45 years (mean 37.8 years), operated between May 1994 to December 2001, were retrospectively reviewed. After the application of inclusion and exclusion criteria, 28 patients having three years minimum follow-up (mean 4.6 years) were included. Delay between injury and operation varied from four weeks to 42 weeks (mean 16.4 weeks). Closed reduction was achieved in 17 patients; open reduction through Watson-Jones anterolateral approach was performed in the remaining 15 patients in whom closed reduction failed. The fracture was transfixed with three parallel guide wires. Appropriate sized cannulated lag screw (7 mm) was then inserted in two of the wires. Selection of the third guide wire for fibula depended on the space available in both anteroposterior and lateral view. Results: Satisfactory bony union was obtained in 25 patients, of whom in four cases, the union occurred in 10-20° (mean 15°) of varus. Nonunion occurred in three patients (9.37%), and aseptic necrosis occurred in another six patients (18.75%). Of the 25 patients where union was achieved, five patients showed excellent results; 14 good and six had poor functional result, as evaluated using modified Anglen criteria. Conclusion: Nonvascularized fibular strut graft along with cancellous screws provides a dependable and technically less-demanding alternative procedure for neglected femoral neck fractures in young adults. Fibula being cortical provides mechanical strength besides stimulating the union and getting incorporated as biological graft. [ABSTRACT FROM AUTHOR]

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components. [ABSTRACT FROM AUTHOR]

We describe an adult patient with traumatic, nonunion of ulna sustained at 11 years of age who presented with wrist deformity. The possible pathogenesis, differential diagnoses and its successful management are described. A 23-year- old right hand dominant male presented with a progressive wrist deformity of his right upper limb. At 11 years of age, he sustained an isolated open fracture of the right forearm. He had nonoperative treatment. He had 60° of ulnar deviation at wrist. He had no pain in the wrist or elbow. He was able to do all activities using his right upper limb. Radiograph revealed a nonunion of ulna in mid-shaft. The radius was bowed. Radiographs at the time of injury revealed a displaced both bones forearm fracture in mid-shaft. He underwent open reduction, internal fixation of ulna with bone grafting and a corrective osteotomy of the radius. The contracted Extensor carpi ulnaris was Z lengthened. Seven months postoperative, both the nonunion of ulna and radius osteotomy were consolidated. The wrist had no deformity. He had returned to preoperative activity level. Though nonunion is rare in pediatric forearm fractures, asymmetric bone and soft tissue growth can lead to deformities even in the absence of physeal injury. In addition to the standard treatment of nonunion, maintenance of the relative lengths of radius and ulna is essential, to obtain optimum function. [ABSTRACT FROM AUTHOR]

Abstract: The research shows that there are presently about a half million children in foster care, and approximately 20,000 of these youths will turn eighteen years of age, be classified as adults and emancipate or “age out” of the foster care system each year. The capacity to graduate from high school is often difficult and challenging for foster children. Typically, foster children have no continuity in their high school educational experience. These children will attend several high schools before they graduate, and if they move during the school year, classes will be frequently interrupted by changes—often requiring them to move when classes are in session. They will also have no consistency in the development of their educational plan of study because they will see several guidance counselors who mostly will be unfamiliar with the foster child''s social history, background and ability. Foster children will also frequently experience breaks in their direct instruction requiring them to adjust to different teachers, courses, school rules, and expectations. This article addresses and answers the following two questions: (1) “Why do foster children have difficulty after they leave high school?” and (2) “What can be done to help Foster Children Make a More Successful Transition to an Independent life? [Copyright &y& Elsevier]

Neglected Achilles tendon rupture injuries present surgical challenges because of the quality and quantity of tendon tissue during repair combined with the magnitude of mechanical forces placed on this tendon. The purpose of this study was to evaluate the effects of an acellular human dermal tissue matrix, GRAFTJACKET, as an augmentation material in neglected Achilles tendon repair. Nine patients with neglected Achilles tendon ruptures were evaluated and followed up for a minimum of 20 months. Primary repair was followed by augmentation with the graft and suturing circumferentially around the tendon. Patients were placed in an early, functional rehabilitation program with postoperative evaluation at 3, 6, and 12 months. Outcome scores were calculated based on the American Orthopaedic Foot and Ankle Society ankle-hindfoot scoring system. At 20 to 30 months postoperative follow-up range, there has been no incidence of re-rupture or recurrent pain. The average return-to-activity time was 15.2 ± 1.7 weeks. The results from this retrospective clinical series suggest that using an acellular human dermal tissue matrix to augment neglected Achilles tendon rupture primary repair offers desirable return-to-activity time points and viable surgical alternative over previously reported surgical options. [Copyright &y& Elsevier]

Multiple surgical techniques for repair of neglected Achilles tendon ruptures have been described in the literature. The authors present a case using a freeze-dried Achilles tendon allograft for repair of a neglected rupture of the Achilles tendon with a defect of 10 cm. At 1-year follow-up, the patient achieved pre-injury functional use of the affected limb. [Copyright &y& Elsevier]

Abstract: Shoulder neglected anterior dislocation is a rare event and intolerated in young patients. We report a case of shoulder antero-medial dislocation among 15 years. It was a woman aged 35, who had a left shoulder trauma with an unnoticed antero-medial dislocation. Fifteen years later, the patient presented an inesthetic deformity with presevating function. The Rowe and Zarsins score was good. The radiographs showed the humeral neack in a neo-cavity of the joint associated to Malgaine lesion with an advanced arthrosis of the joint. [Copyright &y& Elsevier]

Patients presenting late for treatment of clubfoot deformity are still common in many parts of the world. These feet are often rigid and severely deformed. Surgical correction is the prevailing option to attain a plantigrade foot, and the extent of correction required predisposes to wound-healing problems. We present the results of treatment of 15 patients (21 feet) with severe, untreated congenital talipes equino varus, who underwent operations using a double zigzag incision as a single-stage procedure. These patients ranged in age from 6 months to 4 years and presented late, having received no treatment or inadequate treatment since birth. The desired end point of the study was a fully corrected foot with a wound that would heal primarily without complications. The etiology was isolated congenital talipes equino varus in 11 patients and arthrogryposis multiplex congenita in 4 patients. Eleven patients were boys and 4 were girls; 6 patients underwent bilateral procedures. The patients were graded preoperatively and postoperatively using the Dimeglio classification, with 10 feet classified preoperatively as grade 3 and 11 graded as grade 4. Desired correction was achieved in all feet, and all wounds healed uneventfully with no complications. This single-stage technique is very safe and cost-effective and is an easy alternative to standard techniques for dealing with late-presenting untreated severe clubfoot deformities. [Copyright &y& Elsevier]

Abstract: Elbow dislocations in the infant are not very frequent and are associated to the fractures. Their management must be urgent and rigorous if complications are to be avoided. We report the case of a child aged 12 who presented with a fracture-dislocation of the right elbow, after falling from a tree. The patient was treated in a standard manner for one month. Four months later, the patient presented again, this time complaining of stiffness of the elbow. Physical examination confirmed the reduced range of movement of the elbow (flexion 80°, extension –30°) without associated neurovascular complication. Radiography of the elbow showed a posterior dislocation with remodelling of the humeral contours. Surgical exploration revealed normal articular cartilage, a pseudoarthrosis of the epitrochlea, a dislocation of the radial head and the sigmoid fossa of small size in relation to the trochlea. A reduction was only possible after an "enlargement plasty" of the trochlear notch. The patient was seen after an interval of six months. The elbow was stable with no vasculo-nervous complication.and had flexion of 110° with extension of –30°. [Copyright &y& Elsevier]

We evaluated eight patients after delayed treatment of nine metacarpal bone defects due to gunshot injuries. The mean length of the metacarpal defects was 3 cm and the average time between the gunshot injury and the reconstruction surgery was 10 months. Although all of the patients had been treated with wound irrigation and debridement immediately following injury, no attempt had been made to repair the metacarpal defect or to maintain metacarpal length. As a result, serious shortening had occurred. After the original length of the metacarpal had been restored by distraction of the soft tissues (1 mm/day), a tri-cortical iliac bone graft was inserted into the bone defect. The average follow-up time was 15 months. Clinical and radiological union was established in all cases after an average of 12 weeks. The mean grip strength of the hand and the mean range of motion of the metacarpophalangeal joint increased by 24% and 60%, respectively. [ABSTRACT FROM PUBLISHER]

Monteggia fracture is characterized by radial head dislocation combined with proximal ulnar fracture. If not diagnosed at an early stage, these lesions can gradually lead to forearm deformities and dysfunction, finally resulting in neglected Monteggia fracture. When the radial head is not reduced, several deformities develop at the humeroradial joint, including cubitus valgus and osteoarthritis. Adequate radiographs are crucial when the surgeons deal with forearm injuries. At present, proximal ulnar osteotomy and open reduction of chronic radial head dislocation provides satisfactory functional outcomes because of anatomic alignment reconstruction. Supplementary procedures, including transcapitellar pinning and repair or reconstruction of the annular ligament, which are performed in order to enhance stability of the humeroradial joint, should be thoroughly assessed based on joint rotational stability after reduction and on potential complications.

Background: Schistosomiasis among migrant populations in Europe is an underdiagnosed infection, yet delayed treatment may have serious long-term consequences. In this study we aimed to characterize the clinical manifestations of Schistosoma infection among migrant women, and the degree of underdiagnosis., Methods: We carried out a prospective cross-sectional study among a migrant population living in the North Metropolitan Barcelona area and coming from schistosomiasis-endemic countries. We obtained clinical, laboratory and socio-demographic data from electronic clinical records, as well as information about years of residence and previous attendance at health services. Blood sample was obtained and schistosomiasis exposure was assessed using a specific ELISA serological test., Results: Four hundred and five patients from schistosomiasis-endemic regions were screened, of whom 51 (12.6%) were female. Seropositivity prevalence was 54.8%, but considering women alone we found a prevalence of 58.8% (30 out of 51). The median age of the 51 women was 41.0 years [IQR (35-48)] and the median period of residence in the European Union was 13 years [IQR (10-16)]. Schistosoma -positive women ( N = 30) showed a higher prevalence of gynecological signs and symptoms compared to the seronegative women (96.4 vs. 66.6%, p = 0.005). Among seropositive women, the median number of visits to Sexual and Reproductive Health unit prior to diagnosis of schistosomiasis was 41 [IQR (18-65)]., Conclusion: The high prevalence of signs and symptoms among seropositive women and number of previous visits suggest a high rate of underdiagnosis and/or delayed diagnosis of Schistosoma infection, particularly female genital schistosomiasis, among migrant females., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Roure, Pérez-Quílez, Vallès, Valerio, López-Muñoz, Soldevila, Torrella, Fernández-Rivas, Chamorro and Clotet.)

Anterior shoulder dislocations are the most common major joint dislocations encountered in the emergency departments and fractures of proximal humerus can accompany with dislocations. Although the treatment of acute isolated traumatic anterior shoulder dislocation is generally simple, the treatment of neglected fracture-dislocations becomes more complicated. In this report, a 22-year-old male patient who had posttraumatic locked, shoulder fracture-dislocation is presented. Open reduction and internal fixation was performed because the injury had occurred 3 weeks ago and the humeral head was locked on the anterior rim of glenoid. At sixth month post-operative follow-up, it was seen that the fracture had united and there was no radiological evidence of avascular necrosis. Neglected, locked anterior fracture-dislocations should be managed thoughtfully by open reduction and internal fixation with consideration of the risk for avascular necrosis. [ABSTRACT FROM AUTHOR]

Background: Due to the complexity of retrieving skin-dwelling microfilariae, filarioids of dogs presenting dermal microfilariae (e.g. Cercopithifilaria spp., Onchocerca lupi) are relatively unknown compared to Dirofilaria spp. and Acanthocheilonema spp. whose microfilariae circulate in the blood. Although Cercopithifilaria spp. and O. lupi filarioids are distributed worldwide, there is a paucity of information on their occurrence in Iran. The aim of this study was to investigate these filarioids in a large population of dogs from different regions of Iran., Methods: From October 2018 to September 2020, skin biopsies were obtained from dogs housed in shelters (n = 557) and privately owned dogs (n = 26) in seven provinces of Iran (Hamedan, Kermanshah, Yazd, Mazandaran, Khuzestan, Lorestan, Esfahan), as well as from three road-killed jackals (Canis aureus) and three cats (Felis catus) in Hamedan province. The skin biopsies were first soaked in saline solution at room temperature overnight, and examined for dermal microfilariae under the microscope. Positive skin specimens and sediments were tested by PCR for a 304-bp region of the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene and amplicons were sequenced., Results: Microfilariae of Cercopithifilaria spp. were found in skin biopsies of 32 of the 583 (5.5%) dogs tested, with infection rates of up to 25% in Kermanshah. No microfilariae were recovered from skin biopsy samples collected from dogs in Khorramabad and Ahvaz, nor from the examined jackals and cats. None of the privately owned dogs were found to be infected. Morphologic and morphometric characteristics of the microfilariae were consistent with C. bainae. Eighteen skin samples were positive for the cox1 gene, of which 15 sequences showed a nucleotide identity of 100% and three of 93.4% with the reference sequence of C. bainae available in GenBank (haplotype I; GenBank accession number: JF461457)., Conclusions: The data from this study broadens current knowledge on the geographical distribution of C. bainae in dogs in Middle Eastern countries. Further studies on different wild canine species in the country (e.g. jackal, fox, wolf) could provide further information on the epidemiology of these filarioids. A particular focus should be put on zoonotic O. lupi given the reports of its presence in human patients from this country., (© 2022. The Author(s).)

Low- and middle-income countries (LMIC) have suffered from long-term health system deficiencies, worsened by poor living conditions, lack of sanitation, a restricted access to health facilities and running water, overcrowding, and overpopulation. These factors favor human displacement and deepen marginalization; consequently, their population endures a high burden of infectious diseases. In this context, the current epidemiological landscape and its impact on health and economic development are not promissory, despite the commitment by the international community to eradicate neglected tropical infections - especially tuberculosis and malaria, by 2030. Neglected and (re)-emerging infectious diseases affecting the central nervous system (CNS) are a major public health concern in these countries, as they cause a great morbidity and mortality; furthermore, survivors often suffer from severe neurological disabilities. Herein, we present a retrospective review focused on some neglected and (re)-emerging infectious diseases, including neurocysticercosis, malaria, rabies, West Nile virus encephalitis, tuberculosis, neuroborreliosis, and SARS-CoV-2 in LMIC. A retrospective review of studies on selected neglected and (re)-emerging infectious diseases in LMIC was performed, including reports by the World Health Organization (WHO) published within the last five years. Data on infection by SARS-CoV-2 were provided by the John Hopkins University Coronavirus Resource Center. CNS neglected and (re)-emerging infectious diseases remain as important causes of disease in LMIC. An alarming increase in the prevalence of malaria, tuberculosis, and cysticercosis is observed in the region, compounded by the recent COVID-19 pandemic. The WHO is currently supporting programs/efforts to cope with these diseases. Herein, we highlight the epidemiological burden of some CNS infections in LMIC, and their clinical and neuroimaging features, to facilitate an accurate diagnosis, considering that most of these diseases will not be eradicated in the short term; instead, their incidence will likely increase along with poverty, inequality, and related socioeconomic problems., Competing Interests: Competing interests statement The authors declare that no conflict of interest exists., (Copyright © 2016 - 2021 InfezMed.)

Background: The importance of health policy implementation cannot be overemphasized in contemporary public health. Neglected Tropical Diseases (NTDs) have negatively impacted society, affect quality of life and make the poor societies poorer. Several policies and strategies have been put in place across the world including the neglected tropical diseases programme in Ghana. Though chalked many successes, the programme continues to lag behind in the full attainment of various objectives. Several factors exist that determine how effective a programme is implemented. Identification of these factors on every programme is essential to determine where more programme resources need to be channelled. This study assessed the determinants of successful implementation of the neglected tropical diseases programme in Ghana., Methods: A qualitative approach with the case study design was employed. Purposive and snowball sampling techniques were used to identify key programme officers at the national, regional and district levels of programme implementation. Eighteen (18) Key informant interviews were conducted at all the three levels of the Ghana Health Service NTDs programme. Data were thematically analysed and presented., Results: Findings from the study revealed that determinants that influenced the successful implementation of the NTDs programme include donor support, education and training, partnerships, reliability of the health structure, integrative nature of the programme and management commitment. These determining factors cut across the inner settings of the implementing agency and the external environment., Conclusion: Neglected tropical diseases continuously affect Ghanaians, especially the poor. It is important for both policy makers and implementers to identify the factors that ensure the success of the programme in the Ghanaian context. Though the factors are independently sufficient, they synergistically lead to improved programme implementation. Empowering all units involved (local to national level) and maximizing the enabling factors identified to would improve upon implementation and ensure sustainability., (© 2021. The Author(s).)