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Mid-term results of sub-trochanteric valgus osteotomy for symptomatic late stages Legg-Calvé-Perthes disease

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World Journal of Orthopedics 2023年第5期14卷 328-339页

作者： khaled M emara Ramy ahmed Diab ahmed k emara Mohamed Eissa Mostafa Gemeah Shady Abdelghaffar Mahmoud Department of Orthopedic Surgery Ain Shams UniversityCairo 11591Egypt Department of Orthopedic Surgery Cleveland Clinic FoundationClevelandOH 9500United States Health Care Innovation Program Arizona State UniversityTempeAZ 85287United States

BACkGROUND The treatment of late stages of Legg-Calvé-Perthes disease(LCPD)is *** the concept of femoral head containment is a well-established technique of treatment,its use remains debatable in the late stages of the disease,as it does not improve symptoms in terms of limb length discrepancy and *** To assess the results of subtrochanteric valgus osteotomy in symptomatic patients with late-stage Perthes *** From 2000 to 2007,36 symptomatic patients with late stage of Perthes disease were surgically treated with subtrochanteric valgus osteotomy and followed-up for 8 to 11 years using the IOWA score and range of motion(ROM)*** Mose classification was also assessed at the last follow-up to reflect possible *** patients were 8 years old or older at the time of surgery,in the post-fragmentation stage,and complaining of pain,limited ROM,Trendelenburg gait,and/or abductor *** The preoperative IOWA score(average:53.3)markedly improved at the 1-year post follow-up period(average:85.41)and then slightly improved at the last follow-up(average:89.4)(P value<0.05).ROM improved,with internal rotation increased on average by 22°(from 10°preoperatively to 32°postoperatively)and abduction increased on average by 15.9°(from 25°preoperatively to 41°postoperatively).The mean Mose deviation of femoral heads was 4.1 mm at the end of the follow-up *** tests used were the paired t-test and Pearson correlation test,where the level of significance was a P value less than *** Subtrochanteric valgus osteotomy can be a good option for symptomatic relief in patients with late-stage of LCPD.

关键词： Legg-Calvé-Perthes disease Femoral head avascular necrosis Valgus osteotomy Deformity correction Post fragmentation stage Late stage Perthes

Virtual orthopedic assessment:Main principles and specific regions

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World Journal of Orthopedics 2021年第9期12卷 672-684页

作者： khaled M emara Ramy ahmed Diab Mohamed Amr Shady Abdelghaffar Mahmoud Mohamed Nour ahmed Abdelsalam Mahmoud ahmed Elshobaky Mona Farhan Mostafa Gemeah ahmed k emara Orthopedic Surgery Department Ain Shams UniversityCairo 11566Egypt Orthopedic Surgery Department Bank Ahly HospitalCairo 11566Egypt Department of Health Care Innovation Arizona State UniversityArizonaAZ 85287United States Department of Orthopedic Surgery Cleveland ClinicOhioNY 44195United States

Telemedicine was originally created as a way to treat patients who were located in remote places far away from local health facilities or in areas with shortages of medical *** is still used today to address those problems,and is increasingly becoming a tool for convenient medical *** the emergence of pandemics,telemedicine became almost a mandatory and valuable option for continuing to provide medical care in various *** the threat of pandemic progress has continued for months and may continue for years,it is essential to validate existing tools to maintain clinical assessment and patient treatment to avoid negative consequences of the lack of medical ***,the establishment of a virtual assessment technique that can be conducted effectively is of outmost importance as a way of adapting to the current *** study evaluated the role of telemedicine in the assessment of various orthopedic pathologies by means of a systematic virtual evaluation.

关键词： Telemedicine Virtual assessment Orthopedics Epidemic diseases

Trends and risk factors for opioid administration for non-emergent lower back pain

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World Journal of Orthopedics 2021年第9期12卷 700-709页

作者： Chukwuweike U Gwam ahmed k emara Noor Chughtai Sameer Javed T David Luo kevin Y Wang Morad Chughtai Tadhg O'Gara Johannes F Plate Department of Orthopedic Surgery Wake Forest School of MedicineWinston-SalemNC 27157United States Department of Orthopedic Surgery Cleveland Clinic FoundationClevelandOH 44195United States Department of Orthopaedic Surgery University of Pittsburgh5200 Centre AvenueSuite 415PittsburghPA 15232USA

BACkGROUND Non-emergent low-back pain(LBP)is one of the most prevalent presenting complaints to the emergency department(ED)and has been shown to contribute to overcrowding in the ED as well as diverting attention away from more serious *** has been an increasing focus in current literature regarding ED admission and opioid prescriptions for general complaints of pain,however,there is limited data concerning the trends over the last decade in ED admissions for non-emergent LBP as well as any subsequent opioid prescriptions by the ED for this *** To determine trends in non-emergent ED visits for back pain;annual trends in opioid administration for patients presenting to the ED for back pain;and factors associated with receiving an opioid-based medication for non-emergent LBP in the ED METHODS Patients presenting to the ED for non-emergent LBP from 2010 to 2017 were retrospectively identified from the National Hospital Ambulatory Medical Care Survey ***“year”variable was transformed to two-year intervals,and a weighted survey analysis was conducted utilizing the weighted variables to generate incidence *** statistics were used to assess differences in count data,and logistic regression was performed to identify factors associated with patients being discharged from the ED with *** significance was set to a P value of *** Out of a total of 41658475 total ED visits,3.8%(7726)met our inclusion and exclusion *** was a decrease in the rates of non-emergent back pain to the ED from 4.05%of all cases during 2010 and 2011 to 3.56%during 2016 and *** most common opioids prescribed over the period included hydrocodone-based medications(49.1%)and tramadol-based medications(16.9),with the combination of all other opioid types contributing to 35.7%of total opioids *** significantly associated with being prescribed narcotics included age over 43.84-years-old,higher income,priva

关键词： Opioids Low back pain Emergency Department Spine Complications Trends

Post-cholecystectomy iatrogenic bile duct injuries:Emerging role for endoscopic management

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World Journal of Gastrointestinal Surgery 2023年第12期15卷 2709-2718页

作者： Mohamed H emara Mohammed Hussien ahmed Mohamed I Radwan Emad Hassan emara Magdy Basheer ahmed Ali Asem ahmed Elfert Department of Hepatology Gastroenterology and Infectious DiseasesKafrelsheikh UniversityKafr-Elshikh 33516Egypt Department of Tropical Medicine Zagazig UniversityZagazig 44519Egypt Department of Diagnostic and Interventional Radiology Kafrelsheikh UniversityKafr-Elshikh 33516Egypt Department of Surgery Mansoura UniversityMansours 44176Egypt Department of Emergency Hargeisa Group HospitalHargeisa 1235Somalia Department of Tropical Medicine Tanta UniversityTanta 33120Egypt

Post-cholecystectomy iatrogenic bile duct injuries(IBDIs),are not uncommon and although the frequency of IBDIs vary across the literature,the rates following the procedure of laparoscopic cholecystectomy are much higher than open *** injuries caries a great burden on the patients,physicians and the health care systems and sometime are *** are associated with different manifestations that are not limited to abdominal pain,bile leaks from the surgical drains,peritonitis with fever and sometimes *** injuries if not witnessed during the surgery,can be diagnosed by combining clinical manifestations,biochemical tests and imaging *** such techniques abdominal US is usually the first choice while Magnetic Resonance Cholangio-Pancreatography seems the most *** approach was the ideal approach for such cases,however the introduction of Endoscopic Retrograde Cholangio-Pancreatography(ERCP)was a paradigm shift in the management of such injuries due to accepted success rates,lower cost and lower rates of associated morbidity and ***,the literature lacks consensus for the optimal timing of ERCP intervention in the management of *** management of IBDIs can be tailored according to the nature of the underlying *** the subgroup of patients with complete bile duct ligation and lost ductal continuity,transfer to surgery is indicated without *** patients will not benefit from endoscopy and hence should not do unnecessary *** low–flow leaks *** bed leaks,conservative management for 1-2 wk prior to ERCP is advised,in contrary to high-flow leaks *** duct leaks and stricture lesions in whom early ERCP is *** plus stenting is the ideal management line for cases of *** radiologic techniques are promising options especially for cases of failed endoscopic repair and also for cases with altered *** studies will

关键词： Iatrogenic bile duct injuries Cholecystectomy Surgical repair Endoscopic Retrograde Cholangio-Pancreatography Interventional radiology

Cost of external fixation vs external fixation then nailing in bone infection

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World Journal of Orthopedics 2015年第1期6卷 145-149页

作者： khaled Mohamed emara Ramy ahmed Diab khaled Abd EL Ghafar Orthopaedic Surgery Ain Shams University

AIM: To study the cost benefit of external fixation vs external fixation then nailing in treatment of bone infection by segment ***: Out of 71 patients with infected nonunion tibia treated between 2003 and 2006, 50 patients fitted the inclusion criteria(26 patients were treated by external fixation only, and 24 patients were treated by external fixation early removal after segment transfer and replacement by internal fixation). Cost of inpatient treatment, total cost of inpatient and outpatient treatment till full healing, and the weeks of absence fromschool or work were calculated and compared between both ***: The cost of hospital stay and surgery in the group of external fixation only was 22.6 ± 3.3 while the cost of hospital stay and surgery in the group of early external fixation removal and replacement by intramedullary nail was 26.0 ± 3.2. The difference was statistically significant regarding the cost of hospital stay and surgery in favor of the group of external fixation only. The total cost of medical care(surgery, hospital stay, treatment outside the hospital including medications, dressing, physical therapy, outpatient laboratory work, etc.) in group of external fixation only was 63.3 ± 15.1, and total absence from work was 38.6 ± 6.6 wk. While the group of early removal of external fixation and replacement by IM nail, total cost of medical care was 38.3 ± 6.4 and total absence from work or school was 22.7 ± 4.1. The difference was statistically significant regarding the total cost and absence from work in favor of the group of early removal and replacement by IM ***: Early removal of external fixation and replacement by intramedullary nail in treatment of infected nonunion showed more cost effectiveness. Orthopaedic society needs to show the cost effectiveness of different procedures to the community, insurance, and health authorities.

关键词： Cost Fixator Nailing Infection

Methods to shorten the duration of an external fixator in the management of tibial infections

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World Journal of Orthopedics 2011年第9期2卷 85-92页

作者： khaled M emara khaled Abd Al Ghafar Mohamed ahmed Al kersh Orthopaedic Surgery Ain Shams University HospitalsCairo 0020Egypt Lecturer in Orthopaedic Surgery Ain Shams UniversityCairo 0020Egypt Assistant Lecturer of Orthopaedic Surgery Ain Shams UniversityCairo 0020Egypt

Massive segmental bone loss due to chronic osteomyelitis represents a considerable challenge to orthopedic surgeons and is a limb threatening *** only option available in such a clinical situation is segment transport using the Ilizarov technique of distraction osteogenesis;yet the most common problem in cases of bone transport with the Ilizarov technique in massive bone loss,is the long duration of the *** addition to autologous bone grafting,several mechanical,biologic,and external physical treatment modalities may be employed to promote bone formation and maturation during segment transport in osteomyelitis *** approaches include compressive loading of the distraction regenerate,increased frequency of small increments of distraction,and *** nailing and hemicorticotomy can reduce the time in external fixation;however,these techniques are associated with technical difficulties and *** application of low-intensity pulsed ultrasound or pulsed electromagnetic fields may shorten the duration of external *** promising modalities include diphosphonates,physician-directed use(off-label use)of bone morphogenetic proteins,and local injection of bone marrow aspirate and platelet gel at the osteotomy ***-designed clinical studies are needed to establish safe and effective guidelines for various modalities to enhance new bone formation during distraction osteogenesis after segment transfer.

关键词： Ilizarov Bone infection Intramedullary nail Hemicorticotomy Tibiofibular synostosis Fibular transport

Recent biological trends in management of fracture non-union

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World Journal of Orthopedics 2015年第8期6卷 623-628页

作者： khaled M emara Ramy ahmed Diab ahmed khaled emara Department of Orthopaedic Surgery Ain Shams University Faculty of Medicine Ain Shams University

Bone regeneration is a complex, well-orchestrated physiological process of bone formation, which can be seen during normal fracture healing, and is involved in continuous remodelling throughout adult life. Currently,there is a plethora of different strategies to augment the impaired or "insufficient" bone-regeneration process, including the "gold standard" autologous bone graft, free fibula vascularised graft, allograft implantation, and use of growth factors, osteoconductive scaffolds, osteoprogenitor cells and distraction osteogenesis. Improved "local" strategies in terms of tissue engineering and gene therapy, or even "systemic" enhancement of bone repair, are under intense investigation, in an effort to overcome the limitations of the current methods, to produce bone-graft substitutes with biomechanical properties that are as identical to normal bone as possible, to accelerate the overall regeneration process, or even to address systemic conditions, such as skeletal disorders and osteoporosis. An improved understanding of the molecular and cellular events that occur during bone repair and remodeling has led to the development of biologic agents that can augment the biological microenvironment and enhance bone repair. Orthobiologics, including stem cells, osteoinductive growth factors, osteoconductive matrices, and anabolic agents, are available clinically for accelerating fracture repair and treatment of compromised bone repair situations like delayed unions and nonunions. A lack of standardized outcome measures for comparison of biologic agents in clinical fracture repair trials, frequent off-label use, and a limited understanding of the biological activity of these agents at the bone repair site have limited their efficacy in clinical applications.

关键词： Biological Fracture repair Nonunion Cell therapy Bone substitutes

Effect of alternative antibiotics in treatment of cefotaxime resistant spontaneous bacterial peritonitis

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World Journal of Gastroenterology 2013年第8期19卷 1271-1277页

作者： ahmed Abouelkhair Badawy Tarik Ibrahim Zaher Samar Mahmoud Sharaf Mohamed Hassan emara Noha Elsaid Shaheen Talaat Fathy Aly Department of Tropical Medicine Zagazig University Faculty of MedicineZagazig 44519Egypt Department of Clinical Pathology Zagazig University Faculty of MedicineZagazig 44519Egypt

AIM:To evaluate effective alternative antibiotics in treatment of cefotaxime-resistant spontaneous bacterial ***:One hundred cirrhotic patients with spontaneous bacterial peritonitis [ascitic fluid polymorphonuclear cell count(PMNLs) ≥ 250 cells/mm 3 at admission] were empirically treated with cefotaxime sodium 2 g/12 h and volume expansion by intravenous human *** patients were subjected to history taking,complete examination,laboratory tests(including a complete blood cell count,prothrombin time,biochemical tests of liver and kidney function,and fresh urine sediment),chest X-ray,a diagnostic abdominal paracentesis,and the sample subjected to total and differential cell count,chemical examination,aerobic and anaerobic *** were divided after 2 d by a second ascitic PMNL count into group Ⅰ;patients sensitive to cefotaxime(n = 81),group Ⅱ(n = 19);cases resistant to cefotaxime(less than 25% decrease in ascitic PMNL count).Patients of group Ⅱ were randomly assigned into meropenem(n = 11) or levofloxacin(n = 8) *** patients performed an end of treatment ascitic PMNL *** were considered improved when:PMNLs decreased to < 250 cells/mm 3,no growth in previously positive culture cases,and improved clinical manifestations with at least 5 d of antibiotic ***:Age,sex,and Child classes showed no significant difference between group Ⅰ and group Ⅱ.Fever and abdominal pain were the most frequent manifestations and were reported in 82.7% and 80.2% of patients in group Ⅰ and in 94.7% and 84.2% of patients in group Ⅱ,*** in group Ⅱ had a more severe ascitic inflammatory response than group Ⅰ and this was demonstrated by more ascitic lactate dehydrogenase(LDH) [median:540 IU/L(range:150-1200 IU/L) vs median:240 IU/L(range:180-500 IU/L),P = 0.000] and PMNL [median:15 000 cell/mm 3(range:957-23 822 cell/mm 3) vs 3400 cell/mm 3(range:695-26 400 cell/mm 3),P = 0.000] *** fluid culture was po

关键词： Spontaneous bacterial peritonitis Cefotaxime Ascitic polymorphonuclear count Cirrhosis Meropenem Levofloxacin

Sonographic gallbladder wall thickness measurement and the prediction of esophageal varices among cirrhotics

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World Journal of Hepatology 2023年第2期15卷 216-224页

作者： Mohamed H emara Mariam Zaghloul Ibrahim F Amer Aya M Mahros Mohammed Hussien ahmed Mahmoud A Elkerdawy Eslam Elshenawy Abdelrahman M ahmed Rasheda Tarik I Zaher Mona Talaat Haseeb Emad Hassan emara Hassan Elbatae Department of Hepatology Gastroenterology and Infectious DiseasesKafrelsheikh UniversityKafr-Elshikh 33516Egypt Department of Internal Medicine Gastroenterology UnitSecurity Forces HospitalRiyadh 11481Saudi Arabia Tropical Medicine Zagazig UniversityZagazig 44519Egypt Department of Diagnostic and Interventional Radiology Kafrelsheikh UniversityKafr-Elshikh 33516Egypt

Acute variceal bleeding in patients with liver cirrhosis and portal hypertension(PHT) is the most serious emergency complication among those patients and could have catastrophic outcomes if not timely managed. Early screening by esophago-gastro-duodenoscopy(EGD) for the presence of esophageal varices(EVs) is currently recommended by the practice guidelines for all cirrhotic patients. Meanwhile, EGD is not readily accepted or preferred by many patients. The literature is rich in studies to investigate and validate non-invasive markers of EVs prediction aiming at reducing the unneeded endoscopic procedures. Gallbladder(GB) wall thickness(GBWT) measurement has been found promising in many published research articles. We aim to highlight the validity of sonographic GBWT measurement in the prediction of EVs based on the available evidence. We searched databases including Cochrane library, Pub Med, Web of Science and many others for relevant articles. GBWT is associated with the presence of EVs in cirrhotic patients with PHT of different etiologies. The cut-off of GBWT that can predict the presence of EVs varied in the literature and ranges from 3.1 mm to 4.35 mm with variable sensitivities of 46%-90.9% and lower cutoffs in viral cirrhosis compared to non-viral, however GBWT > 4 mm in many studies is associated with acceptable sensitivity up to 90%. Furthermore, a relation was also noticed with the degree of varices and portal hypertensive *** cirrhotics, GBWT > 3.5 mm predicts the presence of advanced(grade Ⅲ-Ⅳ) EVs with a sensitivity of 45%, the sensitivity increased to 92% when a cut-off ≥ 3.95 mm was used in another cohort. Analysis of these results should carefully be revised in the context of ascites, hypoalbuminemia and other intrinsic GB diseases among cirrhotic patients. The sensitivity for prediction of EVs improved upon combining GBWT measurement with other non-invasive predictors, e.g., platelets/GBWT.

关键词： Sonographic Gallbladder wall thickness Prediction Esophageal varices Portal hypertension Esophago-gastro-duodenoscopy