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Abstract Background Perennial malaria chemoprevention (PMC) is a chemoprevention strategy endorsed by the World Health Organization (WHO) and is increasingly being adopted by National Malaria Programmes. PMC aims to reduce morbidity and mortality caused by malaria and anaemia in in young children through provision of antimalarial drugs at routine contact points with the local health system. This study aims to evaluate the impact of the programmatically-implemented country-tailored PMC programmes targeting children up to two years of age using sulfadoxine-pyrimethamine (SP) on the incidence of malaria and anaemia in children in Cameroon and Côte d’Ivoire. Methods We will assess the impact of PMC using passive and active monitoring of a prospective observational cohort of children up to 36 months of age at recruitment in selected study sites in Cameroon and Côte d’Ivoire. The primary and secondary outcomes include malaria, anaemia and malnutrition incidence. We will also conduct a time-series analysis of passively detected malaria and anaemia cases comparing the periods before and after PMC introduction. This study is powered to detect a 30% and 40% reduction of malaria incidence compared to the standard of care in Cameroon and Côte d’Ivoire, respectively. Discussion This multi-country study aims to provide evidence of the effectiveness of PMC targeting children in the first two years of life on malaria and anaemia and will provide important information to inform optimal operationalization and evaluation of this strategy. Trial Registration Cameroon - NCT05889052; Côte d’Ivoire - NCT05856357.

A single specimen of a rare species of armored searobin, Paraheminodus kamoharai Kawai, Imamura et Nakaya, 2004, is recorded from Taiwan, South China Sea, for the first time. While this particular species has been recorded in the Philippines and Japan, it has never been found in Taiwan. Therefore, our specimen fills the distribution gap of this species in the western Pacific Ocean. A detailed description of the specimen is provided and compared to the data of type specimens. Additionally, a checklist of species recorded from Taiwan is provided. Currently, 20 peristediine species under six genera are recorded from Taiwan’s EEZ.

Interventions in Africa designed to stop biodiversity decline have often failed because they were based on a top-down approach to management and focused on enforcing restrictive rules and imposing bans. They were equally misaligned with the values and needs of local actors. This paper presents an African perspective on the discourse regarding the bushmeat crisis and shows that bushmeat in Africa goes beyond being a source of livelihood, having a multifaceted use that must be considered when designing interventions. We show that current conservation initiatives often do not address the right issues, by neglecting nonmonetary dimensions of bushmeat use, inadequately planning interventions, failing to align wildlife laws with realities on the ground, and carrying out ineffective law enforcement characterized by poor governance and corruption. We recommend a revision of current legal frameworks to enhance local ownership, tenure rights, and the sustainable economic empowerment of local communities to reduce hunting. We also call for development of regionally led innovative programs that invest in nature-based solutions and payments for environmental services. Finally, we identify where more research is needed to understand why wildlife use in Africa is overlooked in national development policies and not considered in national accounting.

Sameer A Alkubati,1 Salman Hamdan Alsaqri,1 Gamil G Alrubaiee,2 Mokhtar Abdu Almoliky,1 Talal Ali Hussein Alqalah,1 Eddieson Pasay-An,3 Awatif Mansoor Alrasheeday,4 Shimmaa Mohamed Elsayed5 1Department of Medical Surgical Nursing, University of Hail, Hail, Saudi Arabia; 2Department of Community Health, University of Hail, Hail, Saudi Arabia; 3Fundamental of Nursing Department, King Khalid University, Abha, Saudi Arabia; 4Nursing Administration Department, University of Hail, Hail, Saudi Arabia; 5Critical Care and Emergency Nursing Department, Damanhour University, Damanhour, EgyptCorrespondence: Sameer A Alkubati, Department of Medical Surgical Nursing, University of Hail, Hail, Saudi Arabia, Tel +966506575284, Email alkubatisa@yahoo.comBackground: A continuous and high frequency of alarms from monitoring and treatment devices can lead to nurses’ sensory exhaustion and alarm fatigue in critical care settings.Aim: The purpose of this study was to evaluate the level of alarm fatigue and determine the relationship between nurses’ sociodemographic and work-related factors and the level of alarm fatigue in critical care settings in Hail City, Saudi Arabia.Methods: Between May and July 2023, 298 nurses who worked in the emergency, intensive care, and critical care units of all the public hospitals in Hail City participated in a cross-sectional survey. Sociodemographic and work-related sheet and the Nurses’ Alarm Fatigue Questionnaire were used to collect data.Results: The total mean score of alarm fatigue was 26.38± 8.30 out of 44. The highest score was observed for the item “I pay more attention to the alarms in certain”, while the lowest score were observed for the items “I turn off the alarms at the beginning of every shift” with mean scores of 2.51 and 1.61, respectively. Nurses who were males, older than 30 years and Saudi citizens had significantly higher mean scores of alarm fatigue than their counterparts. In addition, significantly higher mean scores of alarm fatigue were noticed for nurses experienced for 10 years or more and who had regular morning shifts. Multiple linear regression showed that male (p=0.014), age (p=0.012), and Saudi nationality (p < 0.029) were the independent factors affecting the level of fatigue alarm among nurses.Conclusion: Nurses working in critical care settings at hospitals in Hail city are exposed to average levels of alarm fatigue, which can be influenced by sex, age, nationality, and experience of nurses. Therefore, it is imperative to manage alarm fatigue in critical care units by considering work-related and personality-related factors to ensure patient safety.Keywords: alarms, fatigue, nurses, intensive care units, emergency

As the first inquiry of a Historically Native American Fraternity and Sorority (HNAFS), the purpose of this research study was to provide greater understanding of the impact of a Native American sisterhood. The genealogical connections (literature review) examined the recent work written about HNAFS and narrowed down the influence of HNAFS on Indigenous women scholars. Indigenous feminism guided the study as it describes how Native/Indigenous women define feminism for them and their communities, which added deeper understanding and meaning to the major findings. This study utilized talking circles as an Indigenous research tool to center sisters' stories collectively. Major findings for this article highlight how the Native American sisterhood empowered Native women, developed them as leaders, and provided opportunities for advocacy work. Recommendations and future directions for HNAFS and higher education professionals are provided.

The prevalence of patients with primary aldosteronism (PA) is about 5%–15% in hypertensive patients, and it is common cause of secondary hypertension in clinical practice. Two major causes of PA are noted, namely bilateral adrenal hyperplasia and aldosterone-producing adenoma, and the general diagnosis is based on three steps: (1) screening, (2) confirmatory testing, and (3) subtype differentiation (Figure 1). The recommendation for screening patients is at an increased risk of PA, here we focus on which patients should be screened for PA, not only according to well-established guidelines but for potential patients with PA. We recommend screening for 1) patients with resistant or persistent hypertension, 2) hypertensive patients with hypokalemia (spontaneous or drug-induced), 3) young hypertensive patients (age

Anti-hypertensive medications may affect plasma renin activity and/or plasma aldosterone concentration, misleading the interpretation of the aldosterone-to-renin ratio when screening for primary aldosteronism. The Task Force of Taiwan PA recommends that, when necessary, using α-adrenergic receptor blocking agents, centrally acting α-adrenergic agonists, and/or non-dihydropyridine calcium channel blockers should be considered to control blood pressure before screening for PA. We recommend temporarily holding β-adrenergic receptor blocking agents, mineralocorticoid receptor antagonists, dihydropyridine calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and all diuretics before screening for PA. Further large-scale randomized controlled studies are required to confirm the recommendations.

A key component of the functioning of a market system of education is the provision of information to consumers. While marketing may be used by schools to provide information to consumers. The marketing information may appeal to some consumers and not others. This study examines independent schools marketing on their websites and how it appeals to consumers in need of special support. The findings show that these schools market their goals and values, studentship, methods and programmes, services as well as facilities. The marketing by these schools may not appeal to students in need of special support in the failure to provide relevant and adequate information to them and framing of their studentship that does not include students in need of special support as well as the focus on academic performance.

Abstract Background The corn borer Ostrinia nubilalis and the fall armyworm Spodoptera frugiperda larvae feed on the aerial parts of maize. It is responsible for significant yield losses and are therefore a cause of food insecurity. This study carried out to evaluate the resistance of three maize varieties (EV8766 SR-MRP, PR9131-SR, CEW-SR), in Tonkpi region’s, to S. frugiperda and O. nubilalis damages. Each maize variety seeds were sown on a one hectare plot subdivided into 6 elementary plots with 75 cm between rows and 40 cm between bunches. Sampling of S. frugiperda and O. nubilalis larvae on maize plants was carried out according to the FAO method, from the third to the fifth week after planting. Maize plants damaged, the intensity of infestation and the number of larvae on maize plants were recorded. Maize plants damaged by the insect pests were marked to avoid recounting. At maturity, 100 maize cobs were harvested per elementary plot, then the larvae number and the attacked cobs by S. frugiperda and O. nubilalis larvae were recorded. Results The lowest damage rate by S. frugiperda were recorded in maize variety EV8766-SR-MRP (23.33%); while, the highest damage rate were in the varieties PR9131-SR (43.33%) and CEW-SR (55%). There are no significant difference values of the density of S. frugiperda larvae per maize plant attacked between the three varieties. The index of intensification of maize plant damaged by S. frugiperda larvae was lower for the variety EV8766-SR-MRP (7.50%) and was moderate for the varieties PR9131-SR (15.42%) and CEW-SR (21.67%). The damage rates of O. nubilalis larvae on maize cobs varied between 9.6 and 22.0%. These damage rates were higher for the varieties PR9131-SR (21.83%) and CEW-SR (17.50%) and were lower for EV8766-SR-MRP (9.66%). There was not significantly different from the density of O. nubilalis larvae per maize cob attacked between the three varieties. It was between 1 to 1.2 larvae. Crop losses were lower for EV8766 SR-MRP (10.228%) than those of PR9131-SR and CEW-SR (19.338%). Conclusions The maize variety EV8766-SR-MRP is found to be the best variety in the control of, O. nubilalis and S. frugiperda.

Résumé : Face aux phénomènes de dérèglement climatique et leurs corollaires de conséquences néfastes sur l’environnement, le besoin de vivre en harmonie avec la nature s’affiche de fait comme une nécessité fondamentale. André Brink attire l’attention de ses lecteurs sur la nécessité de la préservation de la biodiversité. Dans cet article, nous tentons d’analyser dans une perspective écocritique, la manière dont l’auteur représente le rapport entre les humains et la nature. En effet, l’écrivain estime qu’entre l’homme et la nature qui l’environne doit se développer un courant de « sympathie ». Dans les ouvrages de Brink, la nature acquiert une figure salvatrice et place chaque individu devant ses responsabilités. Mots-clés: nature- environnement-biodiversité-écriture-société

There is a limited number of studies analyzing the molecular and biochemical processes regulating the metabolism of the maturation of Cocos nucifera L. zygotic embryos. Our research focused on the regulation of carbohydrate and lipid metabolic pathways occurring at three developmental stages of embryos from the Mexican Pacific tall (MPT) and the Yucatan green dwarf (YGD) cultivars. We used the TMT-synchronous precursor selection (SPS)-MS3 strategy to analyze the dynamics of proteomes from both embryos; 1044 and 540 proteins were determined for the MPT and YGD, respectively. A comparison of the differentially accumulated proteins (DAPs) revealed that the biological processes (BP) enriched in the MPT embryo included the glyoxylate and dicarboxylate metabolism along with fatty acid degradation, while in YGD, the nitrogen metabolism and pentose phosphate pathway were the most enriched BPs. Findings suggest that the MPT embryos use fatty acids to sustain a higher glycolytic/gluconeogenic metabolism than the YGD embryos. Moreover, the YGD proteome was enriched with proteins associated with biotic or abiotic stresses, e.g., peroxidase and catalase. The goal of this study was to highlight the differences in the regulation of carbohydrate and lipid metabolic pathways during the maturation of coconut YGD and MPT zygotic embryos.

Radiofrequency ablation (RFA) is a minimally invasive management strategy that has been widely applied for benign and recurrent malignant thyroid lesions as an alternative to surgery in Taiwan. Members of academic societies for specialists in interventional radiology, endocrinology, and endocrine surgery collaborated to develop the first consensus regarding thyroid RFA in Taiwan. The modified Delphi method was used to reach a consensus. Based on a comprehensive review of recent and valuable literature and expert opinions, the recommendations included indications, pre-procedural evaluations, procedural techniques, post-procedural monitoring, efficacy, and safety, providing a comprehensive review of the application of RFA. The consensus effectively consolidates advice regarding thyroid RFA in clinical practice for local experts.

Objectives: This study aimed to investigate the evolution of Plasmodium falciparum antimalarial drug resistance markers by comparing the pre- and post-adoption of artemisinin-based combination therapies (ACTs) in Yaounde, Cameroon. Methods: The molecular characterization of known antimalarial drug resistance markers (Pfcrt, Pfmdr1, Pfdhfr, Pfdhps, and Pfk13) in P. falciparum-positive samples collected in 2014 and 2019-2020 was achieved using nested polymerase chain reaction, followed by targeted amplicon deep sequencing on the Illumina MiSeq platform. Data derived were compared with those published during the pre-ACT adoption period from 2004 to 2006. Results: A high prevalence of Pfmdr1 184F, Pfdhfr 51I/59R/108N, and Pfdhps 437G mutant alleles was observed during the post-ACT adoption period. The Pfcrt 76T and Pfmdr1 86Y mutant alleles significantly declined between 2004 and 2020 (P

Abstract Background A processing methodology of raw starch extraction from avocado seeds (ASs) and a sequential hydrolysis and fermentation bioprocess in just a few steps was successfully obtained for the bioethanol production by a single yeast Saccharomyces cerevisiae strain and this research was also to investigate the optimum conditions for the pretreatment of biomass and technical procedures for the production of bioethanol. It successfully resulted in high yields and productivity of all the experiments from the laboratory scale and the pilot plant. Ethanol yields from pretreated starch are comparable with those in commercial industries that use molasses and hydrolyzed starch as raw materials. Results Before the pilot-scale bioethanol production, studies of starch extraction and dilute sulfuric acid-based pretreatment was carefully conducted. The amount of starch extracted from dry and fresh avocado seed was 16.85 g ± 0.34 g and 29.79 ± 3.18 g of dry starch, representing a yield of ∼17% and 30%, respectively. After a dilute sulfuric acid pretreatment of starch, the released reducing sugars (RRS) were obtained and the hydrolysate slurries containing glucose (109.79 ± 1.14 g/L), xylose (0.99 ± 0.06 g/L), and arabinose (0.38 ± 0.01 g/L). The efficiency of total sugar conversion was 73.40%, with a productivity of 9.26 g/L/h. The ethanol fermentation in a 125 mL flask fermenter showed that Saccharomyces cerevisiae (Fali, active dry yeast) produced the maximum ethanol concentration, p max at 49.05 g/L (6.22% v/v) with a yield coefficient, Y p/s of 0.44 gEthanol/gGlucose, a productivity or production rate, r p at 2.01 g/L/h and an efficiency, Ef of 85.37%. The pilot scale experiments of the ethanol fermentation using the 40-L fermenter were also successfully achieved with essentially good results. The values of p max, Y p/s , r p , and Ef of the 40-L scale were at 50.94 g/L (6.46% v/v), 0.45 gEthanol/gGlucose, 2.11 g/L/h, and 88.74%, respectively. Because of using raw starch, major by-products, i.e., acetic acid in the two scales were very low, in ranges of 0.88–2.45 g/L, and lactic acid was not produced, which are less than those values in the industries. Conclusions The sequential hydrolysis and fermentation process of two scales for ethanol production using the combination of hydrolysis by utilizing dilute sulfuric acid-based pretreatment and fermentation by a single yeast Saccharomyces cerevisiae strain is practicable and feasible for realistic and effective scale-up strategies of bioethanol production from the starch of avocado seeds.

Background Reversed condition is rarely found in most flatfishes in natural environment, except for some certain species. The mechanism controlling the reversals in flatfishes has been studied in some cultivated species, whereas some have only few cases for the entire family and remain unclear. Here, we report the first record of a dextral (reversed) specimen of Parabothus taiwanensis Amaoka & Shen, 1993 collected off southwestern Taiwan recently. It represents the second reversed case ever recorded in Bothidae. We aim to provide a detailed description of this dextral specimen and compared to the sinistral (normal) specimens collected from the vicinity. Methods Specimens were fixed in 4% formaldehyde and transferred to 70% ethanol for preservation. Meristic and morphometric characters were examined for both dextral and sinistral specimens. Dissections were made on specimens to confirm the position of internal organs. Lastly, X-radiographs were taken to elucidate the osteological features. Results As a result, no differences of both meristic and morphometric characters were observed between the dextral and sinistral specimens. Nevertheless, situs inversus viscerum is discovered in the dextral specimen for the first time in Bothidae and the sixth record within flatfishes.

Mengamati harga saham dan volume perdagangan saham perusahaan pada sektor properti dan real estate pra dan pasca munculnya pandemi COVID-19 merupakan tujuan dari penelitian ini. Sampel diambil dari data harga saham penutupan harian dan volume perdagangan saham selama tiga bulan (-90 hari) dan setelah (+90 hari) munculnya kebijakan pembatasan mengenai COVID-19, sehingga diperoleh 4.860 data harga saham penutupan harian dan volume perdagangan saham. Keseluruhan data tersebut diolah dengan alat analisis IBM SPSS Statistics 26. Hasil penilitian sesuai dengan teori pasar efisien, yang menyatakan bahwa terdapat perbedaan signifikan harga saham harian dan volume perdagangan saham Perusahaan sub sektor properti dan real estate sebelum dan sesudah pandemi COVID-19. Implikasi praktis observasi ini adalah, investor harus lebih cermat dalam mengambil keputusan, investor harus melihat perusahaan yang stabil pergerakan saham harian dan volume perdagangan saham ditengah kebijakan yang berlaku saat COVID-19.

This article presents the foundational praxes to what values, services, and praxes should be in place for Native American Serving Non-Tribal Institutions (NASNTI). Each praxis includes questions and provides actions that each NASNTI should start examining and addressing. These praxes are imperative and interconnected to each other in building a community on campus for Native students while remaining connected to home. They are presented in four major themed areas: (1) Indigenizing institutional narratives and landscapes; (2) Indigenizing leadership; (3) Indigenizing academia; and (4) Indigenizing student support. There are examples of literature or institutional connections for readers to connect each praxis to throughout each section.

Background The boundary between services for children and adolescents and adults has been identified as problematic for young people with mental health problems. Aims To examine the use and cost of healthcare for young people engaged in mental healthcare before and after the child/adolescent and adult service boundary. Method Data from 772 young people in seven European countries participating in the MILESTONE trial were analysed. We analysed and costed healthcare resources used in the 6-month period before and after the service boundary. Results The proportion of young people engaging with healthcare services fell substantially after crossing the service boundary (associated costs €7761 pre-boundary v. €3376 post-boundary). Pre-boundary, the main cost driver was in-patient care (approximately 50%), whereas post-boundary costs were more evenly spread between services; cost reductions were correlated with pre-boundary in-patient care. Severity was associated with substantially higher costs pre- and post-boundary, and those who were engaged specifically with mental health services after the service boundary accrued the greatest healthcare costs post-service boundary. Conclusions Costs of healthcare are large in this population, but fall considerably after transition, particularly for those who were most severely ill. In part, this is likely to reflect improvement in the mental health of young people. However, qualitative evidence from the MILESTONE study suggests that lack of capacity in adult services and young people's disengagement with formal mental health services post-transition are contributing factors. Long-term data are needed to assess the adverse long-term effects on costs and health of this unmet need and disengagement.

Background: Many patients with papillary thyroid cancer (PTC) demonstrate satisfactory outcomes. However, 8%–28% of patients with PTC show tumor recurrence, which may affect prognosis. Therefore, identifying factors associated with tumor recurrence in patients with PTC may be helpful to refine therapeutic strategies. Methods: To identify factors associated with PTC recurrence, we retrospectively reviewed demographic features (sex and age), operation method, image character, serum thyroglobulin (Tg), accumulated radioactive iodine (I-131) therapeutic dose, I-131 uptake, and metastases at diagnosis in 829 patients with PTC. Patients were grouped into early (stage I and II; n = 698) and advanced (stage III and IV; n = 131) tumor-node-metastasis (TNM) stages. Recurrence rate, mortality rate, risk factors of recurrence, recurrent free survival and overall survival curve were compared between two groups. Results: Patients in the early stage demonstrated a lower recurrence rate (7.2%) than did those in the advanced stage (28.2%, p

Abstract Background Increasing evidence suggests that glucagon-like peptide 1 (GLP-1) receptor agonists (RA) can stabilize glycemic variability (GV) and interfere with eating behavior. This study compared the impact of insulin, GLP-1 RA, and dietary components on GV using professional continuous glucose monitoring (CGM). Methods Patients with type 2 diabetes underwent CGM before and after switching from a twice-daily pre-mixed insulin treatment regimen to a GLP-1 RA (liraglutide) plus basal insulin regimen. The dietary components were recorded and analyzed by a certified dietitian. The interactions between the medical regimen, GV indices, and nutrient components were analyzed. Results Sixteen patients with type 2 diabetes were enrolled in this study. No significant differences in the diet components and total calorie intake between the two regimens were found. Under the pre-mixed insulin regimen, for increase in carbohydrate intake ratio, mean amplitude of glucose excursion (MAGE) and standard deviation (SD) increased; in contrast, under the new regimen, for increase in fat intake ratio, MAGE and SD decreased, while when the protein intake ratio increased, the coefficient of variation (CV) decreased. The impact of the food intake ratio on GV indices disappeared under the GLP-1 RA regimen. After switching to the GLP-1 RA regimen, the median MAGE, SD, and CV values decreased significantly. However, the significant difference in GV between the two regimens decreased during the daytime. Conclusion A GLP-1 RA plus basal insulin regimen can stabilize GV better than a regimen of twice-daily pre-mixed insulin, especially in the daytime, and can diminish the effect of food components on GV.

Introduction The top research priority for cavernoma, identified by a James Lind Alliance Priority setting partnership was ‘Does treatment (with neurosurgery or stereotactic radiosurgery) or no treatment improve outcome for people diagnosed with a cavernoma?’ This pilot randomised controlled trial (RCT) aims to determine the feasibility of answering this question in a main phase RCT.Methods and analysis We will perform a pilot phase, parallel group, pragmatic RCT involving approximately 60 children or adults with mental capacity, resident in the UK or Ireland, with an unresected symptomatic brain cavernoma. Participants will be randomised by web-based randomisation 1:1 to treatment with medical management and with surgery (neurosurgery or stereotactic radiosurgery) versus medical management alone, stratified by prerandomisation preference for type of surgery. In addition to 13 feasibility outcomes, the primary clinical outcome is symptomatic intracranial haemorrhage or new persistent/progressive focal neurological deficit measured at 6 monthly intervals. An integrated QuinteT Recruitment Intervention (QRI) evaluates screening logs, audio recordings of recruitment discussions, and interviews with recruiters and patients/parents/carers to identify and address barriers to participation. A Patient Advisory Group has codesigned the study and will oversee its progress.Ethics and dissemination This study was approved by the Yorkshire and The Humber—Leeds East Research Ethics Committee (21/YH/0046). We will submit manuscripts to peer-reviewed journals, describing the findings of the QRI and the Cavernomas: A Randomised Evaluation (CARE) pilot trial. We will present at national specialty meetings. We will disseminate a plain English summary of the findings of the CARE pilot trial to participants and public audiences with input from, and acknowledgement of, the Patient Advisory Group.Trial registration number ISRCTN41647111.

Introduction Eating disorders are serious medical conditions labelled by severe disturbances to one’s eating behaviours. These disorders can affect employees’ physical and mental health. Objectives This study aimed to evaluate the association between eating disorders and workers’ mental health. Methods The study was conducted among a group of workers from an electricity society. Data were gathered between January-June 2022 using a self-administered questionnaire including socio-professional characteristics, eating disorders evaluation, and mental health assessment using the Hospital anxiety and depression scale (HADS). Results Our study included 92 workers. Their mean age was 43.8 ± 11.7 years and 73 were male (79.3%). The average job tenure was 17.6 ± 11.2 years. Thirty-eight participants (41.3%) had eating disorders. With the reference to HADS, 47 (51.1%) and 16 (17.4%) participants presented symptoms of anxiety and depression, respectively. Regarding the patients’ anxiety levels, it was found that 82.6%, 12%, and 5.4% appeared to have mild, moderate, and severe anxiety, respectively. As for the depression levels of patients, 45 were mildly depressed (48.9%), 31 were moderately depressed (33.7%), and 16 were severely depressed (17.4%). Participants with eating disorders had higher scores of anxiety and depression p=0.001 and p=0.003 respectively. Conclusions According to our study, eating disorders had a significant association with the mental health of workers. Therefore, it is important to provide training for workers to have a healthy balanced diet to guarantee good mental health. Disclosure of Interest None Declared

Abstract Objective The present study aimed to evaluate esthetic and functional outcomes from the surgical treatment of Madelung deformity in children. MethodThis is a retrospective study of pediatric patients with Madelung deformity who were surgically treated with dome osteotomy of the distal radius and Vickers ligament section from 2015 to 2018. Patients with a minimum postoperative follow-up period of 12 months were included. Demographic data, surgical technique, clinical and radiographic outcomes were analyzed. Pre and postoperative radiographic evaluation consisted of ulnar tilt, lunate subsidence lunate fossa angle, and palmar carpal displacement measurements. The postoperative clinical evaluation consisted of ranges of motion of the wrist, visual analog scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) score. Results Four patients were included, two with idiopathic Madelung deformity and two with bone dysplasia. All patients were females and presented bilateral disease. Six wrists were operated on. The median age at surgery was 15.5 years old, and the median postoperative follow-up time was of 37.5 months. The postoperative radiographic analysis revealed an average correction of 8.8 ± 7.5° for ulnar tilt, 3.0 ± 3.9 mm for lunate subsidence 8.2 ± 6.6° for lunate fossa angle, and 4.7 ± 2.6 mm for palmar carpal displacement. Average postoperative ranges of motion of the wrist joint were 75.8 ± 3.4° for flexion, 62.5 ± 14.1° for extension, 25.7 ± 2.9° for radial deviation, 40.0 ± 2.9° for ulnar deviation, 88.3 ± 2.4° for pronation, and 82.5 ± 2.5° for supination. The median VAS was 1 for residual pain, 0 for functional deficit, 0 for esthetic impairment, and 10 for recommending the surgical procedure. The median DASH score was 0. Conclusion Madelung deformity treatment using dome osteotomy of the distal radius and Vickers ligament section results in excellent esthetic and functional outcomes.