Left Leg Research Articles

Assessment of Motor Imagery and Its Relationship to Functional Impairment in Post-Stroke Patients: A Descriptive Cross-Sectional Study.

Background: Motor and cognitive sequelae are common in patients who have experienced a stroke. Recent advances in neuroscience have enabled the development of novel therapeutic approaches, such as motor imagery, which facilitate motor learning. The objective of this study is to examine the relationship between implicit and explicit motor imagery abilities and their correlation with functional impairment in post-stroke patients. Methods: A descriptive cross-sectional study was conducted with 36 patients who had experienced a stroke between March 2008 and March 2023. The capacity to generate both implicit and explicit motor imagery and to perform physical functions was evaluated. The relationship between implicit and explicit motor imagery measures was investigated using Pearson's correlation coefficient. The factorial structure, which encompasses the capacity to generate motor imagery, whether implicit or explicit, and physical function, was subjected to analysis. Results: A correlation was identified between the time taken to identify images and the accuracy of this process, with the right hand (R = 0.474), the left hand (R = 0.568), and the left foot (R = 0.344) all demonstrating significant associations. Additionally, a notable correlation was observed between the two subscales of the KVIQ-10 scale (R = 0.749). No association was identified between the capacity to generate implicit and explicit motor imagery. Two- and three-factor solutions were obtained for the right and left hemibodies, respectively. On both sides, accuracy in identifying images and physical function constituted a single factor, while time to generate images for both hands and feet constituted a second factor. Conclusions: In conclusion, no significant data were reported regarding the association between the capacity to generate implicit and explicit motor imagery in the studied sample. However, the ability to generate implicit motor imagery was related to physical function, suggesting that it may serve as a screening criterion for implementing specific therapeutic approaches in post-stroke patients.

Sebaceous Adenoma in a Geriatric Poodle Dog: A Case Report

A 14-year-old black male Poodle was brought to the Animal Teaching Hospital, Udayana University by its owner with clinical signs of frequent licking of its left front paw. Upon examination, red bumps were observed on the left front leg, accompanied by small, round black spots scattered on the dorsal side of the body. Additionally, black nodules were present on the lower eyelids and hind limbs. Surgical intervention was undertaken to excise the tumor mass, with the animal under anesthesia induced by ketamine at 5 mg/kg BW intravenously. The reddish nodule was excised by performing an elliptical incision at the base of tumor. Postoperatively, the animal received an antibacterial injection comprising ceftriaxone and tazobactam at 25 mg/kg BW intramuscularly and antiseptic wound dressing for supportive care. Microscopic examination revealed neoplastic cells arranged into lobules of varying sizes and shapes within the tumor mass. These lobules consisted of differentiated sebocytes and basaloid cells. At the periphery of the neoplastic lobules, the basaloid cells displayed several layers and exhibited invasion with moderate anisocytosis. The mitotic index was no more than ten cells in one field of view. Based on these histopathological features, the tumor was confirmed to be a sebaceous adenoma. After a 10-month follow-up period, there were no signs of tumor recurrence observed.

Cross-Leg Microvascular Free Anterolateral Thigh Flap as a Safe, Viable, and Reserve Option for Reconstruction in a Vessel-Depleted Limb

AbstractWe present the case of a 36-year-old male patient with a posttraumatic composite defect of the lower two-thirds of the anterior aspect of the left leg with exposed necrotic tibia in an old, neglected type 3b fracture of the tibia of 9-month duration. The options for definitive soft-tissue cover include microvascular free tissue transfer and cross-leg flaps. In trauma cases, the surrounding tissue is usually damaged, and the recipient vessels are frequently implicated, ruling out the use of a microvascular free flap. Cross-leg flaps are unachievable due to large defect sizes and lack of appropriate donor tissue. In this case report, we highlight the use of cross-leg microvascular free anterolateral thigh (ALT) flap cover for the composite leg defect. By presenting our case, we aim to advocate the clinical application of cross-leg free flap surgery in vessel-depleted limbs as a safe and viable option.

Regular Physical Activity Seems to Eliminate Lower Limb Perfusion Asymmetries in Sedentary Non-Healthy Older Individuals.

Perfusion asymmetries have been associated with vascular pathology. Physical activity is a component of vascular health. Here, we investigate the impact of a thirty-day regular home-based physical activity program in older individuals with multiple age-related comorbidities. Eleven participants of both sexes were included. Skin perfusion was assessed in both feet by laser Doppler flowmetry (LDF, for deeper perfusion) and polarized light spectroscopy (PSp, for superficial perfusion). At baseline, participants had significant perfusion differences between right and left feet (p = 0.005 with LDF; p = 0.028 with PSp), which disappeared with activity and reappeared in recovery. After 30 days, both feet showed significant perfusion increases as assessed with LDF (p = 0.005) compared to D0. At this point, the perfusion asymmetry observed at D0 was no longer present. However, the superficial perfusion asymmetry assessed by PSp persisted at D30 (p = 0.028). Data show that regular physical activity positively altered the lower limb perfusion pattern. Systolic pressure and mean arterial pressure were also significantly reduced at D30. These impacts seem to be directly related to the physical activity program introduced in the day-by-day routines of these participants. These also encourage further research on the role of symmetry-asymmetry in prevention, treatment, and rehabilitation in vascular medicine.

SPIN-01 PRIMARY MALIGNANT MELANOMA, AN ATYPICAL PRESENTATION IN THE CERVICAL SPINE: A CASE REPORT

Abstract BACKGROUND Few studies have documented the occurrence of melanoma in the cervical spine. Of all malignant melanoma cases, 1% are primary melanoma of the central nervous system, which makes it extremely uncommon and nonspecific. We aim to report a case of the uncommon presentation of primary melanoma in the cervical spine. Case presentation: The patient was a 59-year-old Muganda male who presented with a 2-year history of anterior neck swelling as well as severe pain and a tingling sensation in the left shoulder and arm, which worsened in the recent 6 months. He developed weakness and paresthesia in the upper left arm and progressive gait disturbance of the left leg. A physical examination revealed masses in the left cervical and right submandibular region. Additionally, the upper and lower left extremities revealed hemiparesis and hemihypoesthesia. A magnetic resonance imaging scan showed a hyperintense lesion on TIWI and another hypointense lesion on T2WI, originating from the cervical spine and involving the vertebral bodies and paravertebral soft tissues. The patient underwent surgery, a black tumor was extracted, and histology revealed the tumor to be malignant melanoma. The patient died within 1 month after the diagnosis and surgery. CONCLUSION This case is presented to highlight the significance and challenges associated with making a pre- and postoperative diagnosis of primary cervical melanoma with atypical radiological characteristics. Patients with extradural lesions that show hyperintensity on T1-weighted images and hypointensity on T2-weighted images should have spinal melanoma examined as a possible differential diagnosis.

Relationship between Peak Eccentric Force during the Nordic Hamstring Exercise and One Repetition Maximum Deadlift Performance.

The Nordic hamstring exercise (NHE) is useful for preventing hamstring strain injuries. However, its adoption rates in the sports field are currently low, necessitating a safe and efficient introduction. The purpose was to examine the relationship between the eccentric force during the NHE and the one repetition maximum of deadlift. It was hypothesized that the eccentric force during the NHE would be correlated with the one repetition maximum (1RM) of the deadlift. Cross-sectional study. Healthy student rugby players with no history of hamstring tears were recruited to participate. The peak eccentric forces during the NHE, which is the vertical peak force on the part holding the leg, were measured in both legs, while gradually leaning forward to a prone position over three seconds. The 1RM of deadlift was calculated from the weight that could be raised three times during a deadlift (x kg) using the estimated formula (x kg / 0.93). The correlation between the left and right peak eccentric forces during the NHE, the total left and right forces, and the 1RM of the deadlift was examined using Spearman's rank correlation coefficient, with all values corrected for body mass. During the NHE, the peak eccentric force of the right and left legs and the total peak eccentric force of both legs were 3.8 ± 1.1 N/BM, 3.8 ± 1.2 N/BM, and 7.6 ± 2.1 N/BM, respectively. The 1RM of deadlift was 1.9 ± 0.3 kg/BM. Weak correlations (r = 0.34-0.37) were found between the 1RM of the deadlift and the peak eccentric force in the right and left legs and the total peak eccentric force of both legs. The present study revealed a weak correlation between the peak eccentric force during the NHE and 1RM of deadlift. 2c.

Exercise transcutaneous oximetry in functional popliteal artery entrapment syndrome diagnosis.

Functional poplitealartery entrapment syndrome is a subtype of poplitealartery entrapment syndrome (PAES) without vascular disease or musculotendinous anomaly behind the knee. Symptoms are induced by popliteal artery extrinsic compression, leading to calf pain during lower limbs exercise. Non-invasive tests are still required to improve the diagnostic management of functional PAES. Exercise transcutaneous oxygen pressure (Ex-tcpO2) is of interest to provide objective arguments for the presence of regional blood flow impairment. The aim of the study was to analyze whether Ex-tcpO2 could serve as a non-invasive technique for detecting ischemia resulting from PAES. Patients with suspected PAES were recruited between 2017 and 2020. The diagnosis was confirmed or rejected, according to the surgical decision based on our diagnosis management involving a multidisciplinary team. Each patient underwent Ex-tcpO2 with specific maneuvers. The decrease from rest of oxygen pressure (DROP) index served for the interpretation of exercise results. Sixty-five legs with suspected PAES were recruited. Diagnosis was confirmed in 34 (52.3%) and rejected in 32 (47.7%). The average DROP values found in confirmed and rejected group at left leg were -21.6 ± 15.4mmHg and -10.9 ± 11.1mmHg, respectively (p for Mann-Whitney 0.004), and -15.8 ± 11mmHg and -11.1 ± 7.5mmHg, respectively, at right leg (p = 0.088). Ex-tcpO2 sensitivity and specificity were 52.9% and 78.1%, respectively. Ex-tcpO2 is an original non-invasive investigation for patients with claudication of doubtful arterial origin. The sensitivity and specificity are 52.9% and 78.1% in functional PAES diagnosis using 15mmHg as threshold to detect ischemia during tiptoeing elevations.

A comparative analysis of free fibula flap donor leg and recipient vessel selection in composite oromandibular defect reconstructions

BackgroundThe fibula free flap (FFF) is acknowledged as the primary choice for reconstructing composite oromandibular defects (COMD), yet the impact of donor leg selection remains inadequately explored. This study aims to investigate the correlation between flap failure and the choice of donor leg and recipient vessel side. Materials & MethodsIn a retrospective analysis spanning 2011 to 2020, FFFs for COMD were examined using electronic records. Patient data, comorbidities, radiation history, FFF details, and intraoperative variables were considered. Laterality was categorized into "Cis" and "Trans" groups, further subclassified based on blood supply. Analyses involved logistic regression, bivariate analysis, and propensity score matching. ResultsA total of 155 subjects with intraoral mucosal defects repaired only by the skin paddle of FFF were included. Cases were categorized into "Cis" (n=65; 42%) and "Trans" (n=90; 58%) groups based on COMD side and donor leg selection. No significant baseline differences emerged. Logistic regression found no laterality impact on total FFF failure. Initially, gender correlated with flap failure, but adjustment diminished the association. Partial skin paddle necrosis correlated with diabetes, not laterality. Propensity score matching revealed no significant differences between right and left legs in laterality or total flap failure risk. Subgroup analysis found no differences in parameters or flap failure rates within "Cis" and "Trans" groups. ConclusionDonor leg selection in COMD reconstruction with FFFs does not exhibit specificity. Furthermore, despite potential limitations in vessel anastomosis due to pedicle length or trauma history, recipient vessel side selection does not evidently affect flap failure.

Simultaneous effects of high-speed circuit training (HSCT) and high-speed interval training (HSIT) on physical fitness and lung volumes of males after coronavirus disease

BackgroundPeople who are quarantined after coronavirus disease experience immobility, obesity and changes in the cardiopulmonary system. We hypothesized that the concurrent use of high-speed circuit training (HSCT) and high-speed interval training (HSIT) can be used to improve physical fitness and respiratory functions. MethodologyPhysical education students (n = 65, 18–22 yrs. Old) who recovered from a previous coronavirus infection were randomly divided into either an experimental (n = 38) or control (n = 27) group. Physical fitness tests such as heart rate (HR), Cooper's test, maximum oxygen consumption (VO2max), speed of 30 m, flexibility, balance of right and left legs, agility 4 × 9 m, barfix, sit-up, Sargent jump, push-up, and spirometry tests were conducted before and after the training protocols (HSCT and HSIT for 12 weeks). The control group only took regular university classes. ResultsThe simultaneous implementation of HSCT and HSIT had a positive significant effect on physical fitness indicators (VO2max, flexibility, sit-ups, push-ups, vertical jump, barfix, balance legs, agility 4 × 9, 30 m sprint, and Cooper test) and respiratory indicators (FVC, FEV1, PEF, MVV and FEV1/FVC). While it did not affect other variables. ConclusionThe simultaneous implementation of HSCT and HSIT can have a positive significant effect on physical fitness indicators and respiratory indicators of male university students. Therefore, students have more aerobic capacity for physical activities.

Partial sleep deprivation affects the athletic performance of Sanda athletes: An RCT study

This study explored the effects of partial sleep deprivation (PSD) on Sanda athletes' athletic performance, an area with limited research. Using a randomized crossover controlled trial with 18 male athletes, the PSD group had 4 h of sleep while the NSN group had 8 h. Results showed that after PSD intervention, the RAT time significantly increased compared to the NSN group (P = 0.0311). However, there was no significant change in CMJ (P = 0.2396) or YBT (left leg: P = 0.2767, right leg: P = 0.3225) between the PSD and NSN groups. In the Wingate test, the PSD group exhibited significant reductions in Pmax and Pave at 10s, 30s, and 60s (P＜0.0001), as well as a significant decrease in Prel at 60s (P＜0.0001), with no significant differences in Prel at 10s and 30s. These findings underscore the detrimental impact of limited sleep on anaerobic performance and agility in Sanda athletes, emphasizing the need for proper sleep management for optimal athletic outcomes.

Game-Based Assessment of Peripheral Neuropathy Combining Sensor-Equipped Insoles, Video Games, and AI: Proof-of-Concept Study.

Detecting peripheral neuropathy (PNP) is crucial in preventing complications such as foot ulceration. Clinical examinations for PNP are infrequently provided to patients at high risk due to restrictions on facilities, care providers, or time. A gamified health assessment approach combining wearable sensors holds the potential to address these challenges and provide individuals with instantaneous feedback on their health status. We aimed to develop and evaluate an application that assesses PNP through video games controlled by pressure sensor-equipped insoles. In the proof-of-concept exploratory cohort study, a complete game-based framework that allowed the study participant to play 4 video games solely by modulating plantar pressure values was established in an outpatient clinic setting. Foot plantar pressures were measured by the sensor-equipped insole and transferred via Bluetooth to an Android tablet for game control in real time. Game results and sensor data were delivered to the study server for visualization and analysis. Each session lasted about 15 minutes. In total, 299 patients with diabetes mellitus and 30 with metabolic syndrome were tested using the game application. Patients' game performance was initially assessed by hypothesis-driven key capabilities that consisted of reaction time, sensation, skillfulness, balance, endurance, and muscle strength. Subsequently, specific game features were extracted from gaming data sets and compared with nerve conduction study findings, neuropathy symptoms, or disability scores. Multiple machine learning algorithms were applied to 70% (n=122) of acquired data to train predictive models for PNP, while the remaining data were held out for final model evaluation. Overall, clinically evident PNP was present in 247 of 329 (75.1%) participants, with 88 (26.7%) individuals showing asymmetric nerve deficits. In a subcohort (n=37) undergoing nerve conduction study as the gold standard, sensory and motor nerve conduction velocities and nerve amplitudes in lower extremities significantly correlated with 79 game features (|R|>0.4, highest R value +0.65; P<.001; adjusted R2=0.36). Within another subcohort (n=173) with normal cognition and matched covariates (age, sex, BMI, etc), hypothesis-driven key capabilities and specific game features were significantly correlated with the presence of PNP. Predictive models using selected game features achieved 76.1% (left) and 81.7% (right foot) accuracy for PNP detection. Multiclass models yielded an area under the receiver operating characteristic curve of 0.76 (left foot) and 0.72 (right foot) for assessing nerve damage patterns (small, large, or mixed nerve fiber damage). The game-based application presents a promising avenue for PNP screening and classification. Evaluation in expanded cohorts may iteratively optimize artificial intelligence model efficacy. The integration of engaging motivational elements and automated data interpretation will support acceptance as a telemedical application.

Self-care practices and influencing factors among type 2 diabetes mellitus patients: A hospital-based cross-sectional study

BackgroundDiabetes mellitus (DM) is a widespread non-communicable disease in India that significantly affects the healthcare system owing to its acute and chronic complications. The traditional approach to diabetes care has focused on medical professionals, but recent research has indicated that self-care among patients is crucial. Effective self-care practices can enhance the quality of life of T2DM patients. This study aimed to evaluate self-care practices among T2DM patients at a sub-district hospital in Gujarat State, India. MethodsThis cross-sectional study included 93 T2DM patients. Self-care activities were assessed using the Summary of Diabetes Self-Care Activities (SDSCA) scale. Descriptive statistics and comparative analyses were performed. ResultsThe majority of the participants were male (55.9 %) and over 60 years of age (67.7 %). Participants demonstrated high adherence to medication regimens (mean score = 6.66 ± 0.86). However, adherence to other self-care practices was significantly lower; only 11.8 % reported good dietary behavior, 55.91 % engaged in regular exercise, and 50.5 % performed regular foot care. While 83.8 % reported good monitoring behavior, this contradicts the low adherence to blood glucose testing (mean score = 0.38 ± 0.59). Participants aged <60 years tended to report slightly better adherence to blood glucose testing than those aged ≥60 years. ConclusionThis study revealed a gap in self-care practices among T2DM patients in Gujarat. Despite good medication adherence, the patients demonstrated poor adherence to diet, exercise, and foot care. These findings emphasize the importance of customized interventions to improve self-management education and support, particularly for older adults.

Intramuscular ganglionic cyst in the extensor digitorum longus muscle of the leg: A case report and review of literature

Ganglionic cysts are benign soft-tissue lesions with unclear etiology and pathogenesis commonly occurring on the wrists and hands. Although their diagnosis and management in these characteristic locations are easy, rare occurrences in atypical locations are difficult to diagnose. Ultrasonography and magnetic resonance imaging (MRI) are helpful in diagnosing and differentiating a ganglionic cyst from other soft-tissue lesions. Here, we report a case of 60-year-old male patient with intramuscular ganglionic cyst, measuring 68×41×48 mm, arising in the extensor digitorum muscle of the left leg, which was diagnosed using MRI and treated using excision and biopsy.

Mucor mycosis of tibia: A case report of An unsolved entity

Mucormycosis of tibia is a highly aggressive fungal infection. It is an uncommon affection especially in immunocompromised host who have more propensity for such affections.The nonhealing ulcer of the left leg in an immunocompromised host status of a 45-year-old male presented with a radiological lytic lesion of the distal lower fourth of tibia. The initial biopsy confirmed tubercular affection which responded to antitubercular medications to allow radiological healing. However, the repeat biopsy showed Mucormycosis which remained recalcitrant to antifungal medications with unresponsive wound healing and persisting suppuration. The case presented unique scenario of superadded fungal infection in a healing tubercular osteomyelitis tibia with alcoholic liver disease compromised host immunity.The fungal infection of tibia remains an unsolved entity with poor clinical and functional outcomes. An early detection, high degree of suspicion with an adequate dosage of antifungal medications may allow resolution of the dreaded infection though an effective treatment remains an unsolved entity.

How does prolonged tennis playing affect lower limb muscles' activity during first and second tennis serves?

We examined the effect of prolonged tennis playing on lower limb muscles' activity during the execution of first and second tennis serves. Ten male competitive tennis players executed five first and second serves before (pretest) and after (posttest) a 3-h tennis match. Surface electromyographic (EMG) activity of four lower limb muscles (vastus lateralis, rectus femoris, gastrocnemius lateralis, and soleus muscles) on each leg was recorded along with maximum ball velocity measured by a radar gun and peak vertical forces recorded by a force platform. For the vastus lateralis, gastrocnemius lateralis, and soleus muscles of the left leg as well as the vastus lateralis muscle of the right leg, EMG amplitude decreased from pre- to posttests (p≤0.033). These reductions in the EMG signal were generally more pronounced in the first serve (i.e., ranging from -10% to -40%) compared to the second serve (0% to -25%). Maximum ball velocity for both first (159±12 vs. 154±12km/h) and second (126±20 vs. 125±15km/h) serves remained unchanged from pre- to posttests (p=0.638) Similarly, peak vertical forces did not differ between pretest and posttest for both first (1.78±0.30 vs. 1.72±0.29 body weight) and second (1.62±0.25 vs. 1.75±0.23 body weight) serves (p=0.730). In conclusion, a 3-h tennis match led to decreased activation levels in various leg muscles during serves, particularly in first serves compared to second serves. Despite consistent maximum ball velocity and peak vertical forces, these reductions in EMG signals suggest that skilled tennis players may adopt compensatory strategies after prolonged play.

Work-related musculoskeletal disorder and health risk behaviors in market-vendors: a mixed-methods study.

Work-related musculoskeletal disorders (WRMDs) are frequently observed among market vendors, and engaging in health risk behaviors can exacerbate these issues, leading to various health problems. Common health risk behaviors among market vendors include alcohol consumption and insufficient physical activity. However, there is currently a lack of research examining the prevalence of WRMDs and health risk behaviors among market vendors in Bangkok. Furthermore, the emerging trend of drug misuse within this group remains poorly understood. This study aims to explore the prevalence of muscle pain and flexibility issues and assess health risk behaviors, including alcohol consumption, inadequate exercise, and drug misuse, among market vendors. A mixed-method study was undertaken among 213 market vendors in Bangkok. Data collection utilized direct observation techniques, questionnaires, and muscle flexibility tests. Qualitative data were elucidated and showcased through textual descriptions and quotations. Quantitative data were analyzed using descriptive statistics to present numerical and percentage values. Qualitative findings revealed that market vendors often engage in static muscular work and maintain awkward postures due to their job characteristics and workstation setups. Quantitatively, the right arm was the most common pain region (34.7%), followed by the left leg (31.0%), right leg (30.0%), and left arm (28.6%). Additionally, 64.3% of participants showed poor muscle flexibility. The study also found that 35% of market vendors resorted to alcohol and 11.7% to drug misuse to cope with fatigue and prevent adverse symptoms. Moreover, 68.5% of participants reported no regular exercise due to lack of time. The study highlights the prevalence of musculoskeletal issues among market vendors, largely attributed to static muscular work and awkward postures dictated by their job roles and workstation arrangements. The right arm emerged as the most commonly affected area, followed by the left leg, right leg, and left arm, with significant rates of reported pain. The research also points to a notable lack of muscle flexibility in a majority of vendors and a concerning tendency towards alcohol and drug misuse as coping mechanisms for fatigue and symptom management. Furthermore, a significant portion of the vendors do not participate in regular exercise, primarily due to time constraints. These findings can be used to implement health prevention programs within the market vendor group.

Formulation and Evaluation of Cinnamon and Walnut Foot Scrub

Foot care is a crucial aspect of overall well-being, as our feet endure daily stressors and are often neglected until problems arise. This study focuses on the formulation and evaluation of a cinnamon and walnut foot scrub designed to address common foot issues such as dryness, cracked skin, and fungal infections. Cinnamon is incorporated for its antimicrobial and anti-inflammatory properties, offering a soothing effect while stimulating circulation. Walnut shells serve as an effective natural exfoliant, gently removing dead skin cells and revealing smoother skin underneath. The scrub not only exfoliates but also hydrates, thanks to the nourishing properties of walnut oil, making it particularly beneficial for dry, cracked heels. The prepared formulation was evaluated for various parameters, including color, appearance, consistency, pH, and viscosity. By integrating this scrub into regular foot care routines, individuals can experience improved skin texture and overall foot health. The future of cinnamon walnut foot scrubs looks promising, with potential advancements in formulations tailored to various skin types and conditions, ensuring a natural and effective approach to foot care.

Management of cloacal exstrophy: Experience from tertiary hospital, Tanzania. Case series

Introduction and importanceCloacal exstrophy (CE) is defined as a complex anomaly that affects the urogenital and intestinal tracts. It is the most serious form of anomaly that is described within the so-called exstrophy-epispadias complex. These malformations usually present a challenge in the management of particular conditions, as most of these forms require multiple surgeries, resulting in the use of multidisciplinary approaches, including reconstructive urologists, pediatric surgeons, orthopedic surgeons, endocrinologists, pediatricians, psychologists and nutritionists. Additionally, these patients present with ambiguous genitalia, which is another aspect that needs to be taken into consideration during the management of this condition. Case presentationThe first patient, a baby who was 8 days of life and referred from a peripheral hospital, presented with classic features of cloaca exstrophy. He underwent first-stage cloacal exstrophy repair. The intraoperative findings included a bi-halved bladder and phallus, and the ureters were not appreciated, but there was continuous urine leakage from the bi-halved bladder and no uterus or ovaries. Poorly formed cecum, cecal-cutaneous fistula with an everted part of the terminal ileum protruding outside (mucosa-out), no transverse, no descending colon, collapsing small bowel, left undescended testis in the inguinal region, and right abdominal undescended testis. He first underwent surgery, which involved ileostomy, omphalocele closure and proper bladder exstrophy construction.The second patient, a 6-day-old female, had a similar presentation and physical findings as the first patient did, except that she had elephantoid trunk deformity with a cecal fistula, bifid clitoris, two cervical orifices, and two uteri completely separated with ovaries. Mobilization of the hindgut, closure of the cecal fistula, and proper bladder exstrophy after repair of the posterior wall were performed.The third patient was a 10-day-old female, similar to the second patient, but this patient presented with a left leg deformity with wide diastasis. In this case, the urinary bladder was not bivalved, and the cecal fistula had perforated just below the posterior wall of the urinary bladder. A mild omphalocele, bifid clitoris and vagina, one cervical orifice, and two uteri completely separated, with ovaries observed. Mobilization of the hindgut, closure of the cecal fistula, and proper bladder exstrophy after repair of the posterior wall were performed. The postoperative period was uneventful. Clinical discussionSurgical management of cloacal exstrophy is typically undertaken in the newborn period (48–72 h) as a combined effort between pediatric surgery and urology. In the setting of associated spinal dysraphism, neurosurgical consultation and closure should be undertaken as soon as the infant becomes medically stable. Early operation minimizes bacterial colonization of exposed viscera and may decrease the need for pelvic osteotomy. The goals of treatment include securing the abdominal wall and bladder closure, preserving renal function, preventing short bowel syndrome, creating functional and cosmetically acceptable genitalia, and attaining acceptable urinary and fecal continence. ConclusionCloacal exstrophy remains a rare and complex congenital anomaly characterized by an array of anatomical defects affecting multiple organ systems. With respect to the approach of this congenital malformation, it is therefore important that these individuals and their families remain under the care of a multidisciplinary team of providers who can offer medical care, counseling and life-long follow-up.

Lowering of the Patella — prevention and treatment of a rare complication during leg lengthening: a case report

Background. Changes in the level of the patella position are a well-known complication of knee replacement, reconstruction of the anterior cruciate ligament, high tibial osteotomy and consequences of injuries. However, this problem has not been disclosed in the literature in relation to distraction osteogenesis using the Ilizarov method. The aim of the study is to describe such a rare iatrogenic complication as patella baja during limb lengthening by the Ilizarov method using a clinical case as an example. Case description. In 2017, a 17-year-old teenager was injured in a head-on collision of cars at high speed. The patient was diagnosed with an open fracture of the left femur and fibula and tibia of the left leg. He was treated in another clinic using the Ilizarov apparatus for osteosynthesis of the femur, tibia and proximal osteotomy of the tibia to move the bone to fill the distal bone defect. At the end of the treatment, the patient had a moderate limitation of the knee flexion (180-80°). In 2018, the patient was admitted to our clinic due to osteomyelitis at the level of the consolidated fracture. A new resection of the osteomyelitis lesion and proximal osteotomy for bifocal osteogenesis were performed. During the treatment, limitation of knee flexion (180-120°) was developed and radiographic signs of low position of the patella were obtained. Given the progression of patella baja (the Caton-Deschamps index = 0.51), we were forced to return the patient to the operating room to restore the correct height of the patella. Conclusions. The presented clinical case emphasizes the need for a more thorough assessment of the patella height after surgical treatment on the proximal tibia using the Ilizarov method. It is also noted that it is important to conduct a control MRI, which allows for a more detailed study of the initial position of the anterior tibial tubercle. In our case, early detection of complications allowed us to achieve complete recovery without any consequences.

Not All Antihistamines Are Created Equal: Alimemazine As A Cause Of Drug Induced Parkinsonism

Abstract Background A 67year old female presented to a Movement Disorder Service for assessment of tremor. She had a history of presbycusis, dermatitis herpetiformis, bronchiectasis, osteoporosis and stage A chronic lymphocytic leukaemia. History elucidated hypophonia, somniloquy, REM-sleep behaviour disorder, bruxism, presence hallucinosis, insidious bradykinesia and of titubation of increasing prevalence and amplitude over 20years. Examination demonstrated cognitive impairment (Montreal Cognitive Assessment 12+1/30) in the domains of visuospatial function, executive thinking, naming, attention, language, abstraction and anterograde recall. Luria test was 0/6. Also found was: micrographia, left exotropia, reduced left arm and leg swing, kinetic tremor asymmetry, decrement of amplitude and frequency of rapid repetitive movements asymmetrically, mandibular and lingual tremor, positive Kinnier-Wilson test and orthostatic deterioration in yes-yes titubation. Drg history identified use of Alimemazine 10mg for insomnia for approximately 20years. Methods Modified Simpson Angus Scale score was 6 indicating a clinically significant degree of extrapyramidal side effects. Unified Parkinson’s Disease Rating Scale part III was 17. Results Functional dopamine uptake imaging did not indicate a parkinsonian syndrome. Drg induced parkinsonism was diagnosed. 0.0097% of the Northern Ireland population were prescribed Alimemazine in 2022 for non-dermatological reasons, representing 73.49% of all dispensed preparations. In the first financial quarter of 2024 in Northern Ireland, all dispensed prescriptions cost £218,395. Conclusion Not all antihistamines are created equal. Alimemazine is an older phenothiazine derivative antihistamine with central sedative effects equivalent to Chlorpromazine but without anti-adrenaline action. It is rarely prescribed and easily overlooked as “just another antihistamine”. It is commonly prescribed by dermatologists for urticaria. It has substantial pharmacoeconomic implications given its cost disparity with other antihistamines. Extrapyramidal features of tremor, akinesia and hypertonicity are more common in older people; usually developing within weeks or months of commencement. Stopping the drug is the first-line intervention. Resolution of symptoms is not guaranteed.