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Latar belakang. Pola asuh orangtua diduga memiliki hubungan yang kuat dengan perkembangan bahasa dan bicara anak. Tujuan. Penelitian dilakukan untuk menilai hubungan pola asuh orangtua terhadap perkembangan bahasa dan bicara pada anak usia 18-72 bulan serta menilai kesesuaian antara uji Denver II daring dengan uji Kuesioner Pra Skrining Perkembangan. Metode. Penelitian ini dilakukan dengan menggunakan desain penelitian analitik observasional dengan pendekatan potong lintang. Pengambilan data dilaksanakan pada bulan Januari 2021 sampai Juli 2021. Kuesioner dibagikan secara daring kepada orangtua dan dilakukan panggilan video dengan perangkat lunak melalui aplikasi Whatsapp® untuk pemeriksaan Denver II daring dan Kuesioner Pra Skrining Perkembangan. Hubungan antara pola asuh dan perkembangan dianalisis menggunakan uji Chi square (x2), sedangkan uji kesesuaian antara Denver II daring dengan Kuesioner Pra Skrining Perkembangan menggunakan nilai kappa. Hasil. Uji Chi square menunjukan hubungan yang bermakna menggunakan Denver II daring (p=0,00) dan menunjukan hubungan yang tidak bermakna menggunakan Kuesioner Pra Skrining Perkembangan (p=0,84). Nilai kappa antara Denver II daring dan Kuesioner Pra Skrining Perkembangan bernilai 0,49. Kesimpulan. Terdapat hubungan antara pola asuh orangtua terhadap perkembangan bahasa dan bicara pada anak usia 18-72 bulan tahun 2020 serta terdapat kesesuaian yang baik antara Denver II daring dengan Kuesioner Pra Skrining Perkembangan.

Background:. Drains are used in plastic surgery to remove excess fluid while ameliorating complications. However, there is a paucity of evidence supporting guiding parameters on when to discontinue a drain. The aim of our study was to determine whether two of the most common parameters, drain volume 24 hours before removal or postoperative day, are valid indicators for drain removal. Methods:. A retrospective chart review was conducted for surgical operations performed by our division between July 2014 and May 2019. Of the 1308 patients, 616 had a drain and a complete record. Demographics, medical history, operative time, antibiotic use, anatomic site, donor/recipient, and complication type were recorded. Complications were defined as events that deviated from expected postoperative course or required pharmacological/procedural intervention. T-test and Chi square were used to analyze data. Results:. In total, 544 patients were in the no complication group, and 72 were in the complication group. The complication group patients had drains removed later than patients in the no complication group (15.7 days versus 12.5 days, P = 0.0003) and had similar final 24-hour drain volumes versus patients in the no complication group (16.7 mL versus 18.8 mL, P = 0.2548). The complication group had more operations on the pelvis (11% versus 2.1%; P = 0.000017) or thigh (8.5% versus 3.4%; P = 0.029). Conclusions:. Our data suggest neither postoperative day nor 24-hour volume before drain removal are valid indicators for removal. Late removal correlates with more complications; however, persisting output leading to later removal may be predictive of an impending complication rather than delays in drain removal causing the complication.

Background:. High pressure injection injury to the hand with paint leads to amputation rates near 48%. Historically, authors utilized saline irrigation alone, but have high reoperation rates. We conducted a cadaveric study to determine the ideal detergent for effective paint removal from the soft tissue. Methods:. Two cadaveric hands were amputated from the same cadaver. The left and right hand digits were injected with flat white latex-based paint and flat white oil-based paint, respectively. Each digit received a longitudinal incision and was scrubbed for 120 seconds with 50 mL of a randomly assigned detergent and no detergent (saline) as the control. After achieving a lather, each finger was cleansed with 50 mL saline before being evaluated by two blinded hand surgery faculty. Reviewers assessed the washouts as adequate or inadequate, in order to generate a Kappa statistic and measure inter-rater reliability prior to ranking each digit (1 through 5) (ie, 1 = most paint-free soft tissue). Results:. The two hand faculty had an inter-rater reliability of 0.70. Both reviewers ranked povidone-iodine 10% or Johnson & Johnson shampoo as the best irrigant for latex-based paint. In oil-based paint, povidone-iodine 10%, Johnson & Johnson, & Techni-care were ranked as top three. All reviewers reported detergents were better than saline alone. Conclusions:. The addition of detergent created an irrigant that removed both latex- and oil-based paint better than normal saline alone. Based on these results, surgeons treating high-pressure injection injury should consider using Povidone-Iodine 10% or Johnson & Johnson baby shampoo for latex- or oil-based paint.

Purpose: Current guidelines recommend that open reduction internal fixation (ORIF) for distal radius fractures (DRFs) be performed within 4 weeks of injury. Delayed DRF management (4 weeks or more) is traditionally subject to corrective osteotomy. We report a 5-year single-surgeon series of delayed DRFs that were treated by ORIF rather than osteotomy. Methods: We performed a retrospective review on all patients admitted to a single tertiary care center with a DRF requiring ORIF (2007–2012). Institutional review board approval was obtained. Patients were divided into an early group (EG) (surgery less than 4 weeks after injury) and delayed group (DG) (surgery after 4 or more weeks). Data collected included demographics, injury pattern, intraoperative parameters, and pre- and postoperative x-ray findings. Subjective and objective functional data were determined using a Disabilities of the Arm, Shoulder, and Hand questionnaire score and Mayo Wrist Score. Results: A total of 171 patients (EG = 54; DG = 117) underwent ORIF from 2007 to 2012 and met inclusion criteria. Both groups had similar age, gender, and racial demographics. Of these, 117 patients in the delayed group underwent ORIFs at 40 ± 13.9 days (range, 28–146 days) after injury. Preoperative fracture patterns were radiographically equivalent. A dorsal approach was required more frequently in the EG (7.4%) compared with DG (1.1%). The Orbay maneuver was performed at a significantly higher rate in the DG (55.8%) compared with the EG (38.8%). Blood loss, tourniquet times, intraoperative complications, radiographic parameters, articular incongruency rates, and Disabilities of the Arm, Shoulder, and Hand score, and Mayo Wrist Score were not statistically significant between groups. Conclusions: No significant differences were found in intraoperative technique, operative time, postoperative radiographs, and subjective outcome measures in patients treated with early versus late ORIF. Despite the current belief that primary ORIF in delayed DRF is technically impossible and warrants an osteotomy, our series indicates that ORIF is indeed a viable option in DRFs as late as 5 months after injury. Type of study/level of evidence: Therapeutic IV Key words: delayed internal fixation, distal radius fractures

Background: Bone ingrowth into a cementless prosthesis can be achieved by both porous and hydroxyapatite coatings. The purpose of this study was to compare the performance of a hydroxyapatite-coated proximal sleeve and a porous bead-coated sleeve in patients managed with a modular revision hip system.Methods: Between August 1992 and December 1996, fifty-three consecutive femoral revisions performed with an S-ROM stem in fifty-two patients were prospectively randomized at the time of surgery to either a hydroxyapatite-coated or a porous-coated sleeve. All patients were evaluated clinically and radiographically at three months, six months, and yearly for a minimum of two years (average, four years; range, two to 7.5 years). Femoral defects were classified according to the criteria of Paprosky et al. Six patients died and four patients were lost to follow-up, leaving forty-two patients (forty-three hips) as the final study group.Results: For the entire group, two femoral stems, one of which had been implanted in a hip with a Paprosky type-II femoral defect and the other in a hip with a Paprosky type-IIIB femoral defect, required a repeat revision, one for pain and the other for aseptic loosening. Radiographic evidence of bone ingrowth was observed in 96% (twenty-six) of the twenty-seven femora with type-I or II defects and in 81% (thirteen) of the sixteen femora with type-III defects. Femoral component survival, with use of revision as the end point, was 95% at four years for the entire group. The Harris hip scores were not significantly different when stratified by implant type, but were significantly different when stratified by bone loss (p < 0.05). In the femora with type-I or II defects, no difference was detected between those treated with a hydroxyapatite-coated implant and those that received a porous-coated implant with respect to bone ingrowth. However, in femora with type-III defects, the likelihood of the development of bone ingrowth was 2.6 (95% confidence interval, 1.3 to 5.17) times greater in hips that received a hydroxyapatite-coated implant (all eight developed ingrowth) than in hips that had a porous-coated implant (five of eight developed ingrowth) (p = 0.05).Conclusions: Bone fixation was achieved more often with hydroxyapatite-coated sleeves in femora with Paprosky type-III defects, but no significant difference was noted in outcomes between the two implant types when used in bone with type-I or type-II femoral defects. Overall, the S-ROM modular hip stem performed better in femora with type-I or II bone defects than in femora with type-III defects.Level Of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Motor traffic trauma has become a significant denominator of morbidity and mortality statistics in modern Sri Lanka. In 2010, 26,847 were seriously injured, and 2721 people died as a result of road traffic trauma. In 2014, nearly 38,500 road traffic accidents were reported of which 36% were categorized as “critical” with nearly 7% fatalities. Road traffic crashes have increased by 249% between 1977 and 2004. On average, road traffic trauma kills one person in Sri Lanka every 4.5 h. In the 30 year period of 1977–2007 over 40,000 people have died of road traffic trauma with the cost of accidents being estimated at over Rs100 billion. Increased number of vehicles, poor maintenance of road network and improper expansion of roads, less scrutiny in issuing driving licences, inefficiency of authorities in penalizing for road traffic offences and inefficiency of the public transport system are some of the factors identified for increased incidence of motor traffic trauma in the country. Management of motor traffic trauma victims has become a significant burden for health care institutions. Legislation plays a critical role in regulating motor traffic in a country. The Motor Traffic Act of Sri Lanka has undergone many revisions in the recent past to accommodate new provisions to regularize road traffic effectively. However implementation of such provisions is heavily dependent on the rapid and effective action of the police on road traffic offences and awareness and attitudes of courts towards penalizing offenders in view of streamlining the legislation on road traffic.

BACKGROUND: Following natural disasters, mismanagement of the dead has consequences for the psychological well-being of survivors. However, no technical guidelines currently exist for managing mass fatalities following large natural disasters. Existing methods of mass fatality management are not directly transferable as they are designed for transport accidents and acts of terrorism. Furthermore, no information is currently available about post-disaster management of the dead following previous large natural disasters. METHODS AND FINDINGS: After the tsunami disaster on 26 December 2004, we conducted three descriptive case studies to systematically document how the dead were managed in Thailand, Indonesia, and Sri Lanka. We considered the following parameters: body recovery and storage, identification, disposal of human remains, and health risks from dead bodies. We used participant observations as members of post-tsunami response teams, conducted semi-structured interviews with key informants, and collected information from published and unpublished documents. Refrigeration for preserving human remains was not available soon enough after the disaster, necessitating the use of other methods such as dry ice or temporary burial. No country had sufficient forensic capacity to identify thousands of victims. Rapid decomposition made visual identification almost impossible after 24-48 h. In Thailand, most forensic identification was made using dental and fingerprint data. Few victims were identified from DNA. Lack of national or local mass fatality plans further limited the quality and timeliness of response, a problem which was exacerbated by the absence of practical field guidelines or an international agency providing technical support. CONCLUSIONS: Emergency response should not add to the distress of affected communities by inappropriately disposing of the victims. The rights of survivors to see their dead treated with dignity and respect requires practical guidelines and technical support. Mass fatality management following natural disasters needs to be informed by further field research and supported by a network of regional and international forensic institutes and agencies.

Today's patients require additional guidance in their expectations after replacement surgery. Failure rates for shoulder, hip, and knee replacements across most studies are approximately 0.5% to 1% per year, including infection, loosening, and wear of the parts. Elbow and ankle replacements will likely require more restrictions and have slightly higher revision rates.

Outcomes of free vascularized fibular grafting for the treatment of femoral head (FH) osteonecrosis between 1) physicians/health professionals and 2) a comparison group of the population at large was performed. Twenty-one healthcare providers (32 hips) were treated: 10 stage II, 7 stage III, and 15 stage IV were treated over a 13-year period. The control group consisted of 1257 hips: 221 with stage II, 220 with stage III, and 816 with stage IV. All patients were followed for a minimum of 2 years. The end point for failure was conversion to total hip arthroplasty. The physician group demonstrated a high degree of postoperative compliance. The conversion rate to total hip arthroplasty was significantly lower in the physician group (6.25%) compared to the control group (20.6%). Outstanding postoperative compliance appears to be related to favorable outcomes. Further evaluation of failure in both groups may help better understand FH osteonecrosis and improved patient outcomes.

Of nine plant growth regulators (indoleacetic acid, 1-naphthalene acetic acid, gibberellic acid, giberellin 4/7, 6-benzylaminopurine, 6-furfurylaminopurine, abscisic acid, and 1-aminocyclopropane carboxylic acid) tested, only 6-benzylaminopurine and abscisic acid affected (14)C-photosynthate unloading from excised seed coats of Phaseolus vulgaris L. Unloading, in the presence of KCl, was stimulated by 25 to 40%. Stimulation occurred immediately for 6-benzylaminopurine and for abscisic acid within 10 to 12 minutes of application.

An easily constructed photovoltaic method of growth measurement capable of detecting movement occurring a a speed of 1.7 hum min-1 and avoiding physical interference with plant material is described. The application of this method to the measurement of early gravicurvature of nodal segments of Lolium multiforum and peduncle lengths of Taraxacum officinale is outlined and some measurements of lag times together with speeds of early gravicurvature obtained for these gravitropic systems are presented. Other applications of this photovoltaic method are suggested., (Copyright © 1984 Gustav Fischer Verlag, Stuttgart. Published by Elsevier GmbH.. All rights reserved.)